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Pharmacy Practice IV

Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.


Cystitis // Page 1 of 3
Cystitis

1. Inflammation of the urinary bladder
a. Urethritis is an inflammation of the urethra. Sometimes cystitis and urethritis are
referred to collectively as a lower urinary tract infection (UTI)
b. Infection of the upper urinary tract involves the spread of bacteria to the kidney and
is called pyelonephritis

2. Infection by intestinal bacteria (E. coli). Also by bacteria that live on skin (e.g.
Staphylococcus epidermis) if they get into the urethra, then grow in the bladder

Contributing Factors / At Risk

1. Women in general
a. Urethra very short (travel time short)
b. Urethra opens near anus
2. Pregnant women. Risk of kidney infection and pre-term delivery (if near the due date)
3. Postmenopausal women. Lack of female sex hormones changes in lining of vagina and
urethra more likely to be infected
4. Young people having unprotected sexual intercourse. This is more common in sexually
active women
5. Using tampons - push bacteria into the urethra
6. Inadequate emptying resulting in stagnation of urine. Even the small drop which is always
left behind may contain bacteria. Can be caused by some drugs e.g. antidepressants
7. Toilet hygiene. Particularly common among females (see 1). Must clean thoroughly. Dry
from front to back, towards the anus - to avoid leading bacteria from their intestine into
their urethra
8. Congenital deformity in the urinary system - prevents the complete emptying of the bladder
9. People with a catheter to drain urine will have bacteria in their bladder, usually without
symptoms. During the change of catheter, small lesions (damaged areas) may appear,
which may increase the danger of infection (cystitis) and possible blood infection
10. Men with an enlarged prostate prevents the bladder from emptying completely
11. Other conditions like prostatitis (infection in the prostate) and urethritis (infection in the
urethra) may give rise to similar symptoms in the younger male
12. 'Honeymoon' cystitis. Cystitis in women related to increased frequency of sexual activity
13. Products (such as soaps, bubble bath and vaginal deodorants) alter acidity in the vagina
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Cystitis // Page 2 of 3
14. Diaphragm and spermicide - lower the acidity of the vagina, making it easier for bacteria to
thrive

Diagnosis
1. Based on symptoms and signs
2. Chemical testing - dipstick test
3. Urine culture
4. If recurrent ultrasound scanning or X-rays of the urinary system and cystoscopy
(telescopic examination of the bladder)

Symptoms
1. Burning sensations or sharp pain during urination
2. Frequent and urgent need to urinate, often with little of no urine passes
3. Cloudy, dark and foul-smelling urine
4. Pain at lower back or lower abdomen
5. Children have less concrete symptoms: weakness, irritability, reduced appetite and
vomiting
6. Older women may also have no symptoms other than weakness or fever
7. Occasional blood in the urine

Treatment - Medicines
1. Painkiller - paracetamol, ibuprofen or aspirin
2. Urine alkalinizer (make the urine less acidic)
a. Glass of water with a teaspoon of bicarbonate of soda
b. Ural
c. Potassium citrate
3. Antibiotics (by prescription) Penglobe, Bactrim. If antibiotics do not work, it is possible
that you have a kind of cystitis called interstitial cystitis (IC) - chronic inflammation of the
bladder wall that is not caused by infection and does not respond to antibiotics

Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Cystitis // Page 3 of 3
Treatment Nonpharmacological / Prevention

1. Abstain sex while the attack lasts
2. Hot water bottle
3. Drink sufficiently (8 glasses) help flush out the infection, dilute the urine and reduce the
burning sensation. No evidence, but taking a lot of fresh water is generally good for your
health
4. Pass urine as soon as you need to, rather than trying to "hang on"
5. Try to urinate at least once every three hours.
6. Urinate immediately after sexual intercourse to flush out most bacteria from the urethra
7. Empty bladder completely when urinating
8. Drink cranberry juice every day or take capsules prevents common bacteria from sticking
to the walls of the bladder and so preventing infection
9. After visiting toilet, women should clean thoroughly or wipe themselves from front to back.
10. Avoid potential irritants such as perfumed bath oils and vaginal deodorants
11. Always wash before and after sex. Don't douche
12. Wear cotton underwear and avoid wearing tight trousers as this can create a warm, moist,
airless condition around your genitals in which bacteria may thrive
13. Use a lubricant to reduce friction during sex

When to refer
Mild cystitis can be treated effectively by OTC products. Consult a physician when:
a. symptoms do not improve after a few days
b. blood in urine
c. pregnant
d. accompanied by a high temperature, nausea or vomiting
e. pain in your lower back or severe abdominal pain
f. the cystitis keeps coming back
g. problems with urinary system such as kidney stones, difficulty emptying your bladder
or diabetes
h. children abnormality in urinary tract system
i. men enlarged prostate


This article is for educational purpose only. The writer welcomes any feedback, which may be sent to
farmasianis@gmail.com