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Cystitis - noninfectious

Abacterial cystitis; Radiation cystitis; Chemical cystitis; Urethral syndrome - acute; Bladder pain syndrome; Painful bladder disease complex; Dysuria - noninfectious cystitis; Frequent urination - noninfectious cystitis; Painful urination - noninfectious; Interstitial cystitis

Cystitis is a problem in which pain, pressure, or burning in the bladder is present. Most often, this problem is caused by germs such as bacteria. Cystitis may also be present when there is no infection.

Causes

The exact cause of noninfectious cystitis is often not known. It is more common in women as compared to men.

The problem has been linked to:

• Use of baths and feminine hygiene sprays
• Use of spermicide jellies, gels, foams, and sponges
• Radiation therapy to the pelvis area
• Certain types of chemotherapy drugs
• History of severe or repeated bladder infections

Certain foods, such as spicy or acidic foods, tomatoes, artificial sweeteners, caffeine, chocolate, and alcohol, can cause bladder symptoms.

Symptoms

Common symptoms include:

• Pressure or pain in the lower pelvis
• Painful urination
• Frequent need to urinate
• Urgent need to urinate
• Problems holding urine
• Need to urinate at night
• Abnormal urine color, cloudy urine
• Blood in the urine
• Foul or strong urine odor

Other symptoms may include:

• Pain during sexual intercourse
• Penile or vaginal pain
• Fatigue

Exams and Tests

A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs). Urine may be examined under a microscope to look for cancerous cells.

A urine culture (clean catch) is done to look for a bacterial infection.

A cystoscopy (use of lighted instrument to look inside the bladder) may be done if you have:

• Symptoms related to radiation therapy or chemotherapy
• Symptoms that do not get better with treatment
• Blood in the urine

Treatment

The goal of treatment is to manage your symptoms.

This may include:

• Medicines to help your bladder relax. They can reduce the strong urge to urinate or need to urinate frequently. These are called anticholinergic drugs. Possible side effects include increased heart rate, low blood pressure, dry mouth, and constipation. Another class of drug is known as a beta 3 receptor blocker. Possible side effect can be an increase in blood pressure but this does not occur often.
• A medicine called phenazopyridine (pyridium) to help relieve pain and burning with urination.
• Medicines to help reduce pain.
• Surgery is rarely done. It may be performed if a person has symptoms that do not go away with other treatments, trouble passing urine, or blood in the urine.

Other things that may help include:

• Avoiding foods and fluids that irritate the bladder. These include spicy and acidic foods as well as alcohol, citrus juices, and caffeine, and foods that contain them.
• Performing bladder training exercises to help you schedule times to try to urinate and to delay urination at all other times. One method is to force yourself to delay urinating despite the urge to urinate in between these times. As you become better at waiting this long, slowly increase the time intervals by 15 minutes. Try to reach a goal of urinating every 3 to 4 hours.
• Avoid pelvic muscle strengthening exercises called Kegel exercises.

Outlook (Prognosis)

Most cases of cystitis are uncomfortable, but the symptoms most often get better over time. Symptoms can improve if you are able to identify and avoid food triggers.

Possible Complications

Complications may include:

• Ulceration of bladder wall
• Painful sex
• Sleep loss
• Depression

When to Contact a Medical Professional

Contact your health care provider if:

• You have symptoms of cystitis
• You have been diagnosed with cystitis and your symptoms get worse, or you have new symptoms, especially fever, blood in the urine, back or flank pain, and vomiting

Prevention

Avoid products that may irritate the bladder such as:

• Bubble baths
• Feminine hygiene sprays
• Tampons (especially scented products)
• Spermicidal jellies

If you need to use such products, try to find those that do not cause irritation for you.

Related Information

Urinary tract infection - adults
Radiation therapy
Chemotherapy
Interstitial cystitis
Urethral stricture
Bladder cancer
Anemia

References

American Urological Association website. Diagnosis and Treatment Interstitial Cystitis/Bladder Pain Syndrome (2022). www.auanet.org/guidelines/guidelines/diagnosis-and-treatment-interstitial-cystitis/bladder-pain-syndrome-(2022). Accessed June 20, 2022.

Hanno PM, Erickson D, Moldwin R, Faraday MM; American Urological Association. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193(5):1545-1553. PMID: 25623737. pubmed.ncbi.nlm.nih.gov/25623737/.

Moldwin RM, Hanno PM. Interstitial cystitis/bladder pain syndrome and related disorders. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 57

National Institute of Diabetes and Digestive and Kidney Diseases website. Interstitial cystitis (painful bladder syndrome). www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome. Updated July 2017. Accessed May 26, 2022.

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Review Date: 1/1/2022  

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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