Encyclopedia of Health and Medicine

184 The Urinary System
• 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 coli is
the most commonly the culprit for infectious cystitis
(UTI). Chlamydia and herpes simplex viruses
(HSV-1 and HSV-2) are also common causes of
UTIs. The urologist may choose further diagnostic
procedures such as CYSTOSCOPY or abdominal ULTRA-
SOUND to 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 Outlook
UTIs require therapy with the appropriate medications,
such as ANTIBIOTIC MEDICATIONS for bacterial
infections or ANTIFUNGAL MEDICATIONS for yeastbased
infections. The symptoms of infectious cystitis
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 anesthetic
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 medications
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 sometimes
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 ineffective.
Urologists may prescribe various kinds of
medications to relieve symptoms such as tricyclic
ANTIDEPRESSANT MEDICATIONS (which appear to suppress
certain pain response mechanisms), NON-
STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDS), and
antihistamines. The medication pentosan (Elmiron)
is the only oral medication specifically for
interstitial cystitis, though women who are pregnant
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 medications
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 ALCOHOLIC drinks 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)
vinegar
Risk Factors and Preventive Measures
Women are more likely to develop infectious cystitis
and interstitial cystitis, primarily because a
woman’s shorter URETHRA allows easier access for
pathogens. Diligent personal hygiene, including
urination soon after sexual intercourse and wiping
toilet tissue from front to back, helps reduce exposure
to bacteria. Doctors are unsure why intersti-