Cystitis

Cystitis

ICD-10	N30
ICD-9	595
DiseasesDB	29445
MeSH	D003556

Cystitis is a term that refers to urinary bladder inflammation that results from any one of a number of distinct syndromes.^[1] It is most commonly caused by a bacterial infection in which case it is referred to as a urinary tract infection.^[2]

Signs and symptoms

• Pressure in the lower pelvis
• Painful urination (dysuria)
• Frequent urination (polyuria) or urgent need to urinate (urinary urgency)
• Need to urinate at night (nocturia)
• Urine that contains traces of blood (haematuria)
• Dark, cloudy or strong smelling urine
• Pain above the pubic bone, or in the lower back or abdomen
• Feeling unwell, weak or feverish^[3]

Subtypes

There are several medically distinct types of cystitis, each having a unique etiology and therapeutic approach:

• Traumatic cystitis is probably the most common form of cystitis in the female, and is due to bruising of the bladder, usually by abnormally forceful sexual intercourse. This is often followed by bacterial cystitis, frequently by coliform bacteria being transferred from the bowel through the urethra into the bladder.
• Interstitial cystitis (IC) is considered more of an injury to the bladder resulting in constant irritation and rarely involves the presence of infection. IC patients are often misdiagnosed with UTI/cystitis for years before they are told that their urine cultures are negative. Antibiotics are not used in the treatment of IC. The cause of IC is unknown, though some suspect it may be autoimmune where the immune system attacks the bladder. Several therapies are now available.
• Eosinophilic cystitis is a rare form of cystitis that is diagnosed via biopsy. In these cases, the bladder wall is infiltrated with a high number of eosinophils. The cause of EC maybe attributed to infection by Schistosoma haematobium or by certain medications in afflicted children. Some consider it a form of interstitial cystitis.
• Hemorrhagic cystitis, can occur as a side effect of cyclophosphamide, ifosfamide, and radiation therapy. Radiation cystitis, one form of hemorrhagic cystitis is a rare consequence of patients undergoing radiation therapy for the treatment of cancer. Several adenovirus serotypes have been associated with an acute, self-limited hemorrhagic cystitis, which occurs primarily in boys. It is characterized by hematuria, and virus can usually be recovered from the urine.
• In sexually active women the most common cause of urinary tract infection is from E. coli and Staphylococcus saprophyticus.
• Cystitis cystica is a chronic cystitis glandularis accompanied by the formation of cysts. This disease can cause chronic urinary tract infections. It appears as small cysts filled with fluid and lined by one or more layers of epithelial cells.This are due to hydropic degeneration in center of Brunn's nests

Diagnostic approach

• A urinalysis may reveal white blood cells (WBCs) or red blood cells (RBCs).
• A urine culture (clean catch) or catheterized urine specimen may be performed to determine the type of bacteria in the urine and the appropriate antibiotic for treatment.

Treatment

Treatment depends on the underlying cause.

References

1. ^ "Cystitis Nonbacterial eMedicine". http://emedicine.medscape.com/article/440225-overview. 
2. ^ "Cystitis — MayoClinic.com". http://www.mayoclinic.com/health/cystitis/ds00285. 
3. ^ Cystitis Symptoms on NHS Choices