Cystitis

Overview: What is cystitis?

A bladder infection is also known as cystitis or urinary tract infection. This is an infection of the urinary bladder, which in most cases is caused by bacteria. Only rarely are other pathogens the trigger for urinary bladder inflammation. Cystitis is a “lower urinary tract infection”. This is an infection of the so-called lower urinary tract, which consists of the urethra and the bladder. (The upper urinary tract are the kidneys and ureters).

The germs almost always enter the urethra from the outside, from where they penetrate into the bladder. Here they trigger an inflammation. If your bladder is inflamed, this can lead to cramping pain in the bladder and pain when urinating. You will probably also need to go to the toilet at shorter intervals than usual – although the amount of urine excreted is often only small.

A bladder infection can lead to complications if it is not treated. That’s why you should visit us if you have cystitis. Bladder inflammation can usually be cured quickly with an antibiotic. In mild cases – but only then – you can try to get a bladder infection under control with home remedies (bladder and kidney tea, hot water bottle, sitz baths). However, if any of the following are true, it is not a mild case of cystitis and you should see us:

• Your cystitis is accompanied by a fever
• Your bladder infection has not subsided after three days
• You are suffering from cystitis for the second time

A visit to the doctor is also advisable in the case of cystitis if you belong to one of the following groups:

• Men
• Pregnant women
• Children
• Diabetic
• immunocompromised patients

Although inflammation of the bladder occurs less frequently in men than in women, the course of cystitis is often more complicated in men.

Cystitis: frequency and differences by gender and age

Women:
Women are significantly more frequently affected by cystitis than men. The reason for this is the anatomically shorter urethra, through which germs can more easily ascend into the bladder. More than half of all women will experience at least one cystitis during their lifetime. The risk increases again after the menopause in particular, as hormonal changes dry out the mucous membranes and weaken the natural defense against bacteria. Bladder infections are also more common in women after sexual intercourse.

Men:
Bladder infections are less common in men, as their longer urethra and antibacterial secretions from the prostate offer a certain degree of protection. However, if an infection occurs, it is often more complicated. Common causes are urine outflow problems due to an enlarged prostate or residual urine formation. Such problems increase from the age of 50. It is therefore always advisable for men to undergo a medical examination to rule out diseases of the prostate or urinary tract.

Pregnant women:
During pregnancy, hormonal changes and the pressure of the growing uterus on the urinary tract promote cystitis. Urine builds up more easily, allowing bacteria to multiply. As an untreated infection during pregnancy can increase the risk of pelvic inflammatory disease or premature birth, any bladder infection should be treated medically. Pregnant women are usually given a special, well-tolerated antibiotic.

Children:
Children can also get bladder infections – girls more often than boys, as their urethra is shorter. In infants and small children, the symptoms are often unspecific, for example fever, irritability or loss of appetite. Recurrent infections should always be clarified by a doctor, as they may indicate a malformation of the urinary tract or vesicoureteral reflux (backflow of urine into the kidneys).

Causes of cystitis

In most cases, bacteria are the cause of cystitis. More than three quarters of all bacterial bladder infections are caused by pathogens of the Escherichia coli type (E-coli for short). These bacteria are part of the human intestinal flora. As the distance between the anus and the end of the urethra is only short in girls and women, intestinal bacteria can easily get from the anus to the exit of the urethra (and from there into the bladder). Other bacteria can also cause cystitis in much rarer cases. For example enterococci or staphylococci. Less frequently, cystitis is caused by fungi or viruses.

There are several possible reasons why all the different germs can get into your urethra and bladder in the first place:

• incorrect cleaning technique on the toilet (always wipe your bottom from front to back to prevent intestinal bacteria from reaching your urethra)
• Sex (the bacteria spread during sex, mostly from the intestinal flora, cause an inflammation of the bladder called “honeymoon cystitis” or “honeymoon cystitis”)
• Disturbed vaginal flora (can be caused by excessive, negligent or incorrect intimate hygiene, lack of lactic acid bacteria during the menopause)
• Vaginitis
• Pregnancy (the hormone progesterone dilates the muscles of the urinary tract, making it easier for germs to ascend to the bladder. In addition, the proportion of infection-inhibiting substances in the urine is reduced in pregnant women).
• Menopause

Various risk factors can promote the development of urinary bladder inflammation. This primarily includes hypothermia, for example due to wet swimwear. A weakened immune system, diabetes mellitus, incontinence and bladder stones are further risk factors for cystitis.

Symptoms of cystitis

Two characteristics are particularly typical of cystitis:

• Burning pain when urinating
• Frequently recurring urge to urinate

In addition to these symptoms, there are a number of other signs of cystitis that do not necessarily occur in every case. Nor do they all appear together:

• Pain in the abdomen
• cloudy urine
• unpleasant smelling urine
• Blood in urine
• Sudden, urgent urge to urinate with incontinence (because there is not enough time to go to the toilet)
• Fever
• Back pain (if the cystitis spreads to the kidneys or, in men, to the prostate)

Differentiation from other diseases of the urinary tract

Cystitis is often confused with other diseases of the urinary tract, as the symptoms – such as a burning sensation when urinating or a frequent urge to urinate – can be similar. However, these are different clinical pictures that affect different areas of the urinary system. The exact distinction is important because the treatment and possible complications differ.

