Cystitis refers to the inflammation of the urinary bladder. Inflammation of the bladder refers to a situation where the bladder is irritated and therefore becomes swollen, red and with altered functionality.

The bladder is part of the urinary tract which starts from the kidneys (two bean-shaped organs on either side of the loins), to the ureters (two slender pipes that carry urine from the kidneys to the bladder for storage), then bladder (responsible for storing urine) and finally the urethra (a pipe that transports urine from the bladder outside).

Cystitis may occur alone or as part of the general urinary tract infection.

Causes of cystitis

1. Bacterial infection (e.g. ascending infection from the urethra into the bladder)
2. Certain drugs (e.g. drugs used in the treatment of cancer such as cyclophosphamide). This may result in what is referred to as interstitial cystitis (prolonged inflammation of all the layers of the bladder wall)
3. Radiation therapy (e.g. for cancers in the pelvis)
4. Prolonged use of catheter, leading to ascending infection into the bladder
5. Certain chemicals such as spermicides, which is usually included in condoms and diaphragms (for contraception)

Risk factors for cystitis

These are conditions that make it easy for cystitis to occur. These include:

1. Being a woman – Cystitis from bacteria tend to be more common in women that men as a result of their shorter urethra, which is about 4cm compared with 25cm in men.
2. Sexual activity – Bacteria find their ways into the urethra during sexual intercourse. This is more common in women due to their shorter urethra
3. Pregnancy – Modification of the body’s immune system during pregnancy makes urinary tract infection (especially cystitis) to be more common
4. Menopause – The lack of hormone support to the pelvic tissues after menopause makes the bladder easily susceptible to irritation
5. Use of spermicide-containing diaphragms – The chemical contained in the spermicide may irritate the bladder 
6. Enlarged prostate – This commonly leads to incomplete voiding of urine, which may serve as reservoir to bacteria, leading to bladder infection
7. Medical conditions such as diabetes, HIV, spinal cord injuries
8. Kidney or bladder stones – These stones serve as hiding place for bacteria

Symptoms of cystitis

1. Cloudy urine
2. Traces of blood in urine
3. Increased frequency of urination, usually of small quantity
4. Pain while urinating
5. Low grade fever
6. Lower abdominal pain 
7. Pain while having sex

Investigations for cystitis

1. Urine analysis – This is a simple test which may only suggest the presence of urinary tract infection
2. Urine culture – This helps to identify the bacteria causing cystitis and the drugs that can be used for its treatment
3. Ultrasound – This is not a commonly used investigation in cystitis. However, it may be important in ruling out bladder stone in cases of recurrent urinary tract infection
4. Cystoscopy – This refers to looking into the bladder with the aid of an instrument with light and camera. The cause of the cystitis may be identified during this procedure and tissue sample can be taken for further testing. It is not a commonly used method for investigating cystitis but may be necessary when an underline disease of the bladder is thought to be responsible for cystitis.

Treatment for cystitis 

The treatment for cystitis depends on its cause. It is important to know that many mild cases of cystitis may resolve on their own within few days; and therefore may not require treatment. If symptoms however exceed three days, there may be need for investigation and treatment.

Antibiotics – These are used in the treatment of cystitis caused by bacteria. The specific antibiotics needed for treatment depends on the sensitivity of the bacteria to each of the antibiotics. However, treatment is usually commenced with some antibiotics which target organisms of different classes before the sensitivity test is available, which may take 48 hours to 72 hours.

Pain relief – This may be achieved with the use of pain-relieving drugs such as acetaminophen, diclofenac, ibuprofen etc. This helps to relieve the immediate symptoms while the definitive treatment is being applied. By the time the disease has been well treated, the pain-relieving drugs will no more be needed. 

Drinking plenty of fluids – This increases urine flow and thereby helps to flush away some of the bacteria.

Surgery – Surgery may be necessary to remove some nerves around the bladder, which are responsible for transmitting pain signals to the spinal cord. This is not routinely done but may be necessary in women with prolonged pain from the bladder due to previous chemotherapy or radiotherapy.

Prevention of cystitis

1. Women should pass urine immediately after sexual intercourse.
2. After bowel movement, women should wipe from front backwards to prevent bacteria from faeces finding their way into the urethra, and from there into the bladder.
3. Spermicides should be avoided as much as possible.
4. Hormone replacement therapy may help postmenopausal women in returning the pelvic tissues, including the bladder, to premenopausal state.
5. When the urge to urinate is felt, do not delay voiding. Delaying voiding when the bladder is full may encourage bacterial growth in the bladder.
6. Enlarged prostate, resulting in significant post-void volume of urine, should be treated.
7. Chemotherapy drugs that cause cystitis should be given with large volume of fluid so as to encourage clearing the drug from the bladder.
8. Diabetes should be treated and blood sugar maintained within normal range.
9. Precautions should be taken while passing catheter to prevent bacteria from getting into the bladder while catheter should be changed at recommended intervals in those requiring prolonged catheterisation.