Cystitis - acute

Answer 1

Definition

Acute cystitis is a bacterial infection of the bladder or lower urinary tract. Acute means sudden or severe.

See also:

• Cystitis - recurrent
• Cystitis - noninfectious
• Interstitial cystitis
• Urinary tract infection

Alternative Names

Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis

Causes, incidence, and risk factors

Acute cystitis occurs when the lower urinary tract (urethra and bladder) become infected by bacteria. Most cases are caused by Escherichia coli (E. coli), a bacteria found in the intestines. When you urinate, you help remove bacteria from the bladder. However, sometimes the bacteria grow so fast that some remain in the bladder.

Cystitis is rare in men. Women are more likely to have cystitis. It is much easier for the bacteria to travel into a woman's bladder, because it does not have to travel as far.

The condition is very common, and most often affects sexually active women age 20 to 50. Sexual intercourse may increase the risk of cystitis. However, the infection may also occur in those who are not sexually active.

Older adults also have a high risk for developing cystitis. This is due in part to conditions such as benign prostatic hyperplasia (BPH), prostatitis, and urethral strictures.

The following also increase your risk for cystitis:

• Bowel incontinence
• Diabetes
• Blockage of the bladder or urethra
• HIV
• History of analgesic nephropathy or reflux nephropathy
• Immobility or decreased mobility
• Insertion of instruments into the urinary tract (such as a catheter or cystoscope)
• Not drinking enough fluids

Symptoms

• Abnormal urine color (cloudy)
• Frequent or urgent need to urinate
• Foul or strong urine odor
• Need to urinate at night (nocturia)
• Painful urination (dysuria)
• Pressure in the lower pelvis

Additional symptoms that may be associated with this disease:

• Chills
• Fatigue
• Fever
• Flank pain
• Mental changes or confusion*
• Nausea and vomiting
• Pain during sexual intercourse
• Penis pain(rare)

*Often in an elderly person, mental changes or confusion are the only signs of a possible urinary tract infection.

Signs and tests

Urinalysiscommonly shows white blood cells (WBCs) or red blood cells (RBCs). There may be blood in the urine.

Urine culture (clean catch) or catheterized urine specimenmay be done to find out what kind of bacteria is causing the infection and to determine the appropriate antibiotic for treatment.

Treatment

Cystitis should be promptly treated. Antibiotics are used to fight the bacterial infection. You should finish the entire course of antibiotics. Commonly used antibiotics include:

• Amoxicillin
• Cephalosporins
• Ciprofloxacin or levofloxacin
• Doxycycline
• Nitrofurantoin
• Sulfa drugs (sulfonamides) such as trimethoprim-sulfamethoxazole (Bactrim)

A medicine called phenazopyridine (Pyridium) may be used to reduce the burning and urgency associated with cystitis.

Over-the-counter products that increase acid in the urine, such as ascorbic acid or cranberry juice, may be recommended to decrease the concentration of bacteria in the urine.

Follow-up may include urine cultures to make sure the bacterial infection is gone.

Expectations (prognosis)

Most cases of cystitis are uncomfortable but disappear without complication after treatment.

Complications

• Acute kidney failure
• Chronic or recurrent urinary tract infection
• Kidney infection

Calling your health care provider

Call your health care provider if you have symptoms of cystitis, or if you have already been diagnosed and symptoms get worse. You should also call if new symptoms develop, particularly fever, Back pain, stomach pain, or vomiting.

Prevention

Keeping the genital area clean and wiping from front to back may reduce the chance of introducing bacteria from the rectal area to the urethra.

Drink plenty of fluids to allow for frequent urination to flush the bacteria from the bladder.

Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. If you do not urinate for a long period of time, the bacteria has time to multiply. Frequent urinating may reduce the risk of cystitis in those who are prone to urinary tract infections.

Drinking cranberry juice prevents certain types of bacteria from attaching to the wall of the bladder and may reduce your risk of infection.

References

Norrby SR. Approach to the patient with urinary tract infection. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap.306.

Foster RT Sr. Uncomplicated urinary tract infections in women. Obstet Gynecol Clin North Am. 2008;35(2):235-248.

Answer 2

Definition

Acute cystitis is a bacterial infection of the bladder or lower urinary tract. Acute means sudden or severe.

See also:

• Interstitial cystitis
• Urinary tract infection
• Urinary tract infection - children

Alternative Names

Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis

Causes, incidence, and risk factors

Cystitis is caused by germs, usually bacteria that enter the urethra and then the bladder. These bacteria can lead to infection, most commonly in the bladder. The infection can spread to the kidneys.

Most of the time, your body can get rid of these bacteria when you urinate. However, sometimes the bacteria can stick to the wall of the urethra or bladder, or grow so fast that some bacteria stay in the bladder.

Women tend to get infections more often than men because their urethra is shorter and closer to the anus. For this reason, women are more likely to get an infection after sexual intercourse or when using a diaphragm for Birth Control. Menopause also increases the risk for a urinary tract infection.

