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Cystitis

Urinary System

What is cystitis?

Cystitis is the inflammation and irritation of the bladder. It is a very common infection for women fortunately for men it is rarer. It can also be known as the honeymoon disease, or a UTI (urinary tract infection).

The organs which are involved with producing and excreting urine consist of your kidneys, which filter the waste (urine) from the blood, tubes which then carry the urine from your kidneys to the bladder. This is where the urine is stored you will know when you need to excrete the urine when your bladder feels full. The urine leaves the body via the urethra this in men is much longer than in women which is why women tend to get cystitis. The bacteria usually caused by E.Coli (Escherichia coli) which is found around the anus and genital area, can travel up the urethra and begin to multiply. Normally urine is sterile and does not have any harmful bacteria in it; once the bacteria have invaded the bladder it multiplies quickly causing all the symptoms of bacterial cystitis.

Occasionally other factors can imitate the irritation of cystitis Thrush can cause mild pain when passing urine. Bubble baths, douching, highly perfumed soaps and deodorants may all cause irritation and inflammation.

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Bacterial:

Bacterial cystitis is caused by bacteria usually E.coli travelling up the urethra (the tube through which urine passes out of the body) it multiplies in the bladder  rapidly causing a variety of symptoms. When treated quickly and effectively the discomfort and duration of the problem can be reduced, and does not reoccur.

Recurrent Cystitis:

This is usually bacterial cystitis which has returned repeatedly, however it is difficult to say with any certainty how many episodes have to be suffered in a given time period before it is called recurrent as the doctors seem to contradict each other. Some say three episodes in 12 months others it needs to be six episodes. It is important to ask your doctor to send a specimen of urine to the laboratory for analyse to make sure you are taking the right antibiotics if you are suffering from repeated infections. Results will be in approximately 2-5 days.

Interstitial
:

Interstitial cystitis on the other hand is not caused by bacteria and when samples are sent for analysis there is no evidence of bacterial contaminants. There are thousands of people in the U.K. who suffer from this with nearly 90% of them being women. This is a chronic (constant) condition whereby the bladder wall is inflamed and irritated, causing frequency, urgency and pain. The bladder wall may become scarred and inflexible meaning only small quantities of urine are stored.

This condition can become very debilitating as the person often feels a prisoner in their own home as trips out are dictated by where the toilets are located. The condition often means repeated trips to the toilet in the middle of the night causing pain and can be severely exhausting.

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The differences between bacterial cystitis and interstitial cystitis are: 
Bacterial:

  • Only lasts a few days

  • Frequency and pain when emptying the bladder

  • Bacteria shows up on urine test

  • Antibiotics are used to treat this condition

Interstitial:

  • This condition is ongoing with no breaks or relief

  • Pain and discomfort, continuously aware of  bladder

  • Brief relief when passing urine

  • Never-ending frequency

  • Short term antibiotics have no affect

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Symptoms:

The symptoms can be a combination of:-

  • Frequent urge to pass urine(empty the bladder)
  • A burning sensation when passing urine
  • Pain when urinating ( called dysuria)
  • A pressing urgent need to pass urine
  • Blood in the urine (called haematuria)
  • Cloudy urine
  • Strong smelling urine
  • Low pelvic dragging pressure
  • Passing only small amount of urine
  • Painful sexual intercourse
  • A mild temperature
  • General tiredness and feeling unwell

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Diagnosis:

Diagnosis of cystitis is usually done by your doctor listening to the details of your problem. You will then be asked for a specimen of urine in which a dip-stick can be used to test for bacteria, protein and blood. The colour, odour and whether the specimen is clear or cloudy indicates if you are drinking enough fluids and if there is likely hood of infection. If the signs and symptoms are consistent with cystitis your doctor will prescribe antibiotics and your symptoms should disappear.

Further investigations:

If however your symptoms do not go away or if your condition deteriorates you should return to your doctor and further investigations and diagnostic tests. You will be referred to a consultant Urologist (specialists in the study and treatment of disorders of the urinary tract) they will talk to you about your problem and listen to how it is affecting your life and then discuss with you the investigations which are necessary for a diagnosis and the plan of treatment they suggest. You may be asked to keep a bladder habit diary click here for more information.

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You may need to undergo other investigations which may consist of:
           

  • Urinalysis: This is the analysing of a specimen of urine in the laboratory to detect specific substances, to assist the doctor in the diagnosis.
  • Urine Culture: This is done to grow and identify the bacteria present in the urine
  • Urine Cytology: This is a test in a laboratory, which is done to detect cancer cells, which may indicate if you have a bladder, ureteral (the tubes which carry the urine from you kidneys to your bladder) or Kidney cancer.
  • Urodynamics: This is a test which is done with a continence advisor to assess and measure the bladder’s ability to hold and release urine.
  • A Cystoscopy: This is an examination which is carried out with a local anaesthetic or with a general anaesthetic a flexible cystoscope can be used with a local anaesthetic and a rigid cystoscope with a general anaesthetic.

    flexible cystoscope
    • A flexible cystoscopy procedure: is usually done as a day case or outpatient procedure which means you usually do not have to remain in hospital overnight. The procedure only takes about ten minutes to complete. You will be asked to either change into a gown or to remove your clothes from the waist down and then asked to get on to a theatre trolley or procedure couch you will be covered with a blanket or sheet  to maintain your dignity until the procedure commences.

