Cystitis: Prevention, Management and Treatment

Cystitis is a form of urinary tract infection (UTI) particularly affecting the bladder and the urethra. Because of reported cases where in women contract the infection after having their first sexual intercourse or after having a new sexual partner, the term ‘honeymoon cystitis’ was often used in reference to it. But nobody wants to carry any fear with them on that very special night so it is particularly important that one knows and understands some points that will aid in protecting one’s self against this infection.

How can I protect myself?

CystitisCystitis, so as other UTIs, can be very well prevented by implementing some lifestyle modifications, particularly those that pertain to modifiable risk factors such as diet, voiding practices and sexual behavior. The following are some advices that may provide protection against UTI:

  1. Adequate intake of fluid, preferable 6-8 glass every day, is advised to ensure voiding every 3-4 hours. Intake of cranberry juice is also widely known to be helpful in UTI prevention.

  2. Bladder must be emptied as completely as possible during voiding, especially after coitus. An incompletely emptied bladder provides an avenue for the growth of bacteria, thus leading to possible development of infection

  3. Urge to void must never be put off.

  4. Observance of proper hygiene, most especially in female whose urethra is anatomically close to vaginal opening anus, must be observed. This includes appropriate way of washing the female genitalia, i.e. to wipe from front to back and not from back to front. This prevents transfer of bacteria from anus and/or vagina to the urethra.

  5. Frequent changing of sanitary napkin during menstruation is advised.

  6. Tobacco and alcohol consumption are known to cause a direct irritation to the kidney and the bladder. Caffeine and chocolate are also known to worsen symptoms of infection. These irritants are advised to be avoided.

  7. Some sexual behavior may also be amended for protection. For example, voiding before and after sexual intercourse may help prevent UTI. Also, number of sexual partners is suggested to be limited.

What should I do if I suspect I am infected?

A consultation with your physician will be warranted to confirm diagnosis, most likely via urinalysis. If infection is present, the next action will depend on its severity, but both stable and severely ill patients must initiate empirical antibiotic therapy even before results of the culture are obtained and this should be based on their symptoms and urinalysis. The urine sample for culture and sensitivity test, however, must be taken first before start of antibiotic treatment. The initial antibiotic to be administered depends on the patient’s history (e.g. allergies, frequent infection, other medication recently taken) and the prevalence of resistant organism in the community. Later adjustment to the treatment can be done once result of the culture is obtained. For those who present with high fever and chills, hospital admission and immediate intravenous antibiotic treatment may be needed.

How is cystitis treated?

Traditionally, the firs-line therapy for cystitis is trimethoprim/sulfamethoxazole, followed by fluoroquinolone (e.g. ciprofloxacin, norfloxacin,ofloxacin). For pregnant patients, amoxicillin or trimethoprim alone (without sulfamethoxazole) is provided.

If the patient presents with recurrent or persistent infection despite administration of appropriate therapy, further tests must be performed, with possible referral to urologist, to determine if the infection is secondary to structural or functional abnormality.


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