The following also increase your chances of developing cystitis:

• A tube called a urinary catheter inserted in your bladder
• Blockage of the bladder or urethra
• Diabetes
• Enlarged prostate, narrowed urethra, or anything that blocks the flow of urine
• Loss of bowel control (bowel incontinence)
• Older age (especially in people who live in nursing homes)
• Pregnancy
• Problems fully emptying your bladder (urinary retention)
• Procedures that involve the urinary tract
• Staying still (immobile) for a long period of time (for example, when you are recovering from a hip fracture

Most cases are caused by Escherichia coli (E. coli), a type of bacteria found in the intestines.

Symptoms

The symptoms of a bladder infection include:

• Cloudy or bloody urine, which may have a foul or strong odor
• Low fever (not everyone will have a fever)
• Pain or burning with urination
• Pressure or cramping in the lower abdomen (usually middle) or back
• Strong need to urinate often, even right after the bladder has been emptied

Often in an elderly person, mental changes or confusion are the only signs of a possible urinary tract infection.

Signs and tests

A urine sample is usually collected to perform the following tests:

• Urinalysis is done to look for white blood cells, red blood cells, bacteria, and to test for certain chemicals, such as nitrites in the urine. Most of the time, your doctor or nurse can diagnose an infection using a urinalysis.
• Urine culture - clean catch may be done to identify the bacteria in the urine to make sure the correct antibiotic is being used for treatment.

Treatment

Antibiotics taken by mouth are usually recommended because there is a risk that the infection can spread to the kidneys.

• For a simple bladder infection, you will take antibiotics for 3 days (women) or 7 - 14 days (men). For a bladder infection with complications such as pregnancy or Diabetes, OR a mild kidney infection, you will usually take antibiotics for 7 - 14 days.
• It is important that you finish all the antibiotics, even if you feel better. People who do not finish their antibiotics may develop an infection that is harder to treat.

Commonly used antibiotics include trimethoprim-sulfamethoxazole, amoxicillin, Augmentin, doxycycline, and fluoroquinolones. Your doctor will also want to know whether you are pregnant.

Your doctor may also recommend drugs to relieve the burning pain and urgent need to urinate. Phenazopyridine hydrochloride (Pyridium) is the most common of this type of drug. You will still need to take antibiotics.

Everyone with a bladder or kidney infection should drink plenty of water.

Some women have repeat or recurrent bladder infections. Your doctor may suggest several different ways of treating these.

• Taking a single dose of an antibiotic after sexual contact may prevent these infections, which occur after sexual activity.
• Some women may need to have a 3-day course of antibiotics at home to use for infections, based on their symptoms.
• Some women may also try taking a single, daily dose of an antibiotic to prevent infections.

Over-the-counter products that increase acid in the urine, such as ascorbic acid or cranberry juice, may be recommended to decrease the concentration of bacteria in the urine.

Follow-up may include urine cultures to make sure the bacterial infection is gone.

See also: Catheter-associated UTI

Expectations (prognosis)

Most cases of cystitis are uncomfortable, but go away without complications after treatment.

Complications

• Acute kidney failure
• Chronic or recurrent urinary tract infection
• Kidney infection

Calling your health care provider

Call your health care provider if:

• You have symptoms of cystitis
• You have already been diagnosed and symptoms get worse
• New symptoms develop, particularly fever, back pain, stomach pain, or vomiting

Prevention

Lifestyle changes may help prevent some urinary tract infections.

After menopause, a woman may use estrogen cream in the vagina area to reduce the chance of getting further infections.

BATHING AND HYGIENE

• Choose sanitary pads instead of tampons, which some doctors believe make infections more likely. Change the pad each time you use the bathroom.
• Do not douche or use feminine hygiene sprays or powders. As a general rule, do not use any product containing perfumes in the genital area.
• Take showers instead of baths. Avoid bath oils.
• Keep your genital area clean. Clean your genital and anal areas before and after sexual activity.
• Urinate before and after sexual activity.
• Wipe from front to back after using the bathroom.

CLOTHING

• Avoid tight-fitting pants.
• Wear cotton-cloth underwear and pantyhose, and change both at least once a day.

DIET

• Drink plenty of fluids (2 to 4 quarts each day).
• Drink cranberry juice or use cranberry tablets, but NOT if you have a personal or family history of kidney stones.
• Do NOT drink fluids that irritate the bladder, such as alcohol and caffeine.

Urinating immediately after sexual intercourse may help remove any bacteria that may have gotten in during intercourse. If you do not urinate for a long period of time, the bacteria have time to multiply. Frequent urinating may reduce the risk of cystitis in those who are prone to urinary tract infections.

References

Little P, Moore MV, Turner S, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ. 2010.340:c199. doi:10.1136/bmj.c199.

Norrby SR. Approach to the patient with urinary tract infection. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap.306.

Foster RT Sr. Uncomplicated urinary tract infections in women. Obstet Gynecol Clin North Am. 2008;35(2):235-248.

Reviewed By

Review Date: 09/17/2010

Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.