Cystitis in Women

Introduction

Cystitis literally means inflammation of the bladder, although in practice, cystitis refers to inflammation of the urethra and bladder.

  • When infection is present, the most common bacterium is Escherichia coli, and the source is often the gastrointestinal tract.
  • About half of the cases will resolve within 3 days even without treatment.

In men, cystitis is uncommon.

  • The longer urethra, which provides a greater barrier to bacteria entering the bladder and fluid from prostate gland also confers some antibacterial property.
  • After 50 years of age, urinary tract infection in men become more common due to prostate enlargement.



Symptoms

Cystitis is characterized by pain when passing urine and is associated with frequency, urgency, nocturia and changes to urine's appearance.

  • Symptoms usually start suddenly.

Specific questions to ask:

  • Age - Referral if children <16 years and women >70 years
  • Duration - Symptoms that have lasted longer than 5-7 days should be referred because of the risk that the women might develop pyelonephritis.
  • Vaginal discharge - If a patient reports vaginal discharge, the likely diagnosis is not cystitis.
  • Upper urinary tract infection symptoms - Systemic involvement, demonstrated by fever, nausea, vomiting, loin pain and tenderness is indicative of more serious infection such as pyelonephritis, and patients with such symptoms require urgent referral.



Over-the-Counter Management

Current OTC treatment is limited to products that contain alkalinizing agents such as sodium citrate, sodium bicarbonate and potassium citrate.

  • Alkalinizing agents are used to return the urine pH back to normal, thus theoretically relieving symptoms of dysuria.
  • Proprietary sachets (e.g. Ural, Utix) are more palatable than potassium citrate mixture.

Patients should be advised to drink about 5 L of fluid during every 24-hour period.

  • This will help promote bladder voiding, which is thought to help flush bacteria out of the bladder.



Complementary Therapy

Cranberry is a popular alternative remedy to treat and prevent urinary tract infections, although few clinical trials have been performed to substantiate or refute its clinical effectiveness.

  • Patients taking warfarin should not take cranberry products.

Probiotic Lactobacillus strains may be effective in preventing urinary tract infection in women.



Summary

If urinary tract infection symptoms persist, referral to a physician for empiric antibiotic therapy may be necessary.

  • Antibiotic selection (e.g., nitrofurantoin, fosfomycin, cephalexin) should consider the patient's clinical presentation, tolerability, local antimicrobial resistance patterns, susceptibility of causative pathogens, and cost-effectiveness.



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Comments

  1. AnonymousJanuary 10, 2024 at 10:41 PM

    Hello, would like to ask, for ural sachet, usually the Drs will prescribe it as Ural 1/1 TDS for 5 days. But it's not necessary for patient to complete it like antibiotics right? They can just take as PRN basis right?

    ReplyDelete
    Replies
    1. Soon SengJanuary 11, 2024 at 9:09 PM

      The justification of completing antibiotic as prescribed is to prevent the development of antibiotic resistance. On the other hand, when Ural is used for relief of painful UTI, it works as a urinary alkanizer to raise the pH of urine. Hence, once the symptom completely resolves, it is not necessarily to complete the regimen in practice.

      Delete
    2. AnonymousJanuary 13, 2024 at 9:42 PM

      Thank you!

      Delete

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