Cystitis

Introduction

Bladder inflammation (cystitis) is an inflammation of the mucous membrane or the entire wall of the bladder. As the bladder, together with the urethra, forms the lower urinary tract, cystitis, like urethritis, is a so-called lower urinary tract infection.

In most cases, the cause of cystitis is a bacterial infection. Cystitis mainly affects women. Around 50 to 70 per cent of all women have cystitis at least once in their lives. In five to ten per cent of cases, cystitis occurs repeatedly.

Symptoms

The cystitis pathogens migrate into the bladder via the urethra. This causes the bladder mucosa to become inflamed. As the body wants to fight off the pathogens, it produces more urine. As a result, those affected have to go to the toilet more often. Other symptoms of cystitis are

• Burning or pain when urinating
• Pain in the lower abdomen
• Problems holding urine
• Blood in the urine, cloudy or conspicuous smelling urine

If inflammation spreads from the bladder to the kidneys, other symptoms such as fever, back pain or pain in the flanks may also occur.

Course

As a rule, acute cystitis has an uncomplicated course - provided the urinary tract and kidneys are functioning normally and there are no other accompanying illnesses (e.g. diabetes mellitus). In the case of acute cystitis, the inflammation heals within a few days. If the bladder inflammation is persistent or occurs repeatedly, doctors speak of recurrent cystitis. Normally, there are no complications even with recurrent inflammation - as long as it does not spread to other organs.

In severe but rare cases of urinary tract infection, the pathogens can ascend from the bladder via the ureters and lead to inflammation of the renal pelvis. This is accompanied by fever, chills and a general feeling of illness. In extremely rare cases, this process can trigger blood poisoning or acute kidney failure.

Causes

In most cases, cystitis is caused by a bacterial infection. The germs - primarily the bacterium Escherichia coli - enter the urethra from the intestine, migrate into the bladder and cause inflammation there. The bacterium Escherichia coli is responsible for 80 per cent of all bacterial infections. The bacteria Klebsiella, Enterococcus, Proteus or Staphylococcus can also cause cystitis. In rare cases, viruses, fungi or worms are responsible for cystitis (e.g. adenoviruses or polyoma, Candida albicans or the pathogen that causes schistosomiasis).

As the urethra is significantly shorter in women than in men, women are more susceptible to cystitis. In women, the anus is also closer to the urethral opening than in men. For this reason, germs can penetrate more easily from the bowel via the urethra to the bladder and cause inflammation.

In addition to germs, other factors can disrupt the flow of urine and thus favour cystitis. If the urinary outflow is not intact, the urine remains in the bladder and ureters for longer. This gives the pathogens more time to accumulate and trigger an inflammation. Possible causes of impaired drainage are a narrowing of the urethra, foreign bodies in the urethra, malformations in the urinary tract or tumours in the bladder and urethra. Hypothermia, psychological influences or a weakened immune system also favour cystitis.

Pregnant women are particularly susceptible to urinary infections. During pregnancy, the level of sugar in the urine increases and the pathogens can multiply more easily. The growing uterus also causes the ureters to narrow, which slows down the flow of urine and thus also favours the accumulation of pathogens.

In men, prostatitis occurs instead of cystitis because the germs do not enter the bladder, but enter the prostate beforehand. Prostatitis is usually accompanied by fever, severe pain when urinating and a general feeling of illness.

Diagnose

If cystitis is suspected, doctors primarily take a medical history. Thanks to the usually clear symptoms, cystitis can be diagnosed very well based on the symptom questionnaire and can therefore often also be diagnosed well via telemedicine; experienced doctors can then treat those affected over the phone or video. In certain cases, however, further medical examinations - such as a urinalysis - may also be necessary. These are particularly recommended if the affected person has blood in their urine or complains of fever or pain.

In the case of cystitis that lasts longer or occurs repeatedly, a cystoscopy may also be considered for diagnosis. This examination can be used to rule out other causes such as bladder tumours.

Treatment

Without fever and flank pain, a urinary tract infection can initially be treated with painkillers such as ibuprofen. It is advisable to drink enough fluids - at least two litres a day. Those affected can drink tap water, coffee, tea or other unsweetened drinks; it is not necessary to take special kidney or bladder teas. If the pain is too severe or does not improve over three days, a visit to the doctor is recommended to cure the infection with an antibiotic. Blood is not an alarm symptom if the bleeding stops again within three days. If the bleeding returns, a visit to the doctor is also recommended.

In the case of cystitis, herbal preparations can be taken as a supplement. However, these preparations do not replace antibiotics - especially in severe cases of cystitis. However, they do have a supportive effect, as many medicinal plants have bactericidal and virucidal properties and can therefore disinfect the urinary tract. For example, taking nasturtium herb or horseradish in capsule form is helpful.

Prevention

People who are prone to bladder infections can prevent inflammation with simple measures. It is advisable to drink plenty of fluids (two to three litres), as this flushes the bladder and urinary tract and eliminates the bacteria. If you feel the urge to urinate, you should go to the toilet as soon as possible. It is particularly important to dress sufficiently warm - especially during the transitional periods from winter to spring and from summer to autumn. It is also important to change clothes immediately after bathing - the bladder does not like the cold at all.

As women are more susceptible to cystitis due to a shorter urethra, they can prevent cystitis with the following additional measures:

• Women should clean themselves from the vagina to the anus. This prevents bacteria from entering the urethra.
• After sexual intercourse, a toilet should be visited as soon as possible. This flushes any germs out of the urethra.
• Menopausal women are more frequently affected by cystitis. One possible cause is oestrogen deficiency. Taking oestrogen can counteract inflammation, but a doctor should be consulted beforehand.
• Thongs are an ideal route for bacteria to enter the bladder.