What is Cystitis?

It is a special type of chronic cystitis. The main symptoms are severe urinary frequency, urgency, lower abdominal pain, urination pain, and hematuria. More common in female patients. Cystoscopy revealed a decrease in bladder volume and submucosal bleeding in the bladder wall. The etiology of the disease is unknown, and there are no bacterial or viral or fungal infections. Antibiotics for this disease are ineffective. Excessive expansion of the bladder under anesthesia can achieve temporary relief of symptoms.

Cai Lin	(Attending physician)	Department of Urology, Peking University First Hospital
Xiao Yunxiang	(Deputy Chief Physician)	Department of Urology, Peking University First Hospital

Cystitis is inflammation of the bladder that is caused by specific and non-specific bacterial infections, as well as other special types of cystitis. Specific infection refers to bladder tuberculosis. Non-specific cystitis is caused by E. coli, Paracoli, Proteus, Pseudomonas aeruginosa, Streptococcus faecalis, and Staphylococcus aureus. Its clinical manifestations are acute and chronic. The former has a sudden onset, a burning sensation during urination, and pain in the urethral region. Sometimes urgency and severe urination. Women are common. Terminal hematuria is common, and gross hematuria and blood clots are excreted in severe cases. The symptoms of chronic cystitis are similar to acute cystitis, but there is no high fever. The symptoms can last for several weeks or intermittent attacks, making the patient weak and thin, and causing discomfort or pain in the lumbar abdomen and perineal area of the bladder.

Western Medicine Name

Cystitis

Affiliated Department

Surgery-urology

Disease site

bladder

The main symptoms

Frequent urination, urgency, pain, etc.

Classification of cystitis in specific types of cystitis

Hunner Cystitis interstitial cystitis (Hunner ulcer)

It is a special type of chronic cystitis. The main symptoms are severe urinary frequency, urgency, lower abdominal pain, urination pain, and hematuria. More common in female patients. Cystoscopy revealed a decrease in bladder volume and submucosal bleeding in the bladder wall. The etiology of the disease is unknown, and there are no bacterial or viral or fungal infections. Antibiotics for this disease are ineffective. Excessive expansion of the bladder under anesthesia can achieve temporary relief of symptoms.

glandular cyslitis Cystitis glandular cystitis

Edema of the bladder mucosa, which has adenoid hyperplasia and infiltration of many inflammatory cells. Patients are more common in middle-aged women. Antibiotics are used for treatment, and the pathogenesis factors need to be removed.

emphysematous cystitis Cystitis gas cystitis (emphysematous cystitis)

Rare. It often occurs in patients with diabetes. Due to the invasion of glucose in the bladder wall by bacteria (proteus), there is an airy appearance of the mucosa due to fermentation. The gas disappears after antibacterial treatment.

gangrenous cystitis Gangrenous cystitis

This is a rare result of bladder damage. Abscesses and necrosis of the bladder wall can be seen during severe infection. Some patients have gangrene changes throughout the bladder wall, which require fistula repair and antibacterial washing.

chemical cystitis Cystitis chemical cystitis

Intravenous injection of cyclophosphamide can make the drug metabolites formed in the liver and excreted from the bladder, which can stimulate the bladder mucosa and cause severe cystitis. Ulcers in the bladder epithelium. Capillary blood vessels in the lamina propria dilate and bleeding occurs. Severe fibrosis of the lamina propria and muscle fibrosis can cause bladder contracture and bladder ureteral reflux. This cystitis is difficult to treat.

radiocystitis Cystitis radiation cystitis

The bladder receives radiation for months or years. Radiation cystitis may occur if the dose exceeds 40 to 65 Gy (4000 to 6500 rad). Hematuria is the main symptom. Pathological changes are similar to cystitis caused by cyclophosphamide. Treatment is not satisfactory.

