What is cystitis?

Cystitis means inflammation of the bladder. It is usually caused by bacteria. Cystitis is more common in women than men probably because the tube leading out of the bladder, the urethra, is relatively short in women. The inflammation causes dysuria, (pain during micturition - emptying of the bladder) and frequency or shortened intervals between micturition. Haematuria, blood in the urine, may occur with severe cystitis but there are other causes and early, careful medical assessment is always essential.

At one time we thought that infection was confined to a single organ but we now believe that it usually involves other parts of the system. Thus infection is unlikely to be confined to the bladder but may involve the urethra and kidneys: we therefore now call these episodes 'urinary tract infections'. On occasion the infection may reach the kidneys and be severe (pyelonephritis) resulting in severe loin pain and fever. Recurrent episodes of pyelonephritis can lead to renal (kidney) damage.

When urinary tract infection is suspected, a mid-stream sample of urine is usually sent to the laboratory to confirm the diagnosis, determine the type of bacteria and check the sensitivity of the organism to the more common antibiotics. Cystitis usually responds quickly to an appropriate antibiotic.

How prevalent is cystitis?

Cystitis is a common problem in women. A study in Sweden found that 40% of women aged between 21 and 70 years had received treatment within the previous two years. More than one half the women treated for urinary tract infection have a further attack within the next two years.

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What is interstitial cystitis?

Interstitial cystitis (IC), also known as painful bladder syndrome, is a chronic, painful, inflammatory condition of the bladder wall that affects over one million people in the United States. The cause is unknown and there is no cure, but there are many available treatment options to help relieve symptoms.

Although IC is not as well known, it is as common as Parkinson's disease or Type I diabetes.

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What is honeymoon cystitis

This is usually the result of frequent intercourse. There may not be true infection but just inflammation at the base of the bladder, which is situated close to the front wall of the vagina. Antibiotics may help if there is infection but a few days abstention may be required.

How prevalent are frequency and nocturia?

One study found that more than 50% of women emptied their bladders more frequently than three hourly and 11% more frequently than every two hours. Fourteen percent of women emptied their bladders more than once during the night.



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What is a urinary tract infection (UTI)?

A urinary tract infection (UTI) is a bacterial infection that can affect any part of the urinary tract. Urine is usually sterile - it should not have bacteria in it. When bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder infection which is also often called cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more serious. Although they cause discomfort, urinary tract infections are usually quickly and easily treated by antibiotics.

There are a number of symptoms that would suggest a urinary tract infection. The most common symptom is pain or a burning sensation during voiding (micturition). Another common symptom is the need to empty the bladder frequently. There may be a need to empty the bladder during the night (nocturia). The physical signs include pyrexia (elevated body temperature) and cloudy smelly urine. UTIs are more common in sexually active women, those with a tendency to infection due for example to diabetes and those born with a congenital anatomical malformation of the urinary tract. Women are more prone to urinary tract infection as the urethra (the exit tube from the bladder) is relatively short and closer to the anus allowing ascending infection. Some women find that they are liable to develop a UTI if, during sexual intercourse, their partner enters their vagina from behind. This is because in this position it is more likely that bacteria from around the anus may be pushed forward towards the urethra. It is possible to have bacteria in the urinary tract without symptoms (asymptomatic bacteruria).

Dipsticks have been developed to allow a quick diagnosis of UTI. No combination of dipstick and/or symptoms adequately predicted an infection to the point that a recommendation to dispense with the need for a culture in one urogynecology population could be made.0810

The diagnosis of urinary tract infection is confirmed by culture of a mid-stream urine sample (MSU). The most common pathogen is E.coli.

Antibiotics, including trimethoprim, cephalosprins, nitrofurantoin and penicillins such as amoxicillin usually prove to be effective treatments. Urine culture will demonstrate antibiotic sensitivity of the causative bacteria if first line treatment fails. In severe infections, including pyelonephritis, intravenous antibiotic administration may be required.

If a patient has recurrent UTIs, further investigation of the urinary tract, including ultrasound of the kidneys and bladder and x-rays (IVP) may be indicated.

Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). There is some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period, particularly for women with recurrent UTIs. The large number of dropouts/withdrawals in clinical studies indicates that cranberry juice may not be acceptable over long periods of time. It is not clear what is the optimum dosage or method of administration (e.g. juice, tablets or capsules). Further properly designed studies with relevant outcomes are needed.0807

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Support Groups

Members of a support group, provide each other with various types of help for a particular shared difficulty. The support may take the form of providing relevant information, relating personal experiences, listening to others' experiences, providing sympathetic understanding and establishing social networks. A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy. Support groups maintain interpersonal contact among their members in a variety of ways. Support groups also maintain contact through printed newsletters, telephone chains, internet forums, and mailing lists.

Support groups offer companionship and information for people coping with diseases or disabilities. Support groups may not be appropriate for everyone, and some find that a support group actually adds to their stress rather than relieving it.

Evaluation of the quality of Web sites is discussed in (internet information). You may find that several general women's health sites may help you (internet information). The following are more specialised relevant Web sites:-

http://www.cobfoundation.org/ The Cystitis and Overactive Bladder Foundation
webhealth.co.uk/support_groups/interstitial_cystitis_support_group. The Interstitial Cystitis Support Group
http://www. Icaction.com/ Citrus Valley Interstitial Cystitis Support Group Website
http://www. Icnewyork.net/ Interstitial Cystitis Support Group of Manhattan
http://www. Ichelp.org/ Interstitial Cystitis Association



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