Acute uncomplicated cystitis is a symptomatic infection of the bladder causing one or more of the following symptoms: burning, frequency, urgency, bleeding, urinating small volumes, incontinence, and pain (abdominal, pelvic, lower back). Laboratory studies usually show bacteria, white cells and red blood cells in the urine. Cystitis has predictable bacteriology with 80-90% caused by Escherichia coli, 5-15% by Staphylococcus saprophyticus and the remainder by less common pathogens including Klebsiella pneumoniae, Proteus, and Enterococcus. An occasional bout of cystitis is not an uncommon event in the female population; however, when bladder infections recur time and time again, it becomes a major source of inconvenience and debility for the sufferer, and it becomes important to investigate the source of the recurrence.
Studies indicate that women 18-24 years of age have the greatest incidence of cystitis and that the following are risk factors for recurrent cystitis: a new sexual partner, recent sexual intercourse, and the use of spermicides, a diaphragm or spermicide-coated condoms. It is important to distinguish cystitis from urethritis and vaginitis, which may cause similar symptoms. Cystitis also occurs with increased incidence in the post-menopausal population, based upon changes that occur on the basis of estrogen deficiency. As a result of estrogen deficiency, there is a change in the normal resident bacteria (flora) of the vagina in which E. Coli replaces lactobacilli. Topical estrogen cream has been shown to reverse vaginal colonization with E. Coli and help prevent cystitis. Additionally, abnormalities as a result of childbearing and menopausal changes such as pelvic relaxation are common among the post-menopausal population and contribute to the increased incidence of cystitis in this population. It is important to distinguish a symptomatic urinary infection from asymptomatic bacteruria. Asymptomatic bacteruria is the presence of bacteria within the bladder without causing an infection. Asymptomatic bacteruria does not require treatment, which is often futile, achieving nothing but selection of a resistant organism.
Management of recurrent cystitis is based upon:
Management of subsequent recurrences:
Andrew L. Siegel, M.D.
255 W. Spring Valley Ave.