Cystitis

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Cystitis is inflammation of the urinary bladder. While both men and women are at risk for this condition, it is more common in women due to their shorter urethra.

  • Women may be at a higher risk for cystitis if they
    • Are sexually active
    • Are pregnant
    • Use diaphragms with spermicide
    • Have reached menopause
    • Are utilizing irritating personal hygiene products
  • Men with lower urinary tract symptoms-LUTS may be at a higher risk for cystitis

Causes

  • Bacteria -when bacteria enter the bladder/urethra and multiply
  • Viruses
  • Fungi
  • Chemicals
  • Exposure to radiation
  • Indwelling urinary catheters
  • Immunocompromised states
  • Schistosomiasis
  • Vesical calculi

Signs and symptoms

  • Fever - sometimes present
  • Dysuria - painful micturition
  • Suprapubic pain
  • Increased frequency of micturition by day and night
  • Urgency
  • Bloody urine (haematuria)- sometimes present
  • Urine may be cloudy and offensive
  • Pain during sexual intercourse
  • Suprapubic tenderness

Differential diagnosis

  • Vulvovaginitis
  • Urethritis
  • Pelvic inflammatory disease
  • Interstitial cystitis

Investigations

  • Full blood count
  • Urinalysis
  • Urine microscopy, culture and sensitivity tests
  • Blood cultures - if urosepsis is suspected
  • Ultrasound scan of the urinary bladder
  • Cystoscopy

Treatment objectives

  • Eradicate the infection and risk factors
  • Reduce morbidity
  • Prevent complications

Non-pharmacological treatment

  • Liberal oral fluid intake

Pharmacological treatment

Amoxicillin oral

Adult:

500mg every 8 hours orally for 7 days

Child:

<10 years: 125mg every 8 hours for 7 days

>10 years: 250mg every 8 hours for 7 days

OR

Amoxicillin + clavulanic acid oral

500 mg (as trihydrate) + 125 mg every 8 hours for 7 days

OR

Cotrimoxazole oral

Adult:

960mg every 12 hours for 7-14 days

Child:

<10 years: 125mg, oral, two times daily for 7 days

>10 years: 480mg tab, oral two times daily for 7 days

OR

Nitrofurantoin oral

Adult:

100mg four times daily for 7-14 days

Child:

5-7mg/kg/day three times a day

Note: Doses can be doubled for severe infections.

Referral

Refer if the patient does not respond to treatment or there are no facilities for urine microscopy, culture and sensitivity testing, or cystoscopy.

Prevention

  • Women should wipe from front to back after a bowel movement to prevent the spread of bacteria from faeces (E.coli)
  • Avoid any products that irritate the area
  • Women should empty their bladders after sexual intercourse (both sexes: avoid postponing micturition).