Urinary bladder inflammation Diagnosis

The symptoms of cystitis, such as a burning sensation when urinating or a frequent urge to urinate, are often very typical, but can overlap with symptoms of other urinary tract diseases. This is why a precise diagnosis is important in order to determine the affected region, the cause of the infection and the appropriate course of treatment. This is the only way to decide whether antibiotic therapy is necessary and which active substance is appropriate.

Various methods are available to determine the exact circumstances of a bladder infection:

• Urine test with a test strip held in the urine. It should clarify whether the urine contains certain substances. White blood cells (leukocytes) indicate inflammation and nitrite (a metabolic product formed by bacteria) indicates the presence of bacteria.
• Urine test in the laboratory. The bacteria contained in the urine multiply on a culture medium. Once a certain quantity has been reached, they can be precisely identified. If the type of bacteria is known, the most effective antibiotic for your cystitis can be determined. This is particularly important for pregnant women and for patients who have already had several bladder infections.
• Ultrasound examination. For example, the images from an ultrasound machine can show whether you have bladder stones or whether the urinary tract has anatomical changes.
• Cystoscopyof the bladder . During this examination, a doctor inserts an endoscope (a thin cable with a camera) through the ureter into the bladder. For example, you can see if there is a tumor there.

Preventing bladder inflammation & early detection

The easiest way to prevent inflammation of the bladder is to drink plenty of fluids. It should be at least 1.5 liters a day. This flushes out bacteria that could cause cystitis and prevents them from settling so easily in the urinary tract. And: keep warm and above all avoid hypothermia of the abdomen and feet.

If you feel the urge to urinate, do not hold your urine for long if possible. You should also urinate soon after sex. This allows bacteria that may have entered the urethra to be excreted. Make sure you wipe yourself properly on the toilet: always from front to back (from the vagina to the anus). This prevents intestinal bacteria from coming into contact with your urinary tract.

Proper intimate hygiene is also important: too much can be just as harmful as too little. It is best to clean your intimate area with warm water, but not with intimate sprays or disinfectants.

It is also possible to be vaccinated against cystitis. This is not done with an injection, but by swallowing a capsule daily over a longer period of time. It contains a vaccine that contains components of E-coli bacteria.

Course and prognosis of urinary bladder inflammation

In most cases, inflammation of the bladder is harmless. Sometimes cystitis even heals on its own. However, timely and correct treatment can also ensure that you get rid of your bladder infection within a few days. However, such a harmless course of bladder catarrh is linked to several conditions: Your kidneys function without interference, you do not have chronic (recurrent) cystitis, there are no anatomical abnormalities in your urinary tract and you do not have any concomitant diseases that could promote cystitis (for example diabetes mellitus).

It is less likely, but quite possible, that your cystitis will take a more difficult course. For example, bacteria can ascend from the inflamed bladder and trigger an upper urinary tract infection (e.g. inflammation of the renal pelvis).

It is also possible that your acute cystitis recurs several times and develops into a chronic bladder inflammation. In extreme cases, bladder tissue could be damaged in the long term and the result could be a shrunken bladder (a smaller bladder).

Chronic cystitis

Chronic cystitis is when more than two to three episodes of cystitis occur within a year or the symptoms recur over a longer period of time. Women are often affected because their urethra is shorter and germs can ascend more easily.

Causes can be persistent bacterial infections, anatomical features of the urinary tract, residual urine formation (e.g. due to an enlarged prostate) or hormonal changes after the menopause. A weakened immune system, frequent sexual intercourse or certain contraceptives (e.g. diaphragm, spermicides) can also promote recurring infections.

In the case of chronic complaints, a thorough medical examination is important in order to find the cause and provide targeted treatment. In addition to antibiotic therapy, preventive measures such as adequate fluid intake, regular urination, bladder and kidney teas, cranberry preparations or local estrogen therapy in postmenopausal women can help to avoid relapses.

What to do if you have a bladder infection?

Depending on the cause and duration of the disease, there are various approaches to treating urinary bladder inflammation. Bladder infections can almost always be treated successfully. In mild cases, you don’t even need to take antibiotics. However, cystitis should not be left untreated. And: If you suffer from inflammation of the bladder, you should always drink plenty of fluids.

Home remedies for cystitis

In mild, uncomplicated cases, cystitis can be alleviated with home remedies – provided there are no risk factors or concomitant illnesses. Home remedies support healing and can alleviate symptoms, but are no substitute for medical treatment if symptoms persist or a fever occurs.

Proven household remedies and supportive measures:

• Drink a lot: At least 1.5 to 2 liters a day help to flush bacteria out of the bladder. Water, herbal tea or special bladder and kidney teas are suitable.
• Heat: A hot water bottle, a warm bath or warm, moist compresses on the lower abdomen relax the muscles and relieve pain.
• Bladder and kidney teas: Herbal teas with goldenrod, nettle, bearberry leaves or horsetail have a diuretic and anti-inflammatory effect.
• Cranberry products: Cranberry juice or capsules can prevent bacteria from adhering to the bladder wall. The effectiveness varies from person to person, but can be helpful as a preventative or supportive measure.
• Vitamin C-rich diet: A slightly acidic urine environment can inhibit bacterial growth.
• Physical rest: Rest helps the immune system to fight the infection.
• Pain medication: effectively relieves bladder cramps
• Phytotherapeutics: herbal medicines have an antibacterial effect

Important: If the symptoms do not improve significantly after two to three days or if fever, back pain or blood in the urine occur, medical help should be sought. Pregnant women, men and children should always have a bladder infection medically examined.