What is Acute Cystitis?
A urinary tract infection, or UTI, occurs when harmful bacteria cause inflammation in the urinary tract, which could include the bladder or the kidneys. Within this, a specific type called acute simple cystitis refers to a UTI that affects only the bladder in healthy women who are not pregnant and have not reached menopause. UTIs are more common in women because of their body’s structure; the short distance between the urethra (from where urine exits the body) and the rectum, along with a shorter urethra itself, makes it easier for bacteria to reach the urinary tract.
In fact, women are four times more likely to get a UTI than men. Many women are familiar with the symptoms of cystitis, such as frequent urges to urinate (going to the bathroom more than once every two hours), feeling a need to urinate urgently, and experiencing a burning or stinging sensation while passing urine. Other symptoms can include blood in the urine or pain in the lower belly. If a doctor suspects uncomplicated cystitis, they can confirm it with a medical history, physical checkup, urine tests, and urine culture. While UTIs are generally treated at home, sometimes they can become so severe that hospital admission is required. This summary is a brief overview of acute simple cystitis.
What Causes Acute Cystitis?
Urinary Tract Infections (UTIs) in women are usually simple bladder infections primarily caused by certain bacteria. The most common one is Escherichia coli, causing about 86% of infections, followed by Klebsiella, Staphylococcus saprophyticus, and Proteus. However, the use of urinary catheters is responsible for about 80% of UTIs that occur during a hospital stay. Other common causes can include any form of manipulation to the urinary tract, as well as sexual intercourse.
Sexual activity can introduce bacteria into the bladder, increasing the risk of a UTI, and this risk is also higher for those who use a diaphragm or spermicide as their chosen form of birth control. This risk also increases for people with multiple sexual partners and for those who had their first UTI before the age of 15.
In women, the location of the urethral opening (meatus) close to the anus is a major risk factor for acute cystitis, a type of UTI, because it can easily lead to bacteria spreading from the rectum to the area around the urethra. The shorter length of the female urethra also poses a risk because it gives bacteria an easier path to the bladder. For women who have gone through menopause, the lack of estrogen affects the vagina and turns into another risk factor for UTIs.
Risk Factors and Frequency for Acute Cystitis
Urinary tract infections (UTIs) are the most frequent type of bacterial infections in women. Roughly 40% to 60% of women will have a UTI at some point in their lives, with half of these infections occurring by age 32. This common disease results in roughly 8 million visits to emergency rooms or clinics each year in the US. Additionally, it causes 100,000 hospital admissions and adds up to around $3.5 billion in annual healthcare costs. Upon having an initial acute urinary infection, between 27% to 46% of women will suffer another UTI within a year. Moreover, between 30% to 44% will have a second UTI within six months of their first infection.
On the other hand, UTIs are much less common in men, with under 10 cases reported per 10,000 men below the age of 65 each year. The symptoms are comparable for both genders, but recurrent or persistent symptoms in men could indicate a condition called prostatitis. Various factors make men less prone to UTIs: a longer urethra, a urethral opening (meatus) farther away from the anal area, a drier environment around the urethra, and defenses of the urethra and prostate.
Previously, all UTIs in men were seen as complicated cases. However, now, if a male patient is aged between 15 to 50 and does not have any associated risk factors like bladder outlet obstruction, irregularities in the structure of the urinary system, a less effective immune system, other serious health conditions (such as severe kidney disease, uncontrolled diabetes, or a kidney transplant), or stones in the urinary tract (urolithiasis), their UTI may be treated as an uncomplicated infection.
Signs and Symptoms of Acute Cystitis
Acute uncomplicated cystitis, or a bladder infection, is typically diagnosed based on patient history and a urine test. The presence of frequent and painful urination without any vaginal discharge can indicate a urinary tract infection (UTI) with 90% certainty.
Here are some common symptoms for different types of UTIs:
- Cystitis: Frequent, painful urination, abdominal discomfort, cloudy and potentially bloody urine.
- Pyelonephritis: Similar to cystitis symptoms but also often includes back pain, fever, chills, nausea, vomiting, and systemic symptoms.
- Elderly: Alongside typical symptoms, there could be changed mental state, tiredness, and generalized weakness.
However, having cloudy and unusually smelling urine alone is not enough to diagnose a UTI or start antibiotic treatment.
