現在位置 : 病症 > 泌尿道感染 - 膀胱炎 - Cystitis

膀胱炎 (Cystitis)
     膀胱炎是指膀胱(urinary bladder)發炎的狀態，在女性較為常見，但各年齡層的男女都可能罹患。
膀胱炎種類
膀胱炎可分為以下幾類：
● 細菌性膀胱炎是最常見的一種膀胱炎，發病原因是身體表面的細菌從尿道口入侵，在膀胱內增殖，常併有頻尿、尿急、排尿灼熱感或疼痛、血尿等症狀。發作的過程大多很迅速，半天之內就會造成嚴重不適，甚至在幾天內蔓延到腎臟而成為急性腎盂腎炎。大腸桿菌是最常引起膀胱炎的細菌之一，尤其在喝水量不足、憋尿的狀況下，更容易讓細菌有機會在膀胱孳生。蜜月膀胱炎特別指年輕女性在性接觸以後罹患膀胱炎，並不限於新婚期。
● 慢性膀胱炎初期也一樣是由細菌感染而起，若是經過治療但不夠完全，排尿不適症狀會一再復發，並且細菌將對抗生素產生抗藥性，增加治療的難度。
● 間質性膀胱炎的患者症狀和一般膀胱炎類似，但各種檢驗均沒有細菌孳生的跡象。患者的膀胱容量變小，一漲尿就會劇痛，尿路動力學檢查可見膀胱的彈性變差。膀胱鏡檢查可發現膀胱重覆灌水再排空後，黏膜下出現分散的絲球狀出血點（glomerulization）。間質性膀胱炎較難治療。
● 輻射性膀胱炎是某些癌症（如子宮頸癌）患者接受放射治療後，膀胱受到池魚之殃，組織彈性差、血管壁較脆弱，歷經年至數十年後容易大量出血。近年由於放射治療的進步，病灶周邊器官承受的劑量較小，輻射性膀胱炎的患者也越來越少。
Picture
膀胱 (Urinary bladder)
Picture
膀胱 (Urinary Bladder)
急性膀胱炎
書田診所泌尿科主任醫師  周固
膀胱的構造與功能
      膀胱是一個中空球體，上接輸尿管，下通尿道。位於恥骨後方的骨盆腔內，能收（縮）能放（鬆），活像人體的蓄水池。在150cc 時即有便意，平均最多可存至400ｃｃ 的尿液。在適當的時機(如厠所)，膀胱廹尿肌便会收縮，而膀胱出口及尿道之括約肌放鬆，讓尿液自然排出。
急性膀胱炎的症狀
     由於女性的尿道很短(約３～４公分)，鄰近又是陰道和肛門，故於房事時易將細菌帶至尿道，造成感染。尿道一旦被感染時，很快便会漫延到膀胱，致使尿及膀胱同時發炎。因此，膀胱炎也稱為尿道膀胱炎。
      發炎初期多出現小便灼熱疼痛，繼而小便頻數，急尿而尿不多。然後小便帶血，尿到最後時小腹劇痛。
急性膀胱炎的診斷與治療
      膀胱炎的診斷，除上述症狀的判斷外，尿液分析及細菌培養是確定診斷的依據。從發炎的小便可驗出過多白血球、紅血球、甚至細菌。輕微或及早發現的話，大量增加喝水量，有時也会痊癒，但是最好還是先檢查小便，再對症下藥最為可靠。一般而言，大量喝水，加上三至五天的抗生素治療，便能药到病除。有時會遇到抗藥性的細菌，則須做細菌培養，以確定其菌種及其敏感之抗生素，來加以治療。
如何才能預防急性膀胱炎？
一、房事前局部須先行清洗由於女性的尿道很短，且開口緊隣陰道與肛門，房事時易將肛門附近的大腸桿菌帶至尿道，造成感染。男性包皮過長易藏汚納圬，因此，在房事前，男女雙方應先行沐浴清洗 。
二、飬成多喝水多小便的習慣細菌停留在體內愈久會增生愈多，若能多喝水產生大量尿液，可將細菌及早沖走，達到不藥而愈的效果。
三、切忌憋小便同理，憋小便使細菌有機可乘，一旦細菌量增生到某個程度時，即會引起發炎。
急性膀胱炎為什麼會解血尿?
