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Cystitis

What Is Interstitial Cystitis?
Interstitial cystitis (IC), one of the chronic pelvic pain disorders, is a condition resulting in recurring
discomfort or pain in the bladder and the surrounding pelvic region. The symptoms of IC vary from case to
case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or
intense pain in the bladder and surrounding pelvic area. Symptoms usually include an urgent or frequent
need to urinate. Pain may change in intensity as the bladder fills with urine or as it empties. Women’s
symptoms often get worse during menstruation.

What Causes IC?
In IC, the bladder wall may be irritated and become scarred or stiff. Glomerulations (pinpoint bleeding
caused by recurrent irritation) may appear on the bladder wall. Some people with IC find that their
bladders cannot hold much urine, which increases the frequency of urination. Frequency, however, is not
always specifically related to bladder size; many people with severe frequency have normal bladder
capacity. People with really severe cases of IC may urinate as many as 60 times a day.

Also, people with IC often experience pain during sexual intercourse. IC is far more common in women
than in men. Some of the symptoms of IC resemble those of bacterial infection, but medical tests reveal no
organisms in the urine of patients with IC. Furthermore, patients with IC do not respond to antibiotic
therapy. Researchers are working to understand the causes of IC and to find effective treatments.

One theory being studied is that IC is an autoimmune response following a bladder infection. Another
theory is that a bacterium may be present in bladder cells but not detectable through routine urine tests.
Some scientists have suggested that certain substances in urine may be irritating to people with IC, but no
substance unique to people with IC has as yet been isolated. Researchers are beginning to explore the
possibility that heredity may play a part in some forms of IC. In a few cases for example, IC has affected a
mother and a daughter or two sisters, and yet does not commonly run in families. No gene has yet been
implicated as a cause.

What is Cystitis?
Cystitis is inflammation of the bladder. Usually we use this term to mean an infection causing inflammation
of the bladder. This is an annoying and irritating condition which most commonly affects women, but can
affect all age groups from either sex.

What causes Cystitis?
The main cause of cystitis is bacteria known as coliform bacteria, which are a common occupant of the
bowel. Also, other bacteria may be involved or other types of infection may inflame the bladder. Trauma
as in "Honeymoon Cystitis" following unaccustomed and rather prolonged or vigorous sexual activity and
radiation, eg. after radiotherapy to other organs in the pelvis are known to cause cystitis.

Symptoms
  • Frequency of passing water
  • Urgency or the need to pass water quickly
  • Burning or pain on passing water
  • Smell in the urine
  • Cloudy urine
  • Blood in the urine. (This is a common issue and need not cause undue alarm)

Diagnosis
Most often this can be based on the case alone. If there is doubt, then a urine specimen can be examined
by the doctor, using a testing dip-stick, or at the laboratory - using a microscope to show up the organisms,
and trying to culture or grow the organisms in the laboratory. The latter method allows us to test the
organism to find which antibiotic will best eradicate it.

The doctor may well wish to organise further tests to rule out any possible underlying cause for urinary
infection, either after one attack in a male or multiple attacks in a female. This may involve ultrasound
scans, X-Ray of the kidneys and bladder using a dye injected into the blood vessels (intravenous
urography), or looking into the bladder using an endoscope (cystoscopy).

Treatment
  • The best first aid treatment is to drink LOTS of water during the day
  • To some extent, alkalising the urine helps to eradicate the germs and also soothe the bladder.
    You can try using bicarbonate of soda, 5 ml in half a glass of water, two or three times a day, or
    one of the over the counter cystitis remedies.
  • For similar reasons the folklore remedy is barley water or, these days, cranberry juice.
  • If the symptoms are any more than transient, you should contact your doctor, when next able to,
    regarding the possibility of antibiotics.

Prevention
  • In general, drink more fluids on a regular basis. Preferably at least 1.5 litres daily.
  • Passing water shortly after sex is probably a good idea in women with recurrent cystitis.
  • Particularly in girls it is important to confirm they use a hygienic approach to cleaning themselves.

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