Cystitis (interstitial, acute): what it is, symptoms and treatment

Urinary infections are quite common conditions for women, mainly due to the female anatomy, which favors the entry of infectious agents in the urinary canal. This is because the anus is very close to the entrance to the vagina.

It is estimated that approximately 80% of women will suffer from at least one urinary tract infection in their lifetime, which can be frequent, repetitive and, in some cases, more serious.

Although most infections and inflammations of the urinary tract are mild or moderate, with easy treatment, the episodes tend to be quite uncomfortable and unpleasant, and can cause pain, burning and itching when urinating.

Among the diseases that can develop is cystitis, an infection that affects the bladder. Find out more about it in this text.

What is cystitis?

Cystitis is characterized by inflammation and / or infection of the bladder , which in most cases occurs by the entry of bacteria into the urinary canal. They invade the urethra (channel that eliminates the pee) and migrate to the bladder, causing symptoms such as urge to urinate, pelvic pain, burning and urinary incontinence.

In infectious cases, the most common causative agent is the bacterium Escherichia coli , representing 85% of diagnosed cases.

But it is possible that the disease has different causes, albeit less frequent, such as the use of medications, radiotherapy treatments or autoimmune factors.

The condition is considerably less frequent in men, with only 10% of patients being male.

The prevalence in women occurs due to a number of factors, but mainly due to the anatomy of the woman’s intimate region, which favors the entry and migration of bacteria to the bladder.

In ICD-10, cystitis can be classified under the codes:

  • N30 – Cystitis;
  • N30.0 – Acute cystitis;
  • N30.1 – Interstitial (chronic) cystitis;
  • N30.2 – Other chronic cystitis;
  • N30.3 – Trigonite;
  • N30.4 – Radiation cystitis;
  • N30.8 – Other cystitis;
  • N30.9 – Cystitis, unspecified.

Types

The most common type of cystitis is infectious, caused by the installation of bacteria in the bladder. However, there are other types that are less frequent. Know more about each one:

Bacterial cystitis (acute)

Acute cystitis is caused when bacteria enter the urinary tract and settle in the bladder. Due to the causative agent, it can also be called bacterial cystitis.

Most infections are due to the bacterium Escherichia coli , representing approximately 85% of diagnoses.

In general, the condition is not severe and the patient tends to have a constant urge to pee, burning in the urinary canal, pain and itching in the intimate region and changes in the color of the urine.

In most diagnoses, the condition can be treated without major complications, as long as medical recommendations are properly followed.

Fungal cystitis

The urinary tract can be infected by agents other than bacteria, such as fungi. Although less frequent, the number of diagnoses of cystitis due to fungi is increasing.

In general, the case occurs in patients with immune deficiency, diabetes , who use bladder catheters, use antibiotics , are admitted to the ICU or have undergone surgery, due to the difficulty that the body has to defend itself against invading microorganisms.

Among the most common species of fungi in this type of cystitis is C. albicans, which causes candidiasis . The agent is not contagious and cannot be transmitted during sexual intercourse, but when it finds an environment conducive to proliferation (such as humid region, pH change, low immunity), it can affect the bladder and trigger cystitis.

In general, the condition is treated with antifungal drugs, such as fluconazole , with good responses to therapy.

Interstitial cystitis (chronic)

Currently, the condition is also called bladder pain syndrome or chronic cystitis . Studies published in Revista Femina, in 2011, point out that interstitial cystitis still has a complex diagnosis, due to the difficulty in understanding its causes and its development.

Among the causes most associated with interstitial cystitis are:

  • The accumulation of urine in the bladder, causing tissue irritation;
  • Loss of one of the protective layers of the bladder, causing substances present in the urine to irritate the organ;
  • Changes in the body capable of triggering inflammations that affect the bladder;
  • Pressures or changes in the pelvic region, which can compress the bladder;
  • Autoimmune changes that cause the body to attack the cells of the bladder itself.

