Cystitis

Introduction

Cystitis is a medical condition characterized by inflammation of the bladder, often resulting from a bacterial infection. It is a common type of urinary tract infection (UTI) that predominantly affects women, although men and children can also be affected. The condition can cause significant discomfort and, if left untreated, may lead to more severe complications, such as kidney infections. This article delves into the etiology, pathophysiology, clinical manifestations, diagnostic approaches, and treatment modalities of cystitis, providing a comprehensive understanding of the condition.

Etiology

Cystitis is most commonly caused by bacterial infections, with the majority of cases attributed to the bacterium Escherichia coli (E. coli), which is part of the normal intestinal flora. Other bacteria, such as Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis, can also be responsible. Non-infectious causes of cystitis include radiation therapy, chemical irritants, and certain medications. Interstitial cystitis, a chronic form of the condition, has an unclear etiology but is believed to involve a combination of factors, including autoimmune responses, genetic predisposition, and nerve dysfunction.

Pathophysiology

The pathophysiology of cystitis involves the invasion of the bladder mucosa by pathogens, leading to an inflammatory response. In bacterial cystitis, uropathogens adhere to the urothelial cells lining the bladder, often facilitated by fimbriae or pili. This adherence triggers an immune response, resulting in the release of cytokines and other inflammatory mediators. The inflammation causes the characteristic symptoms of cystitis, such as dysuria, urgency, and frequency. In interstitial cystitis, the pathophysiological mechanisms are less well understood but may involve defects in the glycosaminoglycan layer of the bladder, mast cell activation, and neurogenic inflammation.

Clinical Manifestations

The clinical presentation of cystitis can vary, but common symptoms include:

- Dysuria: Painful or burning sensation during urination. - Urinary urgency: A sudden, compelling need to urinate. - Increased urinary frequency: Frequent urination in small amounts. - Hematuria: Presence of blood in the urine. - Suprapubic pain: Discomfort or pain in the lower abdomen.

In some cases, patients may experience systemic symptoms such as fever and malaise, particularly if the infection ascends to the kidneys, resulting in pyelonephritis.

Diagnosis

The diagnosis of cystitis is primarily clinical, based on the patient's symptoms and medical history. Laboratory tests, such as urinalysis and urine culture, are essential for confirming the diagnosis and identifying the causative organism. Urinalysis typically reveals pyuria, bacteriuria, and sometimes hematuria. A urine culture is crucial for determining the specific pathogen and its antibiotic susceptibility, guiding appropriate treatment.

Treatment

The treatment of cystitis depends on the underlying cause. For bacterial cystitis, antibiotics are the mainstay of therapy. Commonly prescribed antibiotics include trimethoprim-sulfamethoxazole, nitrofurantoin, and fosfomycin. The choice of antibiotic should be guided by local resistance patterns and the results of urine culture and sensitivity testing.

For non-infectious cystitis, treatment focuses on addressing the underlying cause, such as discontinuing an offending medication or managing radiation-induced inflammation. Interstitial cystitis requires a multifaceted approach, including dietary modifications, bladder instillations, and oral medications such as pentosan polysulfate sodium.

Complications

If left untreated, cystitis can lead to complications such as:

- Pyelonephritis: Infection of the kidneys, which can result in renal damage. - Recurrent UTIs: Frequent episodes of cystitis, often requiring long-term management. - Bladder damage: Chronic inflammation can lead to scarring and reduced bladder capacity.

Prevention

Preventive measures for cystitis include:

- Adequate hydration: Drinking plenty of fluids to flush out bacteria. - Proper hygiene: Wiping from front to back to prevent bacterial spread. - Urinating after intercourse: Reducing the risk of bacterial transfer. - Avoiding irritants: Steering clear of potential bladder irritants such as caffeine and spicy foods.

Prognosis

The prognosis for cystitis is generally favorable with appropriate treatment. Most cases resolve with antibiotics, and complications are rare when the condition is managed promptly. However, interstitial cystitis can be more challenging to treat, often requiring long-term management strategies.