cystitis

(sis-tīt′ĭs)

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[cyst- + -itis]
Inflammation of the bladder, usually the result of a urinary tract infection. Associated organs (kidney, prostate, urethra) may be involved. The condition may be acute or chronic. Females are affected 10 times more than males. Adult males and children may develop lower urinary tract infections from anatomic or physiologic abnormalities such as prostatic hypertrophy (adult men) or anomalies of the ureterovesicular junction. The infection usually is ascending, caused by a gram-negative enteric bacterium, e.g., Escherichia coli, Klebsiella, Proteus, Enterobacter, Pseudomonas, or Serratia, and occasionally by gram-positives (Staphylococcus saprophyticus or enterococci). When an indwelling catheter is present or the patient has a neurogenic bladder, multiple pathogens may be responsible.
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SYMPTOMS
Cystitis is marked by urinary urgency, frequency, and pain. Bladder spasms and perineal aching or fullness are also reported. Most patients do not have a fever.

TREATMENT
Antibiotics are useful in treating the infection, but more definitive therapy is required if the basic cause is a kidney stone or a structural defect in the urinary tract such as obstruction.

PATIENT CARE
The patient is assessed for pain, burning, urinary frequency, bladder spasms, chills, and fever. The urinary bladder is palpated and percussed for distention. Volume and frequency of urinary output are monitored, and urine is inspected for cloudiness and gross hematuria. A clean-catch or catheterized specimen is sent to the laboratory for urinalysis and culture and sensitivity tests. Oral fluid intake is encouraged to dilute urine and to decrease pain on voiding. Heat is applied to the lower abdomen to decrease bladder spasms. Urinary antiseptics, analgesics, and antibiotics are administered and evaluated for therapeutic effectiveness and any adverse reactions. The patient is warned that urinary antiseptics such as phenazopyridine hydrochloride (Pyridium) will color the urine reddish orange and may stain fabric. The importance of follow-up urinalysis and culture testing to ensure that the cause of cystitis has been eliminated is emphasized in cases of recurrent disease.

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