In general, the diagnosis is made through exclusion. In other words, it is necessary that other conditions be ruled out through exams until the possibility of bladder pain syndrome is reached through exams such as urine culture, biopsy, physical examination of the pelvis and urodynamics.

The patient usually experiences pain, feelings of pressure and discomfort in the pelvic area (close to the navel) as the bladder fills up, making the person need to go to the bathroom frequently (but pee a little).

But studies indicate that each condition is very particular and must be evaluated intensively, making up a very specific treatment.

Eosinophilic cystitis

Eosinophilic cystitis is characterized by the presence of inflammation laden with eosinophils (types of white blood cells, fundamental for the defense of the organism) in the bladder wall, with fibrosis or tissue necrosis.

The type of cystitis is quite rare, but it is easily identified through tests that point to the high concentrations of the defense cells in the bladder wall, that is, in the bladder.

Learn more: What are Eosinophils?

Radiation cystitis

Also called actinic cystitis , the condition is characterized by an inflammation of the bladder resulting from exposure to radiation therapy.

Usually, the condition takes time to manifest, and can occur between 3 months and 14 years after radiological treatments in the pelvic region.

Cystitis occurs because the incidence of radiation waves can damage bladder tissues, which start to show thickening and necrosis, causing changes in organ functioning and symptoms of cystitis (such as burning, pain and itching when urinating, incontinence and bladder spasms) .

Milder cases can be treated with medication and physical therapy to relieve symptoms.

Hemorrhagic cystitis

Hemorrhagic cystitis is a complication that occurs, most of the time, in patients who use drugs after bone marrow transplantation or radiotherapy treatments.

In addition to the characteristic symptoms of cystitis, there is blood in the urine, which can be in different amounts, depending on the severity of each case.

Glandular cystitis

Glandular cystitis occurs when there is an irregular and exaggerated growth of epithelial tissue or formation of intestinal cells in the bladder.

That is, the walls in the bladder show changes that are, in most cases, microscopic due to the appearance of a layer of tissue.

The causes are not completely known, but glandular cystitis predominates in men over 50 years old.

Causes

Most cystitis is of bacterial origin, which occurs when infectious agents invade the urinary canal and migrate to the bladder, but there are also other causes that correspond to a much smaller number of occurrences. Know a little about each one:

Infectious cystitis

The prevalence of acute (or bacterial) cystitis occurs because there are bacteria living naturally in the intestine, a region very close to the urinary canal, which occasionally causes them to migrate to the urethra region.

When there are changes in immunity, poor hygiene or factors that favor the entry of microorganisms into the urinary canal, cystitis can develop.

Sexual intercourse itself does not cause cystitis, but it can favor its manifestation, as penetration can facilitate the conduction (or rise) of bacteria through the vaginal canal, leading them more easily to the bladder.

Another possible relationship between infection and penetration is that the urethra may suffer normal injuries or trauma, resulting from contact with the penis. These traumas can weaken the region’s layer and facilitate the action of bacteria.

In cases of fungal cystitis, in general, the fungus most associated with bladder infection is Candida (responsible for candidiasis) and occurs due to the complication of candidiasis, being more common in patients with diabetes or immune deficiencies.

Non-infectious cystitis

Patients who use catheters after surgical procedures (temporarily or prolonged) may be affected by non-infectious cystitis.

In this case, especially prolonged use can cause discomfort in the bladder, causing irritation and triggering cystitis.

Non-infectious types, such as radiation or eosinophilic cystitis, are triggered due to bladder wall injuries, which can cause necrosis, thickening or urinary dysfunction.

The use of some medications (especially chemotherapy) or sensitivity to chemicals can also be the cause of inflammation of the bladder.

Autoimmune or multifactorial factors can trigger interstitial cystitis, and the determining factor for the condition is not always recognized.

Is cystitis transmissible?