      You will be positioned as if you are having a smear test if you are women and lying on your back if a man. The procedure involves the doctor cleaning the genital area with a mild antiseptic solution, and a local gel anaesthetic inserted into the urethra (the tube from your bladder to outside your body).

      The cystoscope is like a long flexible tube which has a fiberoptic light source allowing the doctor to see inside your bladder. The width of the scope is about the size of a pencil and can pass into the urethra and then into the bladder with ease. Some men find it a bit of a toe curler as it passes through the area surrounded with the prostate gland. Once the scope is in the bladder the doctor may fill the bladder with warm fluid and will be able to assess the condition of your bladder and take biopsies if necessary to be sent to the laboratory for analysis. 
    • rigid cystoscopeA rigid cystoscopy operation: This examination is carried out under a general anaesthetic and usually undertaken after a flexible cystoscopy has been done, or the consultant has decided this would be the best course of action for you. Perhaps the urine cytology has suggested that their may be cancer cells present in which case a rigid cystoscopy would be done initially to  be able to examine, take biopsies and treat if appropriate in the one procedure. You will be asked not to eat or drink anything prior to arriving at the hospital for this operation, and then once admitted to the ward or day case unit will be asked to change into a gown. You will have already spoken to the surgeon previously with regards to your consent for the operation but if you have any further questions or clarification needed they will be more than happy to speak to you.

      You will be seen by the anaesthetist who will ask you a variety of questions to ensure you are fit enough for the anaesthetic.  If you have any existing problems with your hips or knees please inform the nursing staff prior to the procedure commencing. When it is time you will be taken into the anaesthetic room and anaesthetised. You will be positioned on the operating table once you are anaesthetised with your legs up in lithotomy position (lying on your back with your hips and knees flexed with feet held in supports) This allows the surgeon to be able to get a good view of your bladder with the cystoscope.

      During the procedure the surgeon will be able to see if there is any narrowing or obstructions in men’s urethra, check that the  lining of the bladder is not damaged, is inflamed or has any growths, tumours or calculi (stones) present. They are able to measure your bladder capacity (how much urine you can hold), take bladder biopsies (tissue samples), and able distend your bladder (to increase your bladder capacity). Once the operation is over you will be taken into the recovery room where you will slowly recover. You may have a catheter (a thin flexible tube) in your bladder after the operation to wash the bladder out.

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    • After the procedure Once you have had either a rigid or flexible cystoscope you may experience burning or stinging when you empty your bladder and you may notice blood in your urine. Both of these will pass in time, if the bleeding becomes heavy or does not stop after twenty four hours, or it becomes difficult to empty your bladder you must contact the hospital where you had the procedure done or your own doctor.

      You will be advised to drink plenty of fluids and may be given antibiotics to take to prevent any infection which you may occur. You can rest after the procedure for a while and if you’re lucky you will be offered a cup of tea, whilst the nursing staff organise your discharge letter for your GP and any medications which you may need to take home with you.

      You should not return to work after this procedure but take it easy at home resting for the day. If you have had a general anaesthetic you should not drive, operate machinery or make any important decisions for at least for 24hrs.

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MSU (Midstream Specimen of Urine) collection

When you visit your doctor or clinic you will be asked to produce a specimen of urine which will be tested with a dipstick to check for protein or the presence of blood. Sometimes you may be asked for an MSU which means that you need to collect the specimen in the middle of emptying urine from your bladder.

If this is not done correctly there is a 25%-30% rate of contamination where either the tip of the penis has gone into the top of the specimen tube or the labia have touched the specimen tube or your fingers have touched the rim of it. If this happens it means that you may have to provide another specimen or that the results are inaccurate or that treatment may be delayed.

Preparation to collect urine sample:

    • It is best to take the sample after you have bathed or showered or alternatively wash the penis or vulva (fleshy folds or lips) area with mild soap and water and dry prior to taking the sample ( this helps to prevent the specimen becoming contaminated)

    • Make sure you understand your instructions for specimen collection i.e. if you need to fill the pot to a certain level, or if it needs to be collected at a certain time in the day.

    • Do not open the pot until you are ready to use it- to reduce the chance of it becoming contaminated

    • Try to arrange for the specimen to be given in to the doctor’s surgery within one to two hours of it being taken.
    • Keep the specimen in the fridge in a plastic bag if you are not able to take it straight away.

To collect the sample:
            For women:

  • After you have cleaned/washed the vulval area
  • Wash your hands
  • Open the sterile container remembering not to touch the inside
  • Sit right back on the toilet seat with legs apart
  • Open your vulval lips with one hand keep them apart throughout collection of sample
  • Begin to empty your bladder into the toilet
  • With your other hand hold the specimen pot at an angle about an inch away from the urethra  and collect your sample in the middle of the  flow of urine
  • Release the folds of your vulva and finish urinating in the toilet
  • Screw the lid on the container
  • Wash your hands again
  • If not taking the specimen to the doctors surgery right away place in a plastic bag in your fridge.

