| Acute cystitis is an inflammation of the lining of the urinary bladder (the mucosa) caused by a bacterial infection.
Most infections occur when bacteria that originates in either the small or large intestine (coliform bacteria) travel up the urethra into the bladder. Once bacteria enter the bladder, they are normally eliminated during urination. Symptoms occur when bacteria multiply faster than they are eliminated.
Risk factors include diabetes, which can result in urine with an unusually high concentration of glucose that encourages bacterial growth; a diet low in fruit and protein, as a lack of these foods makes urine less acidic and thus more hospitable to bacteria; using an ill-fitting contraceptive diaphragm, which can prevent complete emptying of the bladder; poor hygiene habits, such as cleaning from back to front after defecation, or wearing soiled underwear. Other risk factors include urinary tract obstruction, a neurogenic bladder, depressed immune system response (e.g., HIV), insertion of instruments into the urinary tract, vesicoureteral reflux, pregnancy, bowel incontinence, immobility, or decreased mobility.
In men, cystitis occurs most often after age 50 and is usually caused by prostatic enlargement, resulting in incomplete emptying of the bladder. Benign prostatic hyperplasia (BPH), prostatitis, and urethral strictures all may increase risk in elderly men.Risk: Acute cystitis occurs mainly in adult women, as bacteria that inhabit the vaginal opening and anus are easily introduced into the area surrounding the urethral meatus (entrance) during intercourse or while performing normal hygiene. Incidence and Prevalence: This condition is rare for males but common for females, with an annual incidence in the US of approximately 7 million women (Emmons). Twenty percent of all women experience this condition at some point in their lives. |
Source: Medical Disability Advisor
| History: Onset is generally sudden. The most common complaints include a frequent, urgent need to urinate while passing only small amounts of urine, painful urination (dysuria), discomfort felt as pressure or mild to moderate pain in the lower abdomen (suprapubic) and back (flank), loss of bladder control (incontinence), strong urine odor, and blood in the urine (hematuria). In addition, there may be pain during sexual intercourse. Physical exam: Minimal physical findings are present in individuals with acute cystitis. Palpation (touching) of the flank or lower abdomen (suprapubic region) may elicit complaints of pain. The individual may have constitutional complaints such as fatigue, chills, nausea, and/or vomiting. Confusion or mental changes may be present and may be the only sign of cystitis in an elderly person. Tests: Acute cystitis is usually suspected by its distinct symptoms. Urinalysis is used to confirm the diagnosis. Precautions must be taken to avoid contaminating the urine specimen with bacteria from the external genitalia by first cleaning with a disinfectant and then obtaining a midstream specimen (clean catch); nitrites and leukocyte esterase will be present in the urine. The urine is cultured to identify the bacterial infection. Microscopic examination of the urine reveals many white blood cells (pyuria), while red blood cells (hematuria) are seen about half the time. |
Source: Medical Disability Advisor
| Acute cystitis is generally treated with antibiotics for 3 to 10 days. Other drugs, such as a urinary tract pain reliever (analgesic) may be given for the first 1 to 2 days to reduce burning and discomfort.
The individual is encouraged to drink two or more quarts of water per day to encourage flushing of the bladder with dilute urine. Low-dose long-term (prophylactic) antibiotics may be given in cases of recurring cystitis. |
Source: Medical Disability Advisor
| Acute cystitis is usually cured rapidly with antibiotics. Indeed, the condition may resolve without antibiotic therapy, and some individuals self-treat with fluid loading. However, antibiotics provide symptomatic relief, lessen the length and severity of the disorder, and reduce the incidence of complications and recurrence. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
| The employee may need to take more frequent restroom breaks. No other special needs are anticipated. However, in many cases the urgent need to urinate is so constant that work may be impractical for a day or two until the medication begins to take effect. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did individual present with common genitourinary symptoms such as urinary urgency, frequency, pain on urination, incontinence, or abdominal pain?
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Does individual have a history of recurrent cystitis?
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Has a urine culture confirmed the diagnosis of acute cystitis?
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Are the bacteria cultured resistant to the antibiotic used?
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Did individual warrant further diagnostic studies to rule out an underlying urinary tract defect (e.g., stricture or prostatic hypertrophy)?
Regarding treatment:
- Was an antibiotic sensitivity done to determine the appropriate antibiotic treatment? Was individual instructed to increase fluid intake to 2 quarts or more per day?
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Has individual completed the full course of antibiotic therapy?
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If cystitis is recurrent, would individual benefit from prophylactic antibiotics?
Regarding prognosis:
- Did the symptoms persist? Was a repeat culture and sensitivity done to rule out the possibility of antibiotic resistance? Were appropriate adjustments in the antibiotic therapy made?
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Were additional studies done to determine if the infection progressed to the ureters or kidneys?
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Has individual been examined for the possibility of other urinary tract disorders?
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Does individual have any underlying conditions such as diabetes, immune system dysfunction, or structural abnormalities that may affect recovery and prognosis? Have these conditions been addressed in the treatment plan?
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Has individual been instructed on hygiene and other practices, such as emptying the bladder immediately following sexual intercourse, to help prevent additional infections?
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Source: Medical Disability Advisor
| Emmons, Wesley W., Jeffrey M. Tessier, and Mary F. Bavaro. "Urinary Tract Infection, Females." eMedicine. Eds. J. A. Klaber Moffett, et al. 17 Nov. 2004. Medscape. 14 Apr. 2006 <http://emedicine.com/med/topic2835.htm>. |
Source: Medical Disability Advisor