Cystitis, like other urinary infections, is not transmissible – whether through sexual intercourse, contact or sharing intimate objects. This is because it is usually the bacteria in the body itself that infect the urinary tract (those that inhabit the intestine or anal area).

What can happen is intercourse facilitating cystitis due to penetration. In these cases, the penis helps to “push” bacteria through the urethra, making them install more easily in the urinary tract.

Another factor that can be considered is that, during sex, the friction or contact of the penis can generate trauma or lesions in the layer of the urethra. Despite being normal, these lesions can make it easier for bacteria to settle in the region.

But as for transmission, it is not possible to “get” or “pass” cystitis.

Risk factors

Cystitis affects, in the great majority, female patients. This is due to the anatomy of the urinary tract, which has the urethra and anus very close.

In addition to facilitating the arrival of bacteria in the urinary channel, the woman’s body has a smaller urethra than the man’s, making the migration of bacteria to the bladder easier and faster.

Other conditions and behaviors that can favor cystitis are:

  • Immunity changes : they make the organism more sensitive to infectious agents, as it cannot or has more difficulty in fighting them;
  • Diabetes : there is a greater occurrence of urinary infections in patients with diabetes, and it is also related to glycemic control (the higher the glycemic rates, the greater the organism’s involvement with infections);
  • Prostate diseases : can prevent or reduce the elimination of urine, causing the liquid to cause irritation to the bladder;
  • Genetic factors and family history of cystitis : there is a relationship between genetic aspects and the occurrence of cystitis;
  • Urinary incontinence : changes in the functioning of the bladder can cause irritation, especially if there is a concentration of fluid (overflow incontinence);
  • Menopause and menstrual period : hormonal changes can cause irritation to the bladder wall;
  • Penetrating sex : there is favor of bacteria entering the vagina or trauma to the urethra wall;
  • Use of bladder catheter or catheter : they can irritate the bladder and cause non-infectious cystitis;
  • Diaphragm and spermicides : can cause changes in vaginal pH and reduce the body’s natural defenses, facilitating the entry of bacteria.

In addition, pregnant women, people who undergo radiation therapy or use medications that can harm the bladder wall, immunocompromised patients or who maintain behaviors that facilitate urinary tract infections, such as drinking little water, holding urine or performing intimate showers, are also at risk groups. .

Cystitis in men

Despite being much more common in women, men can also suffer from burning, itching, pain and urinary dysfunction. Of the patients diagnosed with cystitis, approximately 10% are male.

The condition is more common in men over 60 and may be related to prostate problems. Usually because the dysfunctions compress the urethra and urine has more difficulty in being eliminated, causing the liquid to accumulate in the bladder and promote the proliferation of bacteria.

When they appear, cystitis in men is differentiated mainly by treatment, since they are usually associated with dysfunctions in the prostate. Therefore, they need follow-up to the source of the problem.

Cystitis in the elderly

Above 60 years of age, urinary infections, including cystitis, can happen more frequently due to immunological changes. Changes in diet, routine and emotional aspects can favor the onset of infections.

Women who have gone through menopause are more likely to have bladder infections and inflammation, and by the time they reach 60, the incidence may be even higher.

The body’s weaknesses and changes in the routine resulting from aging are factors that need to be evaluated together with the doctor, in order to establish better ways to treat the infection and reduce health risks.

What are the symptoms of cystitis?

Symptoms of cystitis are common to other urinary infections, and are usually marked by pain in the pelvic area and burning sensation when urinating . But the manifestation of:

  • Constant desire to pee;
  • Feeling that the bladder has not been properly emptied;
  • Pain when urinating;
  • Difficulty in containing the pee (dripping);
  • Urgency to go to the bathroom and still pee a little;
  • Pain and stinging in the pelvic region;
  • Burning and itching in the genitals;
  • Feeling of pressure in the bladder;
  • Change in the color and smell of urine;
  • Presence of blood in the urine (hematuria);
  • Low fever.

