- HEMATURIA(bloody URINE)
- URINARY URGENCY
- URINARY FREQUENCY, including NOCTURIA (the
need to urinate at night) - cloudy, foul-smelling, or discolored urine
- pain in the lower abdomen
- pain with SEXUAL INTERCOURSE
The diagnostic path begins with urinalysis,
which often shows whether BACTERIA or other
pathogens are present in the urine. Escherichia coliis
the most commonly the culprit for infectious cysti-
tis (UTI). Chlamydiaand herpes simplex viruses
(HSV-1 and HSV-2) are also common causes of
UTIs. The urologist may choose further diagnostic
procedures such as CYSTOSCOPYor abdominal ULTRA-
SOUNDto rule out causes such as tumors or stones
(UROLITHIASIS). Cystoscopy allows the urologist to
assess bladder capacity, an important factor in
determining a diagnosis of interstitial cystitis as
reduced bladder capacity is a characteristic of this
condition. The current standard of diagnosis for
interstitial cystitis further requires the presence of
key symptoms over a period of time as well as the
exclusion of other causes for the symptoms.
Treatment Options and OutlookUTIs require therapy with the appropriate medica-
tions, such as ANTIBIOTIC MEDICATIONSfor bacterial
infections or ANTIFUNGAL MEDICATIONS for yeast-
based infections. The symptoms of infectious cysti-
tis generally subside within a few days of
beginning treatment, and the infection clears with
the full course of medication. The oral medication
phenazopyridine (Pyridium) acts as a topical anes-
thetic to block pain signals from the lining of the
bladder, easing dysuria until the medication affects
the infection. It is essential to take prescribed
medications as the doctor directs and to take med-
ications to treat infections until the medication is
gone (the full course of treatment) even after
symptoms improve. Undertreated or untreated
UTIs can migrate from the bladder to the KIDNEYS,
where they can cause serious illness and some-
times permanent damage to the kidneys.
Treatment for autoimmune cystitis targets the
IMMUNE SYSTEM with ANTIHISTAMINE MEDICATIONS,
IMMUNOSUPPRESSIVE MEDICATIONS, and other
approaches that aim to block the inflammatory
response. Irritation cystitis often resolves with a
combination of increased fluid consumption and
ending the cause of the irritation, when possible.
Common culprits include coffee, tea, carbonated
beverages, citrus fruits and juices, tomatoes and
tomato products, chocolate, ALCOHOL, and pickled
or smoked foods.
Interstitial cystitis is difficult to treat. People
respond differently to treatment regimens, and
sometimes a successful treatment becomes ineffec-
tive. Urologists may prescribe various kinds of
medications to relieve symptoms such as tricyclic
ANTIDEPRESSANT MEDICATIONS(which appear to sup-
press certain pain response mechanisms), NON-
STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and
antihistamines. The medication pentosan (Elm-
iron) is the only oral medication specifically for
interstitial cystitis, though women who are preg-
nant cannot take it. Pentosan also takes up to six
months to provide relief and may cause temporary
HAIR loss. Other treatments include intravesical
therapies in which the urologist instills medica-
tions directly into the bladder via urethral
catheterization. Bladder distention under ANESTHE-
SIA (via cystoscopy) provides long-term though
temporary relief for some people.FOODS AND DRINKS THAT CAN IRRITATE THE BLADDER
beer cantaloupe
chocolate chocolate-covered espresso
coffee beans
cola beverages cranberries and cranberry
lemons and lemonade juice
mixed ALCOHOLICdrinks onions
oranges and orange juice peanuts and peanut butter
peppers (sweet or hot) pineapple
tea (hot or iced) tomatoes and tomato juice
vinegar and dressings with wine (white or red)
vinegarRisk Factors and Preventive Measures
Women are more likely to develop infectious cys-
titis and interstitial cystitis, primarily because a
woman’s shorter URETHRAallows easier access for
pathogens. Diligent personal hygiene, including
urination soon after sexual intercourse and wiping
toilet tissue from front to back, helps reduce expo-
sure to bacteria. Doctors are unsure why intersti-184 The Urinary System