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urinary tract infection

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Female pelvic organs

Alternative Names
cystitis , cystitis, acute bacterial, bladder infection, UTI

Cystitis is an inflammation of the urinary bladder that can be caused by bacterial infection, bladder stones, indwelling catheters or tumours. If a bacterial infection of the bladder occurs, it can spread to the kidney, causing a kidney infection. If cystitis goes untreated, permanent damage both to the bladder and to the kidneys can result.

What is going on in the body?
Bacteria that normally live around the genitals and anus may spread to the urethra, which is the tube through which urine passes that connects the bladder to the exterior of the body.

If the bacteria spread to the urethra, the bacteria can then spread up into the bladder and kidneys. Once bacteria enter the bladder, most bacteria are removed when the person urinates. If bacteria multiply faster than they can be removed by urination, an infection results.

This may be a result of sexual intercourse or poor genital hygiene. Retaining urine for a long time or abnormal bladder function can also lead to infection. Other causes are sexually transmitted diseases, low levels of oestrogen in menopause, and a narrowing of the urethra.

Bladder infections are more common in women than in men because the urethra is shorter, making it easy for bacteria to move into it. The length of the male urethra in the penis creates a longer distance for bacteria to travel. An exception to this rule is men with an enlarged or infected prostate. The prostate contains bacteria that may spread to the bladder.

If cystitis is not treated, bladder and kidney damage can result and bacteria can spread into the bloodstream. This can cause a serious blood infection called septicaemia.

What are the signs and symptoms of the condition?
Symptoms of cystitis can include:
  • burning or pain with urination, or dysuria.
  • urgent need to urinate.
  • pain in the penis.
  • fever.
  • shaking chills.
  • pain in the lower stomach, lower back, or sides.
  • sweats.
  • fatigue.
  • nausea and vomiting.
  • bloody, pink, or cloudy urine.
  • frequent urination.
  • change in the amount of urination.
  • pus in the urine.
  • strong smelling urine.
  • mental changes or confusion. In elderly people this may be the only sign of a bladder infection.
  • pain with sexual intercourse.
What are the causes and risks of the condition?
The most common cause of cystitis is an organism called Escherichia coli or E. coli. These bacteria are normally present in the bowel and can be introduced into the bladder by sexual activity. Cystitis occurs in 2% of women, usually between the ages of 20 and 50. The risk is increased if there are multiple sexual partners. Risk factors for developing bladder infections include:
  • obstruction or blockage of the urethra, sometimes due to a tumour.
  • urological procedures, such as the placing of a catheter in the bladder after surgery.
  • pregnancy.
  • diabetes.
  • poor hygiene.
  • conditions that impair the ability to empty the bladder, such as spinal damage.
  • abnormal ureteral valves in the bladder
  • advanced age.
The elderly, especially those in nursing homes, are at a much higher risk of developing cystitis. Possible causes include inadequate fluid intake, bowel or bladder incontinence, decreased mobility, and incomplete emptying of the bladder.

What can be done to prevent the condition?
Suggestions for helping prevent cystitis include always emptying the bladder completely, emptying the bladder after sexual intercourse, and avoiding going for long periods without emptying the bladder. Prolonged or frequent soaking in the bathtub should be avoided.

After a bowel movement, women should wipe the genital area from front to back. This prevents bacteria in the stool from entering the urethra. All-cotton underwear should be worn and changed every day. Women should avoid using strong soaps, feminine hygiene products, and antiseptic creams that may irritate the urethra.

If men observe any change in urination patterns, the force of the stream, or the length of time to void, they should see a doctor to rule out a prostate infection or enlargement.

Everyone should drink plenty of fluids.

How is the condition diagnosed?
The doctor will take a detailed history of the symptoms. The examination may include a pelvic examination in women and a rectal examination in men. A urine specimen will be tested for bacteria as well as protein and red and white blood cells. A laboratory will culture the urine to determine the exact type of bacteria. This helps in choosing the right antibiotic for treatment. In men, urethral cultures may be taken to see if the prostate is infected.

If infections occur repeatedly, or the symptoms continue despite antibiotics, more tests may be done. These include intravenous pyelogram, in which an X-ray is taken after a dye is injected into the body. Another is cystoscopy, which uses a scope to look into the bladder.

What are the long-term effects of the condition?
Once treatment has begun, the symptoms of cystitis disappear within 24 hours. Antibiotics must continue to be taken for the full course, though.

If chronic cystitis is not diagnosed and treated, it can spread to the kidneys and bloodstream. Permanent kidney and bladder damage, or sepsis and shock, can result.

What are the treatments for the condition?
Cystitis is treated with antibiotics. These are usually given as a single dose, or for 3 days for mild infections. Examples of antibiotics are:
  • nitrofurantoin.
  • sulfa drugs, or sulfonamides, such as sulfamethoxazole.
  • cephalosporins, such as cephalexin
  • trimethoprim-sulfamethoxazole
More serious infections may require treatment for longer periods. If the full course of antibiotics is not completed, the infection may recur, with more damaging types of bacteria or bacteria resistant to the antibiotics used.

What are the side effects of the treatments?
The most common side effects of antibiotics are allergic reactions, rashes, nausea, cramps, upset stomach, and diarrhoea. Side effects usually go away shortly after the drug is stopped.

What happens after treatment for the condition?
During treatment, people with cystitis may be asked to monitor their temperatures. If a temperature goes above 37.5 degrees Celsius, they should rest until the fever is gone. Taking aspirin or paracetamol will control the fever. If the symptoms last for more than 2 days after starting antibiotics, the doctor should be called. Most of the time, if treated properly, cystitis will get better without complications.

How is the condition monitored?
The urine is examined again to make sure that bacteria are gone from the bladder.

Author: Eva Martin, MD
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request

This website and article is not a substitute for independent professional advice. Nothing contained in this website is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.  All Health and any associated parties do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information.


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