UTIs can be classified as either uncomplicated or complicated. An uncomplicated UTI describes a urinary infection in a healthy, non-pregnant woman without any abnormalities related to the urinary tract function. If the infection does not fall under this definition, it is classified as a complicated UTI.
Complicated UTIs are typically associated with other factors such as being biologically male, poorly managed diabetes, weakened immune system, renal failure, dialysis, hospital-related infections, bladder outflow obstruction, nerve-related bladder issues, use of urinary catheters or ureter stents, kidney stones, genital surgery or cancer, backflow of urine to the kidneys, and incomplete bladder emptying.
In elderly patients, changes in mental state alone are not enough to conclude there’s a UTI. Increased hydration, observation and checks for other issues might be necessary.
Managing recurring UTIs is typically based on guidelines provided by the American Urological Association. If an infection recurs with the same organism, a kidney stone may be suspected and further examinations should be carried out.
An acute uncomplicated cystitis diagnosis usually presents a normal physical examination. However, some women may experience lower abdominal pain. Acute pyelonephritis may be suspected if the individual appears unwell, especially if they display fever, rapid heart rate, or tenderness in the lower back area. Pelvic examination may be required in cases of suspected organ prolapse or recurrent UTIs.
Recent studies suggest that women who have previously been treated for uncomplicated cystitis can accurately self-diagnose and manage a recurring infection safely over the phone.
Testing for Acute Cystitis
The urine dipstick test is a convenient and affordable diagnostic tool often used as an alternative for diagnosing uncomplicated cystitis, a type of urinary tract infection. This test looks for nitrites and leukocyte esterase in the urine, which are reliable indicators of cystitis. However, it’s important to have symptoms like pain, bladder spasms, fever, or blood in the urine to confirm the diagnosis.
It’s usually best to collect a mid-stream urine sample for this test to prevent contamination. But don’t worry too much about keeping the sample squeaky clean. Recent studies have shown no major difference in reliability between samples collected with or without initial cleaning.
Nitrites are a particularly reliable sign of urinary tract infection. Normally, your urine won’t contain nitrites. But if bacteria, especially gram-negative ones, invade your urinary tract, they can convert nitrate to nitrite in your urine. There are a few exceptions, such as the bacteria Enterococcus, Pseudomonas, and Acinetobacter, which don’t cause this conversion.
Another compound the test looks for is leukocyte esterase, which is a sign that there are white blood cells in your urine. This typically means your body is fighting off an infection. However, this isn’t as reliable as the nitrite test.
If you’re showing signs of a urinary tract infection and your test is positive for nitrites, your doctor might start treatment right away. However, if the test doesn’t pick up any leukocyte esterase, they may want to run additional tests.
Pyuria, which is when there are more than ten white blood cells per high power field in your urine, is another indicator of an infection. However, this can depend on the quality of the sample and the lab technician processing the test.
Bacteriuria, or bacteria in the urine, is usually defined by more than 100,000 Colony Forming Units per mL from a clean sample. But some individuals with cystitis may only have counts from 100-10,000. If these lower counts come with symptoms, chances are good for a urinary tract infection.
While urine cultures aren’t always necessary, they can be helpful if your symptoms persist after treatment or if you’re dealing with a complicated infection. However, they’re not typically done in emergency rooms. And once you’ve finished your treatment, you won’t need follow-up urine tests or cultures if your symptoms have cleared up.
Unless your case is complicated, you’ll likely not need imaging tests. If you do, ultrasound or CT scans can be used to determine if there’s kidney stones, abscesses, or other complications. Cystoscopies, which involve inserting a small tube into your urethra to see inside your bladder, are usually not needed for simple cases of cystitis.
Treatment Options for Acute Cystitis
Treating cystitis, or bladder infection, requires careful thought and tailoring based on the case. There is no one-size-fits-all medicine, as it depends on factors like how long the treatment will last, the nature of the bacteria causing the condition, likelihood of side effects, and antibiotic resistance. Doctors also take into account costs, availability of the antibiotic, local patterns of antibiotic resistance, and the patient’s history of allergies. On average, patients should start to feel better within a day and a half of starting treatment.
Recently, resistance to antibiotics, particularly fluoroquinolones and carbapenems, as well as the emergence of certain organisms that produce extended-spectrum beta-lactamase (ESBL), has made treating cystitis more challenging.
