Cystitis.

 

Definition:

Cystitis means inflammation of the bladder, and is most commonly seen in women. It is usually caused by a urine infection resulting from the growth of bacteria in the bladder, and usually clears up in around 5 days.

 

 

Causes:

Bacteria can be transferred from the anus to the urethra, for example during sexual

intercourse or because of poor hygiene. The bacteria can travel up to the bladder and cause

inflammation.

 

Dehydration can allow crystals of uric acid to form, which can irritate the delicate tissue in

the bladder and urethra.

 

Irritation can be tiggered by an allergy to food or drink, or by a women 'holding on', instead

of emptying her bladder when she feels the need to, or  by not completely emptying the

bladder.

 

Other factors which can cause cystitis include using perfumed toiletries, tight clothing and

lifestyle (too much sexual intercourse, alcohol and spicy foods can contribute to cystitis)

 

Presentation:

The main symptom is an intense pain and/or burning upon urination.

 

Other symptoms include increased frequency of urination, only passing very small quantities of urine, a feeling of increased urgency to urinate, smelly and cloudy urine and also blood in the urine.

 

 

Differential Diagnosis:

If a patient is suffering from itching within the vagina, or a change in vaginal discharge, it may be vaginal candidiasis.

 

Recurrent cases (second bout in a month) may indicate a more serious cause.

 

If a male presents with cystitis they should be referred as it may be an indication of a more serious underlying cause, such a kidney stones or prostate cancer.

 

Any children under 16 must also be referred.

 

If there is any blood in the urine this may be evidence that there is something more serious causing the symptoms, and the patient should be referred.

 

Any pregnant women, those with pain in lower back or abdomen or symptoms not improving after a day of treatment should also be referred.

 

 

Treatment:

Products which are designed to make the urine less acidic, thereby relieving symptoms, are

recommended,such as Cymalon. ONE sachet should be dissolved in 200ml of water and taken

THREE times daily for TWO days.

 

The patient should drink plenty of fluids and to visit the toilet as soon as they feel the 'urge'.

 

Painkillers such as paracetamol may help with the pain. TWO tablets should be taken FOUR

times daily (or every four to six hours), maximum EIGHT in 24 hours.

 

Self Help Advice:

Avoid alcohol, tea and coffee.

 

Do not have sex until symptoms subside.

 

Urinate immediately after sexual intercourse.

 

Always wipe from front to back.

 

Always urinate when the 'urge' to go is felt.

 

Use unperfumed soaps.

 

Wear loose fitting clothing: skirts and dresses are best- try to avoid tight fitting jeans.

 

Use a hot water bottle to help relieve abdominal pain.

 

 

Sample Question:

A woman visits your pharmacy asking to buy something to relieve her symptoms as she is needing to pass urine more frequently than usual, and

is experiencing a burning sensation when doing so. She has no other symptoms, is otherwise healthy, and takes no regular medication.

Which one of the following would it be appropriate for you to recommend?

 

 

a) Advise that she uses Canestan (clotrimazole) cream Advise her to use 

calamine lotion

b) Advise that she takes Cystopurin (potassium citrate) sachets

c) Advise that she takes Diflucan One (fluconazole capsule 150 mg) 

d) Reassure her and advise that the condition will improve on its own without 

any intervention

E. Refuse the sale and advise that she makes an appointment to see her GP 

urgently

 

Answers to all sample questions can be found by following the link under the Test Yourself tab.