Cystitis

Cystitis is characterized by strong smelling and cloudy urine that indicate signs of bacterial infection. This is caused by inflammation of lining of bladder that is due to infection, irritation or damage. Cystitis is more common in women than men as women have a shorter urethra and is more susceptible to infection. Most of the cases will healed or resolved within 3 days even without treatment. There is no need for panic if women are having cystitis as this is very normal.

According to estimation, most women will have at least once infection of cystitis in their lives. However, if you have more than 3 attacks in one subsequent year, you should seek your general practitioner (GP).

Women who takes cytotoxic drugs e.g. Cyclophosphamide and methenamine hippurate (hexamine) are thought to have higher risk of developing cystitis due to the reason that they are likely to be more sexually active.

Referral
Children present with cystitis need to be referred to the doctor for investigation due to the possibility of urinary tract infection that may damage the kidney or bladder.
Any man who presents with cystitis should be referred immediately because this may indicate more serious conditions such as kidney or bladder stones.

Pregnant women who present with cystitis need to be referred to doctor as well because this can leads to kidney infection.

Haematuria (presence of blood in the urine) is also a sign for referral. This is due to the inflammation in the lining of the bladder that causes bleeding to occur. It can be taken care of with antibiotic treatment and will resolve quickly. However, if there is no pain felt during haematuria, it is important to see your doctor as there is a possibility of a tumor to develop in the bladder or kidney.
Women with recurrent cystitis should also see their doctor.

If anyone experiencing excessive thirst, sudden weight loss and higher tendency to pass urine, he or she should be referred immediately as well as this may be caused by other serious illness such as diabetic.

Why women more susceptible to cystitis compare to men?
The urethra of women are much shorter than men, therefore are more susceptible to infection. Bacteria can pass up along the urethra easily and multiply when they entered within the bladder. Besides, the prostatic fluid in males is believed to have antibacterial properties, giving them additional defence against bacterial infection.

Women who have painful intercourse despite using oestrogen cream should be referred. The oestrogen cream is used to give more lubricant in order to minimize irritation an cystitis attack.

What are the symptoms of cystitis?
• Itching or pricking sensation in the urethra
• Frequent desire to pass urine
• Passing urine with only small amount or few painful drops
• Dysuria
• Vaginal discharge would indicate local fungal or bacterial infection (need to be refer too)

Practical points
Avoid sexual intercourse (honeymoon cystitis) as this may precipitate an attack due to resulting infection as bacteria may be pushed further inside urethra. If you have sexual intercourse, it is best to go to pass urine immediately after that to flushed out possible bacteria present in the urethra.

Lack of hygiene is one of the factors affecting the severity of cystitis. During toiletries, it is recommended to wipe from front to back to minimize or avoid any bacteria from entering into vagina and urethra.

Take large fluids intake per day as this will increase the tendency to pass urine more frequently and as a result help the flushed out any bacterial reside within the bladder.

It is advised to wait for approximately 20s after passing urine to completely empty the bladder.
Avoid any alcoholic and coffee drinks. These will cause irritation to the bladder in some people.

Treatments
Cystitis should resolve itself within 3 days. If the symptoms have not improve after 3 days, referral to doctor is required.

Paracetamol and ibuprofen can be of help in treatment of cystitis.

Potassium and sodium citrate work by alkalinizing the urine. The urine become acidic due to bacterial infection and is thought to be responsible for dysuria. However, potassium and sodium citrate do not have antibacterial effect, therefore if the symptoms have not improve after 3 days, referral to doctor is required. Patients with hypertension are not recommended to take potassium and sodium citrate. They should not be taken by anyone taking potassium sparing diuretics, aldosterone antagonists or ACE inhibitors. It is important to advise the patient that the potassium citrate mixture tastes unpleasant and should be diluted with cold water.

Cranberry juice at 300ml per day is believed to have an antibacteriostatic effect.