Cystitis
What is it?
Cystitis is an inflammatory process of the urinary bladder. In most cases, the etiology of cystitis can be traced back to an infection sustained by bacteria from the gastrointestinal tract, e.g. Escherichia coli, Proteus and Klebsiella. However, there are also non-bacterial forms of cystitis, such as interstitial cystitis and radiation therapy cystitis, which are, however, more rare. Epidemiologically, cystitis is a predominantly female disease, affecting up to 25-30% of adult women over the course of a year. This is mainly due to the different anatomical conformation of the urethra, which is shorter in women (about 5 cm) than in men (about 16 cm). Therefore, for women it is easier to be contaminated by fecal bacteria, which pass from the anal area to the urethra, and then to the bladder. In men, two peaks of incidence are observed: in infants with less than 3 months of life (in relation to anatomical or functional alterations of the urinary tract), resulting in some cases in neonatal sepsis, and in men over 70 years of age (secondary to cervical-urethral obstruction from benign prostatic hyperplasia). Factors that may favor the onset of cystitis are age, frequent sexual intercourse (especially unprotected), use of spermicidal creams, alterations in vaginal flora, use of intrauterine contraceptives, poor personal hygiene and constipation. Urethral catheterization is the key risk factor for acquiring a nosocomial urinary infection.
Which are the symptoms?
Symptomatology of cystitis varies from individual to individual. Usually, it manifests itself by difficulty in urinating, pain on urination and postictal burning, presence of blood in the urine, feeling of heavy bladder and having to urinate even immediately after urination (bladder tenesmus). More rarely, these symptoms may be associated with fever and chills.
- difficulty in urinating
- pain on urination
- burning afterwards
- presence of blood in the urine
- feeling of a heavy bladder
- feeling of having to urinate even immediately after urination (bladder tenesmus)
How is it diagnosed?
The diagnosis of cystitis is primarily clinical. However, urinalysis with urine culture (and eventual antibiogram) may be useful. Sample collection must be adequate so that it is not contaminated with genital bacterial flora. Urinalysis will detect increased white blood cell count, the presence of blood in the urine, nitrites, and increased pH. The urine culture is also useful to isolate the type of bacterium responsible for the infection, and based on the antibiogram you can then set up targeted therapy. Urine culture is indicated in all cases of urinary tract infections, however in cases of first episode of uncomplicated cystitis in premenopausal women, the presence of leukocyte esterase or nitrite in a test strip (positive strip) can be considered sufficient for the diagnosis to start an empirical treatment of short duration (3-5 days).
Suggested exams
How is it treated?
The therapy of choice for cystitis is in fact antibiotic therapy. In particular, empirical therapy can be set up before having the report of the urine culture and antibiogram, and then it will be possible to set up antibiotic therapy targeted to specific pathogen. The most commonly used drugs are fluoroquinolones, trimethoprim-sulfamethoxazole, and nitrofurantoin. It should be noted that cystitis is a condition that tends to recur (it is estimated that about 25% of women who have cystitis will have a new episode within a year). Recurrence may be the result of reinfection or relapse. Reinfection is the cause of 95% of recurrent infections in women. They are caused by germs other than those previously treated, and the period of occurrence is usually more than two weeks after the previous infection. Recurrence, on the other hand, is more common in men and may involve anatomic or functional abnormalities of the urinary tract. It is usually due to the same microorganism as previously treated and usually appears in a shorter time interval (less than two weeks). To reduce the risk of the disease recurring, small lifestyle changes that reduce the risk of such infections may be helpful. In particular, preventive measures include adequate hydration (drink about 1.5-2 liters of water per day), accurate intimate hygiene, avoiding unprotected sexual intercourse, regular urination, urinate immediately after sexual intercourse, complete emptying the bladder with urination and limitation of alcohol use. In addition, drinking cranberry juice may reduce the incidence of new episodes due to its antibacterial and purifying abilities. In recurrent forms of cystitis, continuous or postcoital antibiotic prophylaxis may be necessary.
Where do we treat it?
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