Cystitis

Cystitis

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

Cystitis is a urinary bladder inflammation that can result from any one of a number of distinct syndromes. It is most commonly caused by a bacterial infection in which case it is referred to as a urinary tract infection. If urine cultures do not indicate the presence of an infection when bladder irritation is prolonged or recurrent, food allergies should be considered.

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 (hematuria)
• Dark, cloudy or strong-smelling urine
• Pain above the pubic bone, or in the lower back or abdomen
• Feeling unwell, weak or feverish
• Very frequent urge to urinate and weak feeling of head because of tiredness caused by dehydration
• Intense desire to pass more urine after urination (strangury)

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 may be 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.These 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

Urinary Tract Infection (UTI) and Recurrent Urinary Tract Infection (RUTI) are usually treated with antibiotics. Otherwise there could be complications such as kidney infections. However other therapeutic alternatives should be considered because continuous antibiotic administration can create bacteria cross resistances against antibiotics and it will make it much more difficult to cure such infections. Furthermore, continuous/chronic ingestion of antibiotics could cause other problems like intolerances, allergies and gut problems among others.

Home remedies abound, including: cranberry, sodium bicarbonate, Alka-Seltzer, lemon juice, vinegar, and honey. However, such remedies often lack clinical evidence for their effectiveness. Cranberry juice has been shown to reduce the number of symptomatic UTIs over a 12 month period, particularly for women with recurrent UTIs, although its effectiveness for other groups is less certain.

Proanthocyanidin, American cranberry is a traditional and well known fruit commonly used among American Indians to treat UTI for more than 200 years. Within the last 20 years, A-type Proanthocyanidins have been identified as the active ingredient of American cranberry to treat recurrent cystitis as it inhibited the adherence activity of the E. coli bacteria from attaching to the inner urinary balder wall. The dose of 118 mg/day of PACs has demonstrated significant efficacy in various clinical studies.

Prevention of RUTI

The most common treatments to prevent RUTI are the continuous ingestion of sub-therapeutic doses of antibiotics for up to 3 months or, sometimes, even more. The use of these lower therapeutic doses have been proven to be one of the main causes of bacterial antibiotic resistance, making it more and more difficult to treat further UTI. Furthermore, long-term use of sub-therapeutic antibiotic doses will not avoid further UTI.

RUTI prevention is not an easy issue. In some cases it is possible to cure/improve if it has been possible to identify a specific cause and it has been possible to remove it surgically and/or it has been possible to modify the risk factors which are involved in its etiology. Weight reduction and intensive exercise to improve muscle tone of the pelvic floor have been proven to significantly prevent RUTI, reducing UTI episodes and then antibiotic needs. However most of RUTI are not solved just with risk factor management and alternative approach should be considered.

American cranberry fruit has been used for more than 200 years by original Indian American women to prevent UTI. First research on this fruit was suggested that its preventing effect was due to several compounds found like vitamins and organic acids. In parallel, Vitamin C started to be used to prevent RUTI because of its capacity to reduce urine pH (increase urine acidification). However the amount needed of Vitamin C to reduce urine pH was significantly higher than the doses prescribed. Then its preventive effect was very low if not any. Furthermore American cranberry fruit doses used did not modify the urine ph. Other products have been unsuccessfully evaluated (D-mannose, lingo berries, etc.) to prevent RUTI.

Further and more recent research on American cranberry extracts (ACE) has identified a group of substances called Pronathocyanidins (PACs) which, after several studies have been proven to be effective against RUTI. PACs are polyphenol chemical entities quite common in other fruits (grape, etc.). However only PACs from ACE have proven to have this RUTI preventive effect. It seems this effect is closely related to the PAC A subtype, although other PAC subtypes present in ACE have also shown some effect.