Generally, the patient tends to notice the worsening of symptoms (such as burning and pain in the pelvic area) as the bladder fills. Some may feel relief when peeing, but the pain does not always soothe.

Interstitial cystitis may take time to show symptoms, but after they appear, some behaviors or situations can intensify them, such as menstrual periods or consumption of foods rich in potassium.

How is the diagnosis made?

The most suitable professionals for the diagnosis and treatment of cystitis are the general practitioner, gynecologist and urologist .

As the picture is usually very characteristic, the doctor will make a survey of the patient’s symptoms, manifestations and routine, which are usually sufficient to establish the diagnosis of cystitis.

In addition to the history, clinical exams may be requested to confirm the condition, but treatment is usually started to prevent the infection from prolonging.

Among the most common requests are:

  • Examination of urine or urine culture : a urine sample is collected to identify the presence of bacteria;
  • Cystoscopy : by inserting a small camera through the urethra, the doctor inflates the bladder to assess the condition of the organ;
  • X-ray and ultrasound : imaging tests are done to assess changes in the bladder.

Is there a cure?

-Yeah . The treatment of bacterial cystitis consists of the use of antibiotics and observations regarding lifestyle. It is worth mentioning that cystitis can be cured, but it does not prevent new inflammations or infections from occurring.

Other types of cystitis can be cured, but treatment – which may include surgery – needs to be evaluated.

As for interstitial cystitis, the rates of definitive solution to the problem are low, with the majority needing constant treatment to relieve the condition.

What is the treatment?

Most cases of cystitis are treated with the use of medications and identification of the triggering factors.

Acute cystitis

Cystitis patients generally receive the recommendation to maintain adequate fluid intake and establish a regular urination, always respecting the needs of the body.

Behavior change is critical to assist treatment and prevent future episodes of infection or inflammation of the bladder. The treatment of acute cystitis is based on the use of antibiotics and, if necessary, analgesics to help relieve pain.

In patients with recurrent acute cystitis, it is necessary to evaluate the duration of treatment, as it may be necessary to prolong the use of medications for 7 days or more. In other cases (not prolonged), the medication is usually maintained for 3 to 5 days.

Interstitial cystitis

Interstitial cystitis needs treatment that is very specific to each case, as the causes tend to be multifactorial.

Generally, oral drug therapies are recommended and applied directly to the bladder, physiotherapy with electrostimulation, changing eating habits and urinals (for example, going to the bathroom every 3 hours), in addition to constant monitoring with the doctor.

Physiotherapy and electrostimulation sessions aim to recover the muscle tone of the bladder, reducing urinary incontinence or urination dysfunctions.

It is also important that the patient adopts emotionally lighter routines, including physical activities and relaxing on a daily basis.

Each case needs a very individual assessment, but drug indications to treat interstitial cystitis are common, in which non-hormonal anti-inflammatory drugs, antidepressants and antihistamines can be used, usually in combination, to alleviate symptoms.

The medications tend to have good responses to symptomatic manifestations, reducing complaints of malaise and severe pain, helping to maintain the treatment as a whole.

Other types of cystitis

In general, the change in the urination routine is fundamental in all cases. Drinking fluids and peeing properly is part of the treatment of all cases of cystitis.

In radiation or glandular cystitis, the patient should be individually evaluated, considering surgeries or other invasive therapies, such as hydrodistension (gradual enlargement of the bladder through the application of water) or application of botox (to relieve pain and improve muscle regulation of the bladder), and it is up to the doctor to indicate the best alternative.

Non-surgical therapies can be used to eliminate tissues that form incorrectly in the bladder wall.

Medicines

For acute cystitis, the use of antibiotics is the most frequent treatment. For healthy people who do not have recurrent urinary tract infections, drug therapy generally consists of using:

  • Fosfomycin trometamol : in a single dose;
  • Norfloxacin : for 3 days;
  • Ciprofloxacin : for 3 days;
  • Sulfamethoxazole + Trimethoprim : for 3 days;
  • Cefuroxime : for 3 days;
  • Nitrofurantoin : for 5 days.