Causes of cystitis

Common non-specific cystitis is caused by E. coli, Paracoliformis, Proteus, Pseudomonas aeruginosa, Streptococcus faecalis, and Staphylococcus aureus. Most are caused by retrograde infection through the urethra. Because women have a short urethra and are close to the vagina, cystitis is more likely to occur. There are lesions in the bladder itself. Non-specific cystitis is more likely to occur when there are bladder stones, foreign bodies and indwelling catheters, or when there is urinary tract obstruction and micturition disorder.

Clinical manifestations of cystitis

Cystitis acute cystitis

Sudden onset of illness, burning pain in the urethra during urination, frequent urination, often accompanied by urgency, similar to urinary incontinence, frequent urinary urgency is particularly obvious, up to 5 to 6 times per hour, not much urine output each time, With only a few drops, there may be lower abdominal pain at the end of urination. Urinary turbidity, sometimes hematuria, often noticeable in the terminal stage.

Mild tenderness in the suprapubic bladder area. Some patients can see mild low back pain. When the inflammatory lesions are confined to the bladder mucosa, there is often no fever and increased white blood cells, mild systemic symptoms, and some patients have fatigue. Acute cystitis in women after their wedding is called honeymoon cystitis. The course of acute cystitis is short. If treated in time, symptoms usually disappear in about 1 week.

Chronic cystitis

Frequent urination, urgency, and dysuria symptoms persist for a long time and recurrent, but not as severe as the acute phase, with a small or moderate amount of pus and red blood cells in the urine. If cystitis is treated in time, the symptoms will quickly disappear. At this time, the patient should not take it lightly and insist on the treatment. The doctor should confirm that the cystitis has been cured before stopping, and do not let the cystitis turn chronic.

Cystitis diagnosis

Cystitis acute cystitis

Symptoms are more typical, and general diagnosis is not difficult. According to the history of frequent urination, urgency, and dysuria, a routine urine test can reveal red blood cells and pus cells. A urine bacteria culture of more than 100,000 urine bacteria per milliliter can confirm the diagnosis.

Chronic cystitis

In addition to general systemic tests, the most important thing is to identify the type of pathogenic bacteria and the results of drug sensitivity tests, and to find the cause of persistent or recurring infections. Chronic non-specific cystitis must be distinguished from other types of cystitis, such as tuberculous cystitis, interstitial cystitis, and chemical cystitis.

Differential diagnosis of cystitis

Cystitis acute pyelonephritis

In addition to bladder irritation, there are chills, high fever, and pain in the kidney area.

Cystitis bladder tuberculosis

She had chronic bladder inflammation, and did not respond well to conventional antibiotics. Acid-fast bacilli were found in the urine, and urography showed tuberculosis of the renal ureter. A contracture bladder is formed at an advanced stage.

Cystitis interstitial cystitis

Clear urine, few pus cells, no bacteria, and severe pain when the bladder is full.

Cystitis disease treatment

Cystitis general treatment

Including proper rest, drink more water to increase urine output, pay attention to nutrition, avoid irritating food, patients with obvious bladder irritation symptoms are given antispasmodic drugs to relieve symptoms.

Cystitis observation

In some special cases, asymptomatic bacteriuria patients do not need conventional antibacterial treatment, and the condition needs to be closely monitored.

Cystitis antibacterial treatment

Antibacterial treatment is the main treatment method for urinary tract infections, and it is recommended to choose drugs based on drug sensitivity tests. ^[1-4]

Prognosis of cystitis disease

The overall prognosis of patients with acute simple cystitis is better after treatment and taking certain preventive measures. Untreated patients with acute cystitis progress to upper urinary tract infections less frequently. Delays into chronic symptoms may last for months, but they can gradually resolve spontaneously.

Cystitis disease prevention

First, drink plenty of water, preferably two liters a day.

Second, urinate in time, do not hold back.

Third, pay attention to personal hygiene, frequently change underwear. Women urinate and wipe with clean toilet paper from front to back.

4. Before and after sexual intercourse, both men and women should thoroughly clean the local area. The urine of the bladder should be cleared before and immediately after sexual intercourse.