Recurrent Cystitis
by Julie Chacko, M.D.
• Definition: Recurrent infection of the bladder.
• Overview:
· Recurrent cystitis refers to repeated infection of the bladder after the initial infection has been cleared.
· This can occur due to re-infection or due to re-population that occurs when there is a source of infection that was not cleared such as a stone.
· The situation in which there is re-population with the same organism is also referred to as bacterial persistence.
• Causes:
· Most commonly bacterial in nature and often without any clear diagnosable cause.
· Recurrent infections can be associated with:
· abnormal connections between the bowel and urinary tract (fistulas)
· immunosuppression
·poorly controlled diabetes
· prostatitis
· urinary tract stones
· sexual activity
·factors that lead to poor drainage of an area or a site in which bacteria can “hide” from antibiotics and other causes.
• Symptoms:
· Dysuria (burning during urination)
· Frequency of urination
· Urgency to urinate and often small volumes urinated
· Pain in the bladder (felt as discomfort in the lower abdomen) is often present.
· The only difference symptomatically from acute cystitis is the recurrent nature.
• Complications:
· Fever
· upper urinary tract infection (see pyelonephritis)
· hematuria (blood in the urine)
• Clinical Findings/signs:
· There may be few signs other than those of acute cystitis.
· Physical examination may reveal:
· tenderness in the kidney area if stone or kidney involvement is present
· urethral diverticuli may be discovered on physical examination of the pelvic organs.
· Depending on clinical suspicion, the work-up may include imaging of the urinary tract with
· plain x-rays, ultrasounds, or CT scans.
· if urethral diverticulum is suspected, MRI may be necessary to confirm the diagnosis.
· using a small camera to evaluate the bladder, known as cystoscopy, may also be performed to evaluate anatomy and rule out other causes for the symptoms.
• Treatment:
· Medication:
· Antibiotics are the mainstay of therapy for bacterial infection. Following treatment of the acute episode, low dose antibiotics to prevent infection may be prescribed and used daily if necessary or just after intercourse if that is the inciting event. Some patients can be given prescriptions to treat infection when it occurs rather than trying to prevent them.
· vaginal estrogen replacement In post-menopausal women can be used to help prevent recurrent infections.
· Lifestyle:
·Prevention of recurrent infection may be helped by controlling diabetes, emptying the bladder regularly and with a catheter when necessary.
· Avoiding use of spermicides and diaphragms is advised.
· Cranberry is believed to be helpful in preventing UTIs but is not likely to be effective in treating UTIs. Data available does not clearly define the dosing necessary. The active ingredient from cranberry is readily destroyed by light and heat making the amount available in any product difficult to control.
· Surgery: May be indicated to remove a kidney stone, urethral diverticulum, fistula or other anatomic abnormality that is thought to be the source. The surgery recommended is specific to the cause identified.
• Prognosis: The prognosis is generally good. Many young women “outgrow” the recurrent infection issue and can be treated effectively in the meantime. Older women can often be controlled with local estrogen replacement and prophylactic antibiotics when needed. Removal of the source of infection is generally curative for those in whom a source is identified.
Posted on April 16, 2009
