Chronic cystitis

What is chronic cystitis (inflammation of the bladder)?

Uncomplicated urinary tract infections usually clear up within a few days with the right treatment. Sometimes, however, a urinary tract infection keeps recurring.

Doctors regard a urinary tract infection as chronic or recurrent if the patient suffers from an infection three times within a year or twice within six months. Chronic or recurrent urinary tract infections can generally be treated well, but more detailed diagnostic methods make sense in order to find the cause of the constantly recurring inflammation.

A chronic urinary tract infection usually manifests with one or more symptoms and problems (just like a normal urinary tract infection):

  • Pain and a burning sensation on urination
  • Difficulty in emptying the bladder
  • Frequent urge to urinate, but only small amounts of urine
  • Bladder cramps
  • Visible or invisible amounts of blood in the urine
  • Passing of purulent urine (urine containing pus)
  • Nocturnal urination
  • Pain over the pubic bone
  • Fever

If the germs spread further, cystitis may develop into an inflammation of the kidneys (pyelitis). The signs of this are high fever, severe pain in the kidney area and feeling very ill.

What are the causes and risks for the development of chronic cystitis?

hronic urinary tract infections are usually caused by intestinal bacteria. Either the germs enter the urinary system for the first time or a previous infection was not completely cured. More than 90 per cent of cases involve a new infection, occurring after an interval of more than two weeks following the previous inflammation.

Women are more likely to suffer from recurrent urinary tract infections than men. An important reason for this lies in the fact that they have a shorter urethra. In older men, the cause of chronic urinary tract infections is quite often an enlarged prostate gland.

Other risk factors are:

  • Bladder stones
  • Bladder emptying disorders, as a result of prostate disease or dropped (prolapsed) bladder, for example
  • Sexual intercourse
  • Pregnancy
  • Scar tissue and protuberances (diverticula), in the bladder for example
  • Catheters and ureteral stents
  • Weakened immune system, following a transplant, for example, or with AIDS
  • Hypothermia
  • Metabolic diseases, such as diabetes
  • Tumours

A common cause of chronic cystitis is a defect in the body’s own protective lining on the internal wall of the bladder, known as the GAG layer. GAG stands for glycosaminoglycan. Once the GAG layer has been damaged, the body’s own protective function is unable to prevent any painful reactions or inflammations. Specially developed products are available to restore this essential protective function.

What role does lifestyle play in chronic cystitis?

One important preventive tip is to drink sufficient fluids and to avoid excessive genital hygiene and hypothermia.

Urinary tract infections are unpleasant and painful but generally harmless. However, they may spread, particularly into the kidney area, and cause serious illnesses: inflammation of the kidneys (pyelitis) for example.

How is chronic cystitis diagnosed?

The diagnosis of recurrent urinary tract infections is made in a similar manner to that used for the acute disease.

The doctor tests the urine for bacteria and signs of inflammation.

Additional tests may sometimes be useful for chronic urinary tract inflammations or if the cause is unclear:

Urine culture: A urine culture identifies the pathogens responsible for the infection so that the right antibiotic can be selected for treatment.

Ultrasound examination: An ultrasound scan is the most important imaging procedure for clarifying urinary tract infections. It can reveal changes in the kidneys, bladder and the prostate in men.

Catheter urine and bladder puncture urine samples: In order to rule out any contamination from the genital region, women’s urine is sampled using a catheter. It is also possible to obtain urine directly from the bladder of men, women and children, using a needle.

Test for sexually transmitted diseases: Sexually transmitted diseases or a vaginal infection can also cause a urinary tract infection.

Structural clarification: the urinary tract is examined using imaging procedures for constrictions, blockage by foreign bodies or abnormalities.

Micturating cysto-urethrography (MCU): This involves an x-ray examination during urination. The bladder is filled with contrast medium and the flow of urine is tracked. This allows any urinary reflux from the bladder to the kidney to be detected.

How is chronic cystitis treated?

If there are no structural changes in the urinary tract or other diseases that are responsible for the chronic urinary tract infection, treatment is identical to that of a normal infection. Antibiotics and possibly spasmolytic and analgesic medicines are used.

If there is a defect in the body’s own protective lining of the internal wall of the bladder (the GAG layer) this can be treated. GAG stands for glycosaminoglycan. Once the GAG layer has been damaged, the body’s own protective function is unable to prevent any painful reactions or inflammations. Specially developed medicinal products are available to restore this essential protective function. The molecules in the product bind water. A protective water layer is formed between the bladder wall and the urine. This layer prevents the irritants and bacteria in the urine from reaching the bladder wall where they could cause painful inflammations or other reactions.

Products that acidify the urine are also suitable for chronic urinary tract infections. A slightly acidic pH blocks the growth of bacteria and prevents them colonising the mucous membrane. A “vaccination” with inactivated E. coli bacteria is also said to help by stimulating the immune defence system.

Urinary tract infections often recur if antibiotics are discontinued too soon. It is important to continue to take the medicine even if the inflammation has already subsided. A urine culture will show whether the pathogens have been totally eliminated.