For patients with immunological changes, pregnant women or cases of recurrent cystitis, the same antibiotics can be prescribed by a doctor, but for a prolonged period, usually for 7 days.

The cases of interstitial cystitis may require different medications, and it is usually necessary to associate remedies that:

  • Relieve pain (painkillers): like paracetamol and ibuprofen ;
  • Reduce allergic markers (antihistamines): such as loratadine and cetirizine ;
  • Stabilize your mood (antidepressants): such as amitriptyline , gabapentin and pregabalin .

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Cystitis teas

Teas can assist in the treatment, relieving symptoms and discomfort of cystitis. But it is necessary to reinforce that they should not replace medical guidelines .

Although natural, teas should also be used with caution, without exceeding the recommended daily dosages, as they can result in adverse symptoms and intoxications.

Some of the most used teas to help treat cystitis are:

  • Horsetail tea : 15g (1 tablespoon) for each 200mL of water, up to 3 times a day;
  • Bearberry tea : 50g for each 1L of water, to be taken during the day;
  • Parsley tea : 50g of parsley herb for each 1L of water, to be taken throughout the day;
  • Corn hair tea : 15g for every 200mL of water, up to 3 times a day.

Living together

In general, cystitis improves rapidly when treatment is started. With the decrease in the intensity of the symptoms and the elimination of the bacteria, approximately on the 2nd or 3rd day of medication it is already possible to notice a total or considerable improvement of the patient.

However, it is important to make the proper use of medications, respecting schedules, dosages and time of use.

As the therapy consists of the ingestion of antibiotics, interrupting it may prevent the infectious agent from being completely eliminated from the body, allowing future infections to be resistant to the drug. Other tips are:

Use heat to relieve pain

To assist in well-being during symptom elimination, taking warm baths, making hot compresses and keeping your body warm can help to alleviate pain and discomfort.

It is worth remembering that hot baths or drinks can help to relax, causing the pain to be relieved due to the decrease in tension.

Go to the bathroom

As there is an urgent need to urinate, staying close to toilets and respecting the will of the bladder is essential. In addition, it is necessary to maintain or intensify water intake, helping to hydrate the body and clean the urinary tract.

Take care of the food

Reinforcing the diet and taking care of the health as a whole facilitates to maintain the good immunity of the organism, accelerating the fight against the infection.

In addition to medical recommendations, it is important to be aware of habits and routines, identifying possible triggers of cystitis or foods that can aggravate symptoms, such as drinks rich in caffeine or diuretics ( black tea , soda and alcoholic beverages, for example).

Train the bladder

Especially when there are recurrent cases or interstitial cystitis, doing exercises and training for the bladder can be quite functional.

In general, training involves establishing pee schedules, avoiding long periods without urinating. It is important to stick to the schedule even without noticing a full bladder.

In addition, it may be indicated to insert exercises that strengthen the muscles of the pelvic region, reducing leakage of urine, for example.

Prognosis

The prognosis of cystitis is good in most cases. For acute cases, the correct use of antibiotics usually cures the infection and eliminates the symptoms quickly, promoting a quick recovery of the organism.

Patients who undergo surgical treatments, in special cases of cystitis, also have good prognosis, usually without complications or recurrences.

Some conditions can be recurrent even if the treatment is properly performed. For these patients, it is necessary to assess the origin of cystitis, which can be bacterial or multifactorial.

In general, people with a predisposition to urinary infections and who are frequently affected by acute cystitis should evaluate the routine and behavior, identifying possible triggers or facilitators of the infection.

After recognizing the cause, recurrent cystitis tends to decrease.

Complications

In general, the most common complication is the recurrence of cystitis, which can become a frequent event and affect the patient’s routine and quality of life. In these cases, the body does not respond to treatment and health is affected by the symptoms of cystitis.

