Understanding Cystitis: Types, Causes, Symptoms and Treatment Options

What Is Cystitis?

Cystitis is the inflammation of the urinary bladder, most commonly caused by a bacterial infection. It is a type of lower urinary tract infection (UTI)that leads to discomfort, frequent urination, and a persistent urge to urinate. While both men and women can develop cystitis, it is significantly more common in women due to anatomical differences, such as a relatively shorter urethra and its close proximity to the rectum and the urethral meatus, which increases the likelihood of bacterial entry into the urinary tract.
Bacteria typically enter the urinary tract through the urethra and travel into the bladder. The body's natural defense mechanisms, such as regular urination, usually flush out bacteria before an infection occurs. However, certain factors like inadequate hydration, holding urine for extended periods, improper wiping techniques (from back to front after using the toilet), and frequent sexual activity can increase the risk of bacterial overgrowth, leading to cystitis.
Cystitis can be classified into two main categories: Complicated and Uncomplicated. Uncomplicated cystitis refers to a lower urinary tract infection (UTI)in either healthy men or non-pregnant women. In contrast, complicated cystitis involves risk factors that heighten the likelihood and severity of the infection, as well as the potential for antibiotic treatment failure.

Risk Factors for Cystitis

Certain factors increase the likelihood of developing cystitis. These can vary based on sex, medical conditions, and lifestyle factors.

Risk Factors in Women

Women are at a significantly higher risk due to anatomical differences, including a shorter urethra and its proximity to the rectum, which facilitates bacterial entry. Additional factors include:

• Sexually active
• Pregnancy
• Menopause
• Use of spermicides and diaphragms for contraception
• Use of tampons, which may disrupt normal urinary tract flora

Risk Factors for Both Men and Women

Both men and women can develop cystitis due to other contributing factors, such as:

• Recent history of UTI
• Being sexually active
• Having urinary catheter
• Medical conditions, such as diabetes,kidney stones,or HIV
• Radiation or chemotherapy
• Urinary flow obstructions
• Spinal cord injuries, which may interfere with bladder emptying and increase infection risk

Causes of Cystitis

The primary cause of cystitis is by bacterial infections. Around 80% of cases are due to Escherichia coli (E. coli),a type of bacteria that normally resides harmlessly in the intestines but can enter the urinary tract and cause infection. Other bacterial species that may lead to cystitis include:

• Proteus mirabilis
• Klebsiella pneumoniae
• Staphylococcus saprophyticus
• Group B streptococci
• Lactobacillus
• Enterococci

• Radiation Therapy
• Foreign Bodies
• Chemical Irritants
• Hormonal Changes
• Other medical conditions
• Medications such as chemotherapy agents

Types of Cystitis

Cystitis can manifest in a variety of ways and can be classified into several types based on its underlying cause, each with unique characteristics

Bacterial Cystitis

Bacterial cystitis is the most common form and results from bacterial infections, usually caused by Escherichia coli (E. coli). The bacteria enter the bladder through the urethra, leading to inflammation and infection. Women are at higher risk due to their shorter urethra and its proximity to the anus.

Interstitial Cystitis (Painful Bladder Syndrome)

Unlike bacterial cystitis, interstitial cystitis is a chronic condition characterized by persistent bladder inflammation without an underlying infection. The exact cause is unknown, but factors such as nerve dysfunction, autoimmune responses, or damage to the bladder lining may contribute to its development. Symptoms include bladder pain, frequent urination, and a constant urge to urinate.

Radiation Cystitis

Radiation therapy, commonly used to treat cancers of the pelvic region (such as cervical or prostate cancer), can damage the bladder’s lining, leading to inflammation known as radiation cystitis. This condition may cause pain, frequent urination, and hematuria (blood in the urine).

Chemical Cystitis

Exposure to certain chemicals found in personal care products, such as perfumed soaps, spermicides, and douches, can irritate the bladder lining and cause chemical cystitis. This form of cystitis presents with symptoms similar to bacterial cystitis, including discomfort and frequent urination.

Hemorrhagic Cystitis

This type of cystitis is characterized by blood in the urine and is often caused by viral infections, chemotherapy drugs, or severe bacterial infections. Hemorrhagic cystitis can be painful and may require intensive treatment to manage symptoms and prevent complications.

Foreign Body Cystitis

Long-term use of urinary catheters or the presence of foreign objects in the bladder can cause irritation and infection, leading to foreign body cystitis. This condition is commonly seen in individuals with prolonged catheter use, and treatment usually involves removal of the foreign object and appropriate antibiotic therapy if an infection is present.

Drug-Induced Cystitis

Certain medications, particularly some chemotherapy drugs, can irritate the bladder lining as they pass through the urinary system. This irritation leads to inflammation, resulting in symptoms such as pain, frequent urination, and discomfort.

