Cystitis - noninfectious

Answer 1

Definition

Noninfectious cystitis is irritation of the bladder that is not caused by a urinary tract infection.

Alternative Names

Abacterial cystitis; Radiation cystitis; Chemical cystitis; Urethral syndrome - acute

Causes, incidence, and risk factors

Noninfectious cystitis is most common in women of childbearing years. The exact cause of noninfectious cystitis is often unknown. However, it has been associated with the use of bubble baths, feminine hygiene sprays, sanitary napkins, spermicidal jellies, radiation therapyto the pelvis area, certain types of chemotherapy medications, history of severe or repeated bladder infections, among other irritants.

Certain foods, such as tomatoes, artificial sweeteners, caffeinated products, chocolate, and alcohol, can cause irritative bladder symptoms.

See also: Interstitial cystitis

Symptoms

• Pressure in the lower pelvis
• Painful urination
• Frequent need to urinate
• Urgent need to urinate
• Decreased ability to hold urine
• Need to urinate at night
• Abnormal urine color -- cloudy
• Blood in the urine
• Foul or strong urine odor

Additional symptoms that may be associated with this disease:

• Pain during sexual intercourse
• Penile pain
• Flank pain
• Fatigue

Signs and tests

A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs). A microscopic examination of the urine by a pathologist may be done to look for cancerous cells.

A urine culture (clean catch) or catheterized urine specimenwill reveal whether you have a bacterial infection.

If the cystitis is related to radiation or chemotherapy, urine tests and cystoscopy (use of lighted instrument to look inside the bladder) may be needed.

Treatment

The goal of treatment is to manage the symptoms.

Medical Treatments:

• Anticholinergic drugs can help improve bladder contraction and emptying. Possible side effects include slowed heart rate, low blood pressure, increased thirst, and constipation.
• Muscle relaxants (such as diazepam) and alpha-1 blockers (prazosin) may be used to reduce the strong urge to urinate or need to urinate frequently.
• Surgery is rarely performed unless a person has severe urinary retention or significant blood in the urine.

Diet:

• Avoid fluids that irritate the bladder such as alcohol, citrus juices, and caffeine.

Other therapies:

• Bladder exercises to re-establish a pattern of regular and complete urination may help. Bladder training exercises involve developing a schedule of times when you should try to urinate, while trying to delay urination at all other times. One method is to force yourself to urinate every 1 to 1 and 1/2 hours, despite any leakage or urge to urinate in between these times. As you become skilled at waiting this long, gradually increase the time intervals by 1/2 hour until you are urinating every 3 to 4 hours.
• Pelvic muscle strengthening exercises called Kegel exercises are used primarily to treat people with stress incontinence. However, these exercises may also help relieve symptoms of urgency related to long-term (chronic) noninfectious cystitis. Performing the exercises properly and regularly increases the method's success.
• Electrical stimulation to the pelvis may be used as a treatment for noninfectious cystitis, but this is controversial.

Expectations (prognosis)

Although most cases of cystitis are uncomfortable, they usually resolve over time.

Complications

• Ulceration of bladder wall
• Urethral stricture
• Diminished bladder capacity
• Bladder cancer
• Anemia

Calling your health care provider

Call your health care provider if you have symptoms of cystitis, or if you have been diagnosed with cystitis and symptoms worsen or new symptoms develop, especially fever, back or flank pain, and vomiting.

Prevention

Avoid using items that may be irritants such as bubble baths, feminine hygiene sprays, sanitary napkins or tampons (especially scented products), and spermicidal jellies.

If you need to use such products, try to find those that do not cause irritation for you.

References

Hanno PM. Painful bladder syndrome/interstitial cystitis and related disorders. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 10.

Lentz GM. Urogynecology: Physiology of micturition, Diagnosis of voiding dysfunction, and incontinence: Surgical and nonsurgical treatment. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 21.