However, untreated or unresponsive cystitis can worsen for pyelonephritis, when the infection affects the kidneys, or septicemia, when the infection spreads through the bloodstream, characterizing a generalized infection.

The conditions are severe, especially septicemia, which can generate risks to the patient’s life, especially if there is an immunological deficiency. Learn more about each one:

Pyelonephritis

Pyelonephritis is an inflammation that affects the kidneys and can be the result of worsening urinary infections.

The symptoms tend to be very similar to those of cystitis, in which there is burning, pain when urinating, changes in the color and odor of the pee. But high fever is the main factor that differentiates conditions.

In addition, reports of nausea, vomiting, fever and pain that radiates intensely to the back region are more frequent in pyelonephritis.

The condition is, in general, considered serious because it affects a vital organ, but patients tend to evolve positively with treatment. It is the cases in which there is immunological deficiency or other associated diseases that cause greater difficulties in treatment.

The worsening of urinary infections for pyelonephritis needs to be monitored and treated quickly, at the risk of progressing to sepsis , a generalized infection.

Sepsis

The case of artist Rogéria, victim of a widespread infection in 2017, pointed to the dangers that urinary infections can generate.

Inpatient with a urinary tract infection, Rogéria presented a worsening of the condition that resulted in a convulsive crisis and death of the actress.

Known as a generalized infection, it is important to know that in sepsis it does not mean that all organs are infected, but rather that a good part of the body begins to manifest symptoms and failures resulting from the focus of the infection.

How to prevent cystitis?

The prevention of cystitis consists mainly in the adoption of adequate habits of hygiene and urination. Check out some methods to prevent infection:

Drink water

It is important to drink fluids so that the bladder is able to produce and eliminate urine consistently, helping to clean the urethra. That is, peeing helps prevent bacteria and infectious agents from migrating and settling in the urinary tract.

Go to the bathroom

But it is no use just drinking water, it is necessary to go to the bathroom whenever the body shows signs. Holding the pee can be very detrimental to the functioning of the bladder and make it easier for bacteria to proliferate.

Take care of intimate health

Especially women, due to the anatomy of the urinary tract, must pay attention to hygiene habits. However, in addition to taking care about the frequency of bathing, it is important to be attentive to the use of products that may affect the natural defenses of the intimate region.

Intimate soaps and spermicides, for example, can deregulate vaginal pH and make bacteria more easily invade the urinary canal and cannot be fought by the body.

Pee after sex

Another key tip for women is to pee after penetrative sex. Because the penis promotes and facilitates the migration of bacteria into the urethra, infections after sex are quite common.

Peeing is a simple measure that helps to stop or eliminate these bacteria.

Take care of health

Keeping immunity strengthened through healthy eating and routines is a measure of protection and prevention against attack by infectious agents in general.

Cystitis and cranberry

The cranberry is a small fruit, but rich in nutrients. For example, its levels of vitamin C, about 14g for every 100g of the product, are so high that the food has gained space in markets, functional stores, pharmacies and supplement stores.

Read more: Cranberry: what is it for?

Quite related to the prevention of urinary infections, cranberry is often used by those who constantly suffer from the discomfort and symptoms of the condition.

Despite the promising fame, some recent studies on the effects of cranberry, carried out by the National Institute of Health and Excellence in Care, a British body, have not proven the effective action in the prevention of urinary infections, such as cystitis.

It is worth remembering that food has several nutrients that can strengthen the immune system and, therefore, if it is correctly combined with food, it can help the body to protect itself from the action of bacteria.

Read more: Why eat vegetables?


Caring for the routine, food and health in general are essential to maintain a balanced routine and reduce the risks of diseases and dysfunctions of the organism.

Simple habits can be adopted to alleviate cystitis, avoiding complications and discomfort for the patient.

For more tips on well-being and prevention, follow the Healthy Minute!

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