Pathophysiology of Cystitis

Cystitis develops when bacteria from fecal or vaginal flora colonize the periurethral mucosa and ascend to the bladder. Uropathogens can evade host defenses due to their virulence factors. Males experience fewer UTIs due to anatomical differences, but uncomplicated UTIs can occur in sexually active men without significant risk factors.
Complicated UTIs are influenced by host factors, such as impaired immunity in diabetesor renal insufficiency, which can reduce host defenses and antimicrobial clearance. Kidney stonesand urinary catheters can also contribute to infection.
Escherichia coliis the primary causative agent, accounting for 75% to 95% of cases, followed by Klebsiella pneumoniaeand Proteus mirabilis.Other organisms, like Pseudomonas and enterococci, may appear in patients with prior hospitalizations. Contaminants like lactobacilli and Group B streptococci are usually only concerning at high quantities.

Signs & Symptoms of Cystitis

• Dysuria (Painful or difficult urination)
• Urgent need to pass urine
• Pain in the lower stomach
• Burning sensation while urinating
• Pain at the lower back or abdomen
• Urinary incontinence
• Enuresis
• Cloudy or dark-coloured urine
• Haematuria
• Foul-smelling urine
• Dyspareunia (pain during sexual intercourse)
• Genital pain
• Low-grade fever
• Fatigue
• Weakness, ache

• Fever
• Lack of appetite
• Nausea and vomiting
• Tiredness
• Weakness
• Aches
• Irritability

Diagnostic Test & Investigations

Urinalysis and Urine Culture

Cystoscopy

Ultrasound

Computed tomography (CT) scans

Magnetic resonance imaging (MRI)

An intravenous urogram (IVU) is an X-ray imaging test that uses contrast dye to evaluate the kidneys, ureters, and bladder. This test helps detect urinary tract abnormalities that may predispose individuals to recurrent infections.

This specialized X-ray test involves injecting contrast dye into the bladder to assess urine flow and detect vesicoureteral reflux—a condition where urine flows backward from the bladder to the kidneys, increasing the risk of recurrent infections.

Retrograde urethrography is performed using contrast dye to examine the urethra for strictures or other structural issues

Treatment of Cystitis

Antibiotics:Bacterial cystitis is treated with antibiotics. The type and duration depend on the severity of infection. Commonly prescribed antibiotics include:

• Nitrofurantoin: 100 mg twice daily for 5 – 7 days.
• Sulfamethoxazole-trimethoprim: Twice daily for 3 days.
• Fosfomycin: A single 4 mg dose.
• Cephalosporins, Amoxicillin, Quinolones, and Sulfonamides: Depending on bacterial resistance and patient factors.

Pain Relievers:Over-the-counter medications such as ibuprofen and acetaminophen can help manage pain and discomfort.

Vaginal Estrogen:For postmenopausal women prone to recurrent infections, vaginal estrogen may be recommended.

• Heating pads - Applying warmth to the lower abdomen or back may help relieve discomfort.
• Sitz baths - Soaking in warm water helps soothe irritation.
• Drinking plenty of fluids helps flush out bacteria and irritants.
• Cranberry juice or tablets may help prevent bacterial adhesion in some cases.
• Avoiding potential bladder irritants such as caffeine, alcohol, and spicy foods.
• Wearing cotton underwear and loose clothing reduces moisture and irritation, promoting bladder health.

Nursing Management of Cystitis

Here are key strategies to employ in the care of patients with Cystitis

• Check T P R BP and record Keep intake and output chart
• Investigate for the primary condition if cystitis persist (e.g. pyelonephritis, bladder calculus,
• urethra stricture or enlarge prostate gland)
• Perform urine examination as and when necessary
• Ensure rest and comfort for patient especially in the acute stage/phase

• High carbohydrate diet
• Adequate protein intake and vitamins
• Liberal amount of fluids including fruit juices

• Give assisted or full bed bath.
• Ensure efficient cleansing of the perineum after defecating especially for confined patients.
• Hand washing before and after eating and at regular times
• Proper care of urethra catheter if any / Cut fingernails short if unkempt

• Frequent hand washing and especially after defecation with carbolic soap and water
• Encourage women to maintain good perineal hygiene to reduce vaginal introidal concentration of pathogens
• Teach women to wipe the perineal area from front to the back and properly dispose off the used tissue.
• For women with repeated urinary tract infections, drink liberal amounts of water to lower bacterial concentration in the urine
• Avoid irritants such as coffee, cola, alcohol and tea
• Pre - coital and post - coital emptying of the bladder must be encouraged
• Encourage the use of condoms
• Avoid external irritants such as perfumed, vaginal cleansers or deodorants
• Instruct patients who have had urinary tract infections during pregnancy to have follow - up
• Identify and treat persons with urinary incontinence and retention

Preventions of Cystitis

Improving personal hygiene for many women is very crucial to prevent and avoid the occurrence of cystitis frequently, the following steps may help;

• Drink more water and other healthy beverages
• Maintaining a clean, dry genital area
• Urinate at regular intervals
• After intercourse, empty your bladder as quickly as feasible
• Emptying the bladder completely when urinating
• Wash hands before wiping after voiding
• Use adult or baby wipes instead of plain toilet paper
• Use showers instead of baths
• Wiping from front to back after voiding
• Avoiding tight underwear and tight pants
• Deodorant sprays and feminine items should not be used in the vaginal region