Melomed Articles


14 February 2019 - Dr. Naseem Aziz

What is Bladder Infection ( Cystitis)


Bladder infection is a type of urinary tract infection, also called Cystitis. Normally urinary tract is free of bacterial growth; bacteria from the rectal reservoir may gain entry into the urinary tract leading to infection. Urinary tract infections are common, effect men and women of all ages. They can vary in presentation and sequelae. They are common cause of morbidity and may lead to significant mortality.

Types of Bladder Infections (Cystitis)
Bacterial Infection.
Uncomplicated Bladder infection ( Cystitis)
Most cases of uncomplicated bladder infections occur in women, approximately 10% of women reports having had UTI and more than 50% have at least one such infection in lifetime. Cystitis can occur in prepupertal girls, but it increases greatly in incidence in late adolescence, during 2nd and 4th decade.
Although it is much less common, young men also experience acute cystitis without underlying structural and functional abnormality.

Complicated Bladder Infection (Cystitis)
Complicated UTI's are those that occur in a patient with a compromised urinary tract or caused by resistant pathogen. All bladder infections in men are considered complicated as entry of pathogens is difficult in male urinary tract due to male urethral size as compared to female.

Non-infectious Cystitis
Although bacterial infections are the most common cause of cystitis, a number of non-infectious factors also may cause the bladder to become inflamed. Some examples include:

Interstitial cystitis. The cause of this chronic bladder inflammation, also called painful bladder syndrome, is unclear. Most cases are diagnosed in women. The condition can be difficult to diagnose and treat.

Drug-induced cystitis. Certain medications, particularly the chemotherapy drugs cyclophosphamide and ifosfamide, can cause inflammation of your bladder as the broken-down components of the drugs exit your body.

Radiation cystitis. Radiation treatment of the pelvic area can cause inflammatory changes in bladder tissue.
Foreign-body cystitis. Long-term use of a catheter can predispose you to bacterial infections and to tissue damage, both of which can cause inflammation.

Chemical cystitis. Some people may be hypersensitive to chemicals contained in certain products, such as bubble bath, feminine hygiene sprays or spermicidal jellies, and may develop an allergic-type reaction within the bladder, causing inflammation.

Cystitis associated with other conditions. Cystitis may sometimes occur as a complication of other disorders, such as diabetes, kidney stones, an enlarged prostate or spinal cord injuries.
 
Who is at risk for a bladder infection?
Anyone can get bladder infections, but women are more prone to getting them than men. This is because women have shorter urethras, located near to rectum making the path to the bladder easier for bacteria to reach.
Neurological damage to bladder such as in spinal cord injury and stroke results in obstruction, urine stasis and multiplication of bacteria leading to infection. 

In men over age of 50 common cause of urine obstruction is prostate enlargement, resulting into infection.
Patients with indwelling catheter also have high risk of bladder infection due to easy bacterial ascent or colonisation.

Risk factors.
  • Poor urine flow: obstruction, neurological issues and dehydration. 
  • Colonization: sexual activity, spermicide, Oestrogen depletion and antimicrobial use.
  • Bacterial Ascent: catheterisation, urine and faecal incontinence.

  • Clinical Presentation 
    Inflammatory response due to infection can cause symptoms which include
  • Dysuria (burning during urine flow)
  • Frequency and /urgency
  • Suprapubic pain (Bladder Spasm)
  • Blood in urine
  • Change in odour of urine
  • Bed wetting in children

  • Complicated UTI can also have similar symptoms as simple infection; however they can develop additional symptoms
  • Fever
  • Chills
  • Nausea
  • Vomiting
  • Flank pain
  • confusion

  • Diagnosis and Management
    Your doctor can diagnose urinary infection by clinical assessment and certain test.

    Urinalysis
    After clinical assessment, doctor will ask for urine specimen. Doctor will look for presence of blood, pus cells and bacteria by urine Dipsticks, reagent on Uri strip will react to urine and colour change will be read by the doctor. 

    Urine Microscopy, Culture and Sensitivity.
    In cases where repeated infection or non-responsiveness to initial treatment, doctor will ask for U-MC&S in order to be guided regarding management.

    Renal Tract Imaging
    Imaging is not necessarily required in most cases of bladder infection because clinical and laboratory findings alone are sufficient for diagnosis and adequate management.

    However infection in most men, compromised host, febrile infections, signs and symptoms of obstruction, failure to respond to appropriate therapy and pattern of recurrent infection warrant imaging for identification of underlying abnormality.

    Renal Tract Ultrasound
    Computed Tomography
    Voiding Cystourethrography
    Radionuclide Studies
    Diagnostic Cystoscopy

    Management: 
  • Simple Cystitis
  • o 3-day course of antibiotic is sufficient to eradicate infection
  • Symptoms more than 7 days, Diabetics, recent infection, male patient & pregnancy
  • o 7-day course of appropriate antibiotic.
  • Complicated Cystitis
  • o 10-14 day course of antibiotic and may require hospitalization. Intravenous antibiotic will be required initially. Once patient responds well than antibiotics are switched over to oral medicines.
  • Non-Infectious Cystitis
  • o Anti-cholinergic drugs to relax the bladder.

    Prevention of Bladder infections:
    The primary aim is to avoid the introduction of harmful bacteria into your urinary tract. 
    Some of the more effective means of prevention:
  • Drinking plenty of water—at least eight glasses per day—to promote urination and kidney health
  • Never holding urine in
  • Cleaning your genitals before and after sex; urinating after sex to help clear the urinary tract
  • Using condoms, Avoiding spermicides and diaphragms
  • Wiping from front to back to avoid the transfer of feacal bacteria from the anus to the vagina
  • Cleaning under the foreskin daily, if you are uncircumcised
  • Wearing breathable cotton underwear to reduce moisture build-up
  • Prophylactic antibiotics

  • For cystitis, basic questions to ask your doctor include:
  • What is the most likely cause of my signs and symptoms?
  • Are there any other possible causes?
  • Do I need any tests to confirm the diagnosis?
  • What factors do you think may have contributed to my cystitis?
  • If the first treatment doesnt work, what will you recommend next?
  • Am I at risk of complications from this condition?
  • What is the risk that this problem will recur?
  • What steps can I take to reduce my risk of a recurrence?
  • Should I see a specialist?
  • Dont hesitate to ask other questions during your appointment.

  • What to expect from your doctor
    Your doctor is likely to ask you a number of questions, including:
  • When did you first notice your symptoms?
  • Have you been treated for a bladder or kidney infection in the past?
  • How severe is your discomfort?
  • How frequently do you urinate?
  • Are your symptoms relieved by urinating?
  • Do you have low back pain?
  • Have you had a fever?
  • Have you noticed vaginal discharge or blood in your urine?
  • Are you sexually active?
  • Do you use contraception? 
  • Could you be pregnant?
  • Are you being treated for any other medical conditions?
  • What medications are you currently taking, over-the-counter, prescription drugs, vitamins and supplements?

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