Cystitis - noninfectious

Definition

Noninfectious cystitis is irritation of the bladder that is not caused by a urinary tract infection.

Alternative Names

Abacterial cystitis; Radiation cystitis; Chemical cystitis; Urethral syndrome - acute; Bladder pain syndrome; Painful bladder disease complex

Causes, incidence, and risk factors

Noninfectious cystitis is most common in women of childbearing years. The exact cause is often unknown. However, it has been associated with the use of:

• Bubble baths
• Feminine hygiene sprays
• Use of sanitary napkins
• Spermicidal jellies
• Radiation therapy to the pelvis area
• Certain types of chemotherapy medications
• History of severe or repeated bladder infections

Certain foods, such as tomatoes, artificial sweeteners, caffeine, chocolate, and alcohol, can cause bladder symptoms.

See also: Interstitial cystitis

Symptoms

• Pressure in the lower pelvis
• Painful urination
• Frequent need to urinate
• Urgent need to urinate
• Decreased ability to hold urine
• Need to urinate at night
• Abnormal urine color -- cloudy
• Blood in the urine
• Foul or strong urine odor

Additional symptoms that may be associated with this disease:

• Pain during sexual intercourse
• Penile pain
• Flank pain
• Fatigue

Signs and tests

A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs). A microscopic examination of the urine may be done to look for cancerous cells.

A urine culture (clean catch) is done to look for a bacterial infection.

A cystoscopy (use of lighted instrument to look inside the bladder) may be done if you have:

• Symptoms related to radiation therapy or chemotherapy
• Symptoms that do not get better with treatment
• Blood in the urine

Treatment

The goal of treatment is to manage your symptoms.

This may include:

• Medicines to help your bladder contract and empty. These are called anticholinergic drugs. Possible side effects include slowed heart rate, low blood pressure, increased thirst, and constipation.
• Muscle relaxers to reduce the strong urge to urinate or need to urinate frequently.
• A medicine called pyridium to help relieve bladder pain

Surgery is rarely performed unless a person has severe urinary retention or significant blood in the urine.

Your doctor or nurse may also recommend:

• Avoid fluids that irritate the bladder such as alcohol, citrus juices, and caffeine.
• Bladder training exercises to help you schedule times to try to urinate and to delay urination at all other times. One method is to force yourself to urinate every 1 to 1 and 1/2 hours, despite any leakage or urge to urinate in between these times. As you become skilled at waiting this long, gradually increase the time intervals by 30 minutes until you are urinating every 3 to 4 hours.
• Pelvic muscle strengthening exercises called Kegel exercises to help relieve symptoms of urgency

Support Groups

Expectations (prognosis)

Although most cases of cystitis are uncomfortable, the symptoms usually get better over time.

Complications

• Ulceration of bladder wall
• Urethral stricture
• Diminished bladder capacity
• Bladder cancer
• Anemia

Calling your health care provider

Call your doctor or nurse if you have symptoms of cystitis, or if you have been diagnosed with cystitis and symptoms worsen or new symptoms develop, especially fever, blood in the urine, back or flank pain, and vomiting.

Prevention

Avoid using items that may be irritants such as bubble baths, feminine hygiene sprays, sanitary napkins or tampons (especially scented products), and spermicidal jellies.

If you need to use such products, try to find those that do not cause irritation for you.

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References

 Hanno PM. Painful bladder syndrome (interstitial cystitis) and related disorders.In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 12. 

Carter C, Stallworth J, Holleman R. Urinary tract disorders. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap40.