Answer 2

Definition

Noninfectious cystitis is irritation of the bladder that is not caused by a urinary tract infection.

Alternative Names

Abacterial cystitis; Radiation cystitis; Chemical cystitis; Urethral syndrome - acute

Causes, incidence, and risk factors

Noninfectious cystitis is most common in women of childbearing years. The exact cause of noninfectious cystitis is often unknown. However, it has been associated with the use of bubble baths, feminine hygiene sprays, sanitary napkins, spermicidal jellies, radiation therapyto the pelvis area, certain types of chemotherapy medications, history of severe or repeated bladder infections, among other irritants.

Certain foods, such as tomatoes, artificial sweeteners, caffeinated products, chocolate, and alcohol, can cause irritative bladder symptoms.

See also: Interstitial cystitis

Symptoms

• Pressure in the lower pelvis
• Painful urination
• Frequent need to urinate
• Urgent need to urinate
• Decreased ability to hold urine
• Need to urinate at night
• Abnormal urine color -- cloudy
• Blood in the urine
• Foul or strong urine odor

Additional symptoms that may be associated with this disease:

• Pain during sexual intercourse
• Penile pain
• Flank pain
• Fatigue

Signs and tests

A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs). A microscopic examination of the urine by a pathologist may be done to look for cancerous cells.

A urine culture (clean catch) or catheterized urine specimenwill reveal whether you have a bacterial infection.

If the cystitis is related to radiation or chemotherapy, urine tests and cystoscopy (use of lighted instrument to look inside the bladder) may be needed.

Treatment

The goal of treatment is to manage the symptoms.

Medical Treatments:

• Anticholinergic drugs can help improve bladder contraction and emptying. Possible side effects include slowed heart rate, low blood pressure, increased thirst, and constipation.
• Muscle relaxants (such as diazepam) and alpha-1 blockers (prazosin) may be used to reduce the strong urge to urinate or need to urinate frequently.
• Surgery is rarely performed unless a person has severe urinary retention or significant blood in the urine.

Diet:

• Avoid fluids that irritate the bladder such as alcohol, citrus juices, and caffeine.

Other therapies:

• Bladder exercises to re-establish a pattern of regular and complete urination may help. Bladder training exercises involve developing a schedule of times when you should try to urinate, while trying to delay urination at all other times. One method is to force yourself to urinate every 1 to 1 and 1/2 hours, despite any leakage or urge to urinate in between these times. As you become skilled at waiting this long, gradually increase the time intervals by 1/2 hour until you are urinating every 3 to 4 hours.
• Pelvic muscle strengthening exercises called Kegel exercises are used primarily to treat people with stress incontinence. However, these exercises may also help relieve symptoms of urgency related to long-term (chronic) noninfectious cystitis. Performing the exercises properly and regularly increases the method's success.
• Electrical stimulation to the pelvis may be used as a treatment for noninfectious cystitis, but this is controversial.

Expectations (prognosis)

Although most cases of cystitis are uncomfortable, they usually resolve over time.

Complications

• Ulceration of bladder wall
• Urethral stricture
• Diminished bladder capacity
• Bladder cancer
• Anemia

Calling your health care provider

Call your health care provider if you have symptoms of cystitis, or if you have been diagnosed with cystitis and symptoms worsen or new symptoms develop, especially fever, back or flank pain, and vomiting.

Prevention

Avoid using items that may be irritants such as bubble baths, feminine hygiene sprays, sanitary napkins or tampons (especially scented products), and spermicidal jellies.

If you need to use such products, try to find those that do not cause irritation for you.

References

Hanno PM. Painful bladder syndrome/interstitial cystitis and related disorders. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 10.

Lentz GM. Urogynecology: Physiology of micturition, Diagnosis of voiding dysfunction, and incontinence: Surgical and nonsurgical treatment. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 21.

Reviewed By

Review Date: 03/22/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Scott Miller, MD, Urologist in private practice in Atlanta, Georgia. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.