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For Men:

  • After you have washed the head of your penis (you will need to retract your foreskin if you have one)
  • wash your hands
  • Open the sterile container remembering not to touch the inside
  • Retract the foreskin
  • begin to empty your bladder into the toilet
  • Pick up the container and holding it at an angle about an inch away from the end of the penis collect your sample of urine whilst urinating.
  • Finish emptying your bladder
  • Screw the lid securely on the container
  • Wash your hands again
  • If not taking the specimen to the doctors surgery right away place in a plastic bag in your fridge

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Treatment for Cystitis:

You can treat mild cystitis at home if you are a fit healthy person with no medical problems and not pregnant, and there is no visible blood in the urine. Studies have shown that even without treatment your own body defences can clear cystitis within three days. Alternatively you can take across the counter remedies from chemists. You can speak to the pharmacist and see if they agree that you have the symptoms of cystitis however if the symptoms do not clear up within three days or reoccur you are advised to see your own GP.

According to The Food Standards Agency it is advised that the average adult should take in 1.5-2 litres of water in a typical day, this would equate to 6-8 (250ml) glasses or 4 x 500ml sports water bottles per day. There seems to be no clear guidelines as to whether you should be drinking more than the daily recommended amount to flush out the bladder or not.

Treatment from your GP will usually be a three day course of antibiotics after which the symptoms should clear up. If they do not clear up or if you begin to suffer from a high temperature you should return to your GP. Occasionally the infection may not have cleared up and you will need to take a second course of antibiotics.

If you are suffering from pain you can take your normal pain relief tablets as instructed. ie Paracetamol

Why do I get cystitis?

You are more likely to suffer from bouts of cystitis if you:

  • Suffer from diabetes – high sugar content in the urine can encourage bacterial growth
  • Have had a catheter (a thin flexible tube) inserted into your bladder, this can sometimes introduce an infection
  • Have reached the menopause this can cause a hormonal decrease which may affect your bladder
  • Are using spermicides or any form of feminine hygiene sprays. Or if you are having sexual intercourse this can sometimes lead to cystitis –However cystitis it is not an STI (sexually transmitted infection)
  • If you have anal intercourse without using a condom for protection
  • Have a problem with emptying your bladder – this can be due to different reasons
  • Being elderly, your bladder control may have deteriorated over time
  • Being pregnant, pressure from the womb on the bladder can cause incomplete emptying.
  • Men may have an  enlarged prostate gland ( an “o” shape gland which goes around the urethra) which may prevent complete emptying
  • Bladder stones can cause problems
  • Inherited defects of the urinary tract system causing problems
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What does normal urine look like?

When you have been drinking sufficiently and you are not dehydrated the colour of your urine should be like the colour of straw. It should not smell, and shouldn’t be cloudy and shouldn’t have “bits” floating in it. If your urine is dark in colour you may need to increase your fluid intake.

Self help:

To reduce your chances of contracting bacterial cystitis you can try

  • Taking showers rather than baths
  • Washing your genital region daily with mild soap and water dry well, to prevent soreness
  • Not using spermicides or feminine hygiene sprays as these can irritate
  • After having your bowels open make sure you wipe from front to the back to prevent the bacteria entering the urethra.
  • Drinking plenty of fluids is good as dehydration is one of the main problems of people with cystitis. The Food Standards Agency advise that the average adult should take in 1.5-2 litres of water in a typical day, this would equate to 6-8 (250ml) glasses or 4 x 500ml sports water bottles per day. This also depends on you age weight and the weather conditions; if it is hot you will need to drink more.
  • Not waiting or hanging on before going to the toilet to empty your bladder
  • Once you have had sexual intercourse try and empty your bladder to flush out any bacteria which may have entered the urethra.
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Helpful Organisations and links

The British Kidney Patient Association
BKPA.
Bordon.
Hampshire
GU35 9JZ
Tel: 01420 472021/2
Fax: 01420 475831
Web: www.britishkidney-pa.co.uk

The Cystitis and Overactive Bladder Foundation
76 High Street,
Stony Stratford,
Buckinghamshire,
MK11 1AH
Tel: +44 (0)1908 569169 
Fax : +44 (0)1908 565665 
Web: http://www.cobfoundation.org

Kidney Research UK
Kings Chambers
Priestgate
Peterborough
PE1 1FG
0845 070 7601
Email - communications@kidneyresearchuk.org
Web: http://www.kidneyresearchuk.org

The National Kidney Federation
6 Stanley Street,
Worksop,
England S81 7HX
Tel: (01909) 487795
Fax: (01909) 481723
Helpline: (0845) 601 0209
Web: http://www.kidney.org.uk

Images with Kind Permission from 3B Scientific

3b Scientific

Images with Kind Permission from Olympus

olympus

 

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