Cystitis

What are the symptoms of this condition?

Cystitis is associated with a number of possible symptoms, the most common of which is a desire to pass water more frequently than normal, and a burning pain on urination. Often, only a small amount of urine will be passed; the urine itself may be different to normal urine - it may be cloudy, or darker in colour, or it may have an offensive smell. Pain or aching may be felt in the lower abdomen, and in come cases, in the region of the back. There may be a constant feeling that the bladder has not been fully emptied.

Cystitis is a problem that most women will encounter at some point in their lives. It is usually a one-off condition; however in some women it may be a recurring problem. The symptoms of cystitis in men, or in children, are very rare, and should be referred to the doctor for further advice.

What is the cause of the condition?

The term 'cystitis' refers to an inflammation of the urinary tract. This consists of the bladder which is a muscular bag situated in the lower abdomen in which urine is stored, and the urethra, the tube that allows the urine to drain from the bladder. The kidneys are also part of the urinary system, but are not normally involved in cystitis.

The kidneys produce urine as part of the process of filtering the blood to remove unwanted waste products. It is approximately 98% water, and may be either acidic or alkaline in nature. The quantity of urine passed varies from day to day, but on average will be about one and a half litres. Balancing this loss of fluid from the body is fluid intake by mouth, which will be approximately the same amount.

One of the other main functions of the kidneys, apart from controlling water balance and removing waste products, is to regulate the acidity or alkalinity of the blood. This is affected by, among other things, the type and quantity of food being digested; some foods being acidic, others less so. Any surplus acid or alkali removed from the blood is added to the urine. Also present in the urine are small amounts of other chemical substances surplus to the body's requirements.

Urine is normally sterile and contains no bacteria; the presence of bacteria in the urine is abnormal, and is one possible cause of cystitis. Bacteria find their way into the bladder and multiply there probably via the urethra, the tube that passes urine out of the bladder. In women, the urethra is considerably shorter than in men; resulting in a shorter distance from the bladder to the outside, which increases the chance of any infection reaching the bladder. This explains the lesser incidence of cystitis amongst men. Also, the position of the female urethra, close to the anus, increases the risk of bacteria from the digestive tract finding their way into the urethra. Commonly, the bacteria found in the urine of cystitis sufferers are bacteria normally found in the digestive tract.

There are non-infective causes of cystitis. Physical disturbance or trauma of the bladder can cause an inflammation. Sexual activity can cause cystitis in women (the so-called 'honeymoon cystitis') because of minor trauma or the pushing upwards of an infection along the urethra. Certain drugs are known to be bladder irritants, and cystitis can also occur in patients receiving radiotherapy in the abdominal area.

What complications might occur?

In a case of simple cystitis, there are unlikely to be any further complications. However, if a mild infection is left untreated, there is a possibility that an infection in the bladder could progress up the tubes ('ureters') that carry urine from the kidneys into the bladder, which could eventually cause a kidney infection; if cystitis is accompanied by back pain and a high temperature, this should be referred to the doctor immediately.

What can I do to treat myself?

Self-help treatment involves good personal hygiene, and increasing your fluid intake.

Hygiene
Often, the bacteria causing the infection in cystitis are bacteria from the digestive system. For women, there is always the possibility that bacteria in and around the area of the anus can find their way into the urethra as they are situated relatively close together. To prevent this from happening, women should always wipe themselves from the vagina toward the back passage and not vice versa. It is also recommended that strongly perfumed soaps and deodorants should not be used to wash the area around the urethra, as they can have an irritant effect.

Paying attention to hygiene will not help in halting an existing episode of cystitis, but will make another infection less likely.

Fluids
Ideally, you should drink around one and a half litres of bland fluids daily, to match the amount of urine being passed; increasing your fluid intake will pass more water through the urinary system, which is thought to help in flushing the bacteria out of the bladder and the urethra.

The type of fluid you drink can make a difference; whilst water is fine, some soft drinks such as barley water or cranberry juice have been shown to offer additional relief. Barley water is an alkaline drink; the resulting slightly alkaline urine provides an unfavourable environment for the infection, as the bacteria prefer acidic conditions - the discomfort of cystitis and the stinging upon passing water is thought to be because of acidic urine, which is neutralised by such drinks. There are several products available without a prescription which contain ingredients to alkalinise the urine - see below for more details. Cranberry juice is thought to contain chemicals which mimic the receptors on the wall of the urethra and bladder, so that the bacteria attach to the chemicals and are washed away with the urine.

Fluids to be avoided include tea, coffee and alcohol as all these are known to be irritant to the bladder lining.

For general comfort, warm towels laid over the abdomen and hot baths may help to reduce the sensation of urgency and aid in relaxation.

What treatments are available for me to purchase?

There are a number of treatments available to purchase which contain sodium or potassium salts. These salts are alkaline and so help to reduce the acidity of the urine. Examples include Canesten Oasis, Cystopurin, Cymalon, Cystemme and Effercitrate. There are some restrictions on who should take these products and the individual product information should be consulted before use. If one course of a non-prescription treatment does not work, you should see your doctor.

The full range of products for cystitis can be viewed here.

If you are at all unsure about the best medication to treat your cystitis please Click here or consult a Pharmacy2U pharmacist.

What treatments are available from my doctor?

Although there are instances of non-infective cystitis most cases are the result of bacterial infection. Usually these will respond to plenty of fluids, attention to hygiene, and the non-prescription products above; if, however, these do not relieve the discomfort, or if you are worried about your symptoms, then you should consult your own doctor. The urine can be tested for the presence of bacteria, and antibiotics may be prescribed if necessary, which will normally rectify the situation quickly.

A doctor should always be consulted if your symptoms last longer than 2 days, if there is blood in the urine, fever, vomiting, a vaginal discharge, or if you are pregnant; all men and children presenting with the symptoms of cystitis should also see their doctor as soon as possible, rather than using any non-prescription treatments.

What additional investigations might be needed?

If the cystitis is not responding to treatment, or is accompanied by indications of a more serious disease, then an examination of the urinary tract may be required. This could involve X-ray examination or the use of an endoscope to directly examine the interior of the bladder and the urethra.

Any other information I should have?

Cystitis rarely progresses to anything more serious, or indicates a serious underlying condition. Paying attention to the hygiene measures discussed above and maintaining a good fluid intake should relieve the symptoms in most cases, and may help to prevent further attacks of cystitis developing. Advice on the prevention and management of cystitis can also be obtained from the Pharmacy2U pharmacist or your own family doctor.