Remarkably, patients can typically achieve complete recovery with only three days of treatment, but in some cases, a longer treatment duration is advised. Use of any drug with a resistance rate exceeding 50% should generally be avoided unless no other options exist and laboratory results indicate it should be effective.
For simple or uncomplicated cystitis, doctors may prescribe options such as:
- Nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin
- Antibiotics like ciprofloxacin or levofloxacin
- Alternatively, B-lactams such as amoxicillin-clavulanate or cephalexin.
Preventative antibiotics may be prescribed for patients with complicated or frequent cystitis, although they wouldn’t typically be recommended for acute, simple cystitis.
For complicated cystitis, there isn’t a set guideline for treatment, but it usually requires a longer duration, around one to two weeks. For patients with a urinary catheter, the catheter should be changed regularly to prevent bacteria build-up and contamination.
For nonpregnant women, nitrofurantoin, trimethoprim-sulfamethoxazole, or ciprofloxacin are options, whilst for pregnant women, amoxicillin-clavulanate, Keflex, or Cefpodoxime may be suitable, with pregnant women being treated even for bacteria presence without symptoms.
In men, cystitis is usually more complicated, and common treatments include ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, and nitrofurantoin, provided the latter is not used when prostatitis is suspected.
What else can Acute Cystitis be?
When diagnosing medical complications, doctors may need to consider various conditions that have similar symptoms. These might include:
- Cervicitis (inflammation of the cervix)
- Epididymitis (inflammation of the tube at the back of testicles)
- Prostatitis (swelling of the prostate gland in men)
- Syphilis (a sexually transmitted disease)
- Urethritis (inflammation of the urethra)
- Vulvovaginitis (inflammation of the vulva and vagina)
- Atrophic vaginitis (a condition where the vaginal wall becomes thin, mainly due to menopause)
- Interstitial cystitis (a chronic bladder condition, also known as Painful Bladder Syndrome)
- Radiation cystitis (bladder inflammation caused by radiation therapy)
By considering these potential diseases and running necessary tests, physicians can make an accurate diagnosis.
What to expect with Acute Cystitis
Usually, symptoms fade away about three days after starting antibiotics. Interestingly, around 20% of women might see their simple urinary tract infections disappear on their own, especially if they drink more fluids. However, it’s common for about 25% of women to experience cystitis, a type of urinary tract infection, recurring in the six months after their initial infection. This likelihood goes up if they’ve had more than one urinary tract infection in the past. Overall, most women without major risk factors can expect a very good outlook if they get a simple urinary tract infection.
Possible Complications When Diagnosed with Acute Cystitis
Although complications from a straightforward case of acute cystitis, or a bladder infection, are uncommon, there’s a risk of recurring urinary tract infections (UTIs).
There are also several other potential complications that could occur, including:
- Acute renal failure (a sudden loss of kidney function)
- Antibiotic-resistant organisms (bacteria that can’t be killed by normal antibiotics)
- Chronic prostatitis (ongoing inflammation of the prostate)
- Emphysematous pyelonephritis (a rare, severe kidney infection)
- Obstructive pyonephrosis (blocked urine flow causing kidney infection and pus)
- Persistent urinary tract symptoms (ongoing discomfort, frequent urination, etc.)
- Pyelonephritis (a type of kidney infection)
- Renal or perinephric abscess (a pocket of pus around or in the kidney)
- Renal vein thrombosis (a blood clot in a vein in the kidney)
- Sepsis (a dangerous response to infection)
Preventing Acute Cystitis
Educating patients about urinary tract infections and personal hygiene can be beneficial. Some tips include:
Wash your hands before cleaning yourself after going to the bathroom. Consider using adult or baby wipes instead of toilet paper as they may provide better cleaning. It’s also a good idea to go to the bathroom shortly after intimate activity.
Avoiding baths can also help prevent urinary tract infections. When cleaning the private area, use a clean, new, and soft washcloth, preferably made of soft cotton or microfiber.
When it comes to soap, choose a liquid one with fewest possible harmful or irritating ingredients. Baby shampoo is a good option as it matches the preferred pH level of both hair and the private area.
Lastly, clean the private area at the start of the shower to avoid possible contamination from other body parts if cleaned later.