What is cystitis?
An inflammation of the urinary bladder is technically known as cystitis. The most frequent cause of cystitis is bacterial infection of the urinary bladder. Cystitis often starts with bacterial infections of the urethra (a condition referred to as urethritis). Both urethritis and cystitis are also generally referred to as urinary tract infections (commonly abbreviated as UTI).
Read more on UTI.
Although urine is normally a sterile fluid, it constitutes an ideal medium for the growth of bacteria. Most infections of the urinary bladder are secondary to infections of the urethra. An infection in the urethra can spread upwards towards the urinary bladder.Apart from bacterial infections, urethritis also has non-infectious causes. These non-infectious causes include mechanical trauma (such as that caused by sexual intercourse), chemical trauma, and autoimmune disorders.
Cystitis can affect both men and women. However, this condition is relatively more frequent in women. This could be because of the comparatively shorter urethra in women . Also, women do not have a prostate gland, which produces bactericidal prostatic fluid in men. Cystitis may also occur as a secondary manifestation of some other primary urogenital condition in both men and women.
For example, cystitis in men could be secondary to benign prostatic hyperplasia (commonly abbreviated as BPH). Cystitis in both men and women may also be secondary to the formation of stones in the urinary bladder.
Types of Cystitis
Cystitis may manifest as an acute or a chronic condition. Chronic cystitis may remain asymptomatic for a long period before symptoms arise. On the other hand, severe signs and symptoms usually occur immediately in acute cystitis.
Cystitis may be categorized according to the underlying cause of the inflammation. Two broad categories that may be used to describe cystitis include bacterial cystitis and non-bacterial cystitis.
As mentioned previously, bacterial cystitis is the most frequent type of cystitis. Non-bacterial cystitis may include causes such as non-bacterial infections (caused by viruses, parasites, and fungi) and trauma. Mechanical trauma (such as that caused by catheters) may lead to both non-infectious and bacterial cystitis.
The following are some of the types of cystitis:
- Infectious cystitis: Infectious cystitis is the most common type of cystitis. The infections could be due to bacteria, viruses, parasites, or fungi.
- Chemical cystitis: Chemical cystitis refers to inflammation of the urinary bladder caused by the use of certain soaps, spermicidal creams, and chemotherapeutic drugs. The affected individuals are usually hypersensitive to certain ingredients in these chemicals.
- Radiation cystitis: Inflammation of the urinary bladder could also result from radiation used to treat pelvic tumors.
- Tuberculous cystitis: Cystitis may also occur due to renal tuberculosis.
- Interstitial cystitis: In some cases, the pathophysiology of chronic bladder infections may not be discernible.
Signs and Symptoms
The presence of cystitis is indicated by the presence of a variety of signs and symptoms of urinary discomfort. The three characteristic features of cystitis include:
- Increased frequency of urination, especially during night (technically referred to as nocturia).
- Pain or burning sensation while passing urine (technically referred to as dysuria).
- Pain in the pelvic region.
These three features of cystitis are independent of the underlying cause. Apart from the above mentioned three cardinal features of cystitis, the following signs and symptoms may also be present:
- Fever, which may or may not be accompanied by chills.
- Pus in the urine (manifested as cloudy urine), indicating an infection.
- Presence of blood in the urine (technically referred to as hematuria).
- Pain in the back, abdomen or the flanks.
- Smelly urine.
- Painful intercourse (technically referred to as dyspareunia).
- Nausea and vomiting
The presence of these additional signs and symptoms depends on the underlying cause and severity of cystitis. These signs and symptoms are not present in all cases.
Read more on urine problems.
Causes of Cystitis
Cystitis has both infectious and non-infectious causes. However, infectious causes are the most frequent cause of urinary bladder infection. A variety of pathogens can cause cystitis. The following are some examples of cystitis causing microbes:
- Bacteria: Bacterial infection is the most common cause of cystitis. A variety of bacteria are capable of causing bladder infection. Examples include Escherichia coli (commonly abbreviated as E. coli), Proteus mirabilis, Staphylococcus saprophyticus, Streptococus fecalis, Chlamydia trachomatis, Klebsiella spp., and Mycobacterium tuberculosis.
- Fungi: Candida albicans and Cryptococcal spp. are two types of fungi that can cause cystitis.
- Parasites: Schistosoma haematobium (also known as the blood fluke) is a parasitic flatworm that is associated with urinary bladder infection.
- Viruses: Adenoviruses and herpes simplex viruses (HSV-1 and HSV-2) can also cause cystitis.
These pathogens usually reach the urinary bladder from other sites of infection. Ascending infection from the urethra is a common reason for infection in the urinary bladder. Microbes may also reach the urinary bladder via the blood, lymphatic system or by infiltration through tissues surrounding the urinary bladder (such as the rectum and the vagina).
The risk of developing cystitis depends on the presence of a variety of facilitating factors. These risk factors may differ between men and women. Some of the risk factors that may contribute to the development of cystitis are as follows:
- Cystitis is more common in women than in men. This could be attributed to the presence of a comparatively shorter urethra in women that allows the spread of urinary tract infections arising in the external components of the urogenital system. Men are also less likely to have cystitis because of bactericidal fluid from the male prostate gland. However, certain conditions such as benign prostatic hyperplasia, stones in the urinary tract and obstruction of the neck of the bladder can increase the risk of cystitis in men.
- Pregnancy and use of certain birth control measures such as diaphragm, also increase the risk of cystitis in women.
- Presence of certain receptors in the endothelial lining of the urethra may predispose certain individuals to bacterial infection and cystitis. These receptors bind bacteria and prevent their expulsion during urination.
- Injury to the urethra during sexual intercourse may increase the risk of infection by compromising the integrity of the skin barrier.
- Conditions that compromise the immune system of an individual (such as chronic HIV infection, uncontrolled diabetes and sexually transmitted infections) also increase the risk of cystitis.
- Chronic use of antibiotics may also increase the chances of cystitis by facilitating growth of Candida and other fungi.
- Dehydration can increase the risk of cystitis.
- Lack of personal urogenital hygiene is also a risk factor in the development of cystitis.