書田泌尿科主任   吳季如醫師
      很多病人因為急性膀胱炎解血尿而驚惶不已, 昨日報載知名女星恬妞因為急性出血性膀胱炎, 在沐浴中大量出血染紅了浴缸而被送急診,險些喪命. 急性膀胱炎為什麼會解血尿? 真的嚴重到會大量出血而使人喪命嗎?
      女性由於尿道較短(正常袛有三到五公分)，且在解剖生理上和陰道及肛門袛有一皮之隔, 因此容易感染細菌, 引發急性膀胱炎, 尤其在工作忙碌, 水份攝取不足, 憋尿,身體抵抗力差時更容易發生。夏天由於流汗多, 尿少, 人容易疲勞, 因此膀胱炎就伺機而動了。膀胱是血管相當豐富的器官，急性膀胱炎時, 膀胱黏膜的微血管遭受破壞, 因此大部份病人都會解血尿, 輕者在擦拭時看到血絲, 嚴重者會有大量鮮紅的血尿, 而讓病人驚惶不已。
      但臨床上因單純細菌性膀胱炎大量出血致死的病例相當罕見。事實上, 很多人是因為看到血而被嚇昏了, 而幾十西西的血就有可能將一大缸的水染成鮮紅。一般健康正常的成人失血量在五百西西以內, 都不會有明顯的症狀, 更不可能因此而喪命(常人每次捐血量都在二百五十到五百西西)，因此報載恬妞因為急性出膀胱炎大量出血險些喪命, 可能和事實有些出入，因為袛有婦科癌症(如子宮頸癌)接受放射線照射治療或其它癌症接受特定化學藥物(如cyclophophamide)的治療, 才有可能引起嚴重的出血性膀胱炎, 因大量出血不止而死亡。
      細菌性膀胱炎除了造成血尿, 病人還會有頻尿, 解尿困難, 灼熱及下腹、尿道口疼痛等現象. 在就醫前首要做的是大量飲水, 這樣不但可以很快的讓症狀緩解, 且能使血尿減輕. 很多病人因為小便時灼熱刺痛而不敢喝水, 反而讓病情加重。急性膀胱炎經抗生素治療後, 在一星期內大都能痊癒。
      避免急性膀胱炎的發生最重要的是不憋尿, 多攝取水份, 以及良好的衛生習慣. 女性大小便後的擦拭一定要由前往後擦, 這樣才不會將陰道及肛門口附近的細菌帶到尿道。如果急性膀胱炎的發作和性行為有關, 病人應養成性行為前多喝水, 性行為後立刻解小便的習慣。如果膀胱炎一直反覆發生, 表示病人膀胱黏膜對細菌的抵抗力相當脆弱, 如果不是因為膀胱異物或結石所引起, 可考慮長期服用三至六個月的抗生素, 讓膀胱有休養生息, 重建健康黏膜的機會。
急性膀胱炎 
佛教慈濟綜合醫院泌尿科  　 郭漢崇主任 
 　　 許多婦女可能都有以下的經驗，一覺醒來突然間覺得尿很急，到了廁所卻解不出什麼尿來，好不容易滴了兩滴卻覺得膀胱非常疼痛，用衛生紙擦一下尿道，竟然發現尿道流出血來，看一下馬桶，赫然發現好像月經來了一樣都是血。
 　　 如果有了這種症狀，那你可能就是得到了急性膀胱發炎。急性膀胱炎其實就是細菌侵入膀胱裡面，並且造成膀胱紅腫熱痛的一種發炎症狀。急性膀胱炎與一般的上呼吸道發炎一樣，都是細菌或病毒侵入所造成的器官發炎反應。不過急性膀胱炎通常是來自於腸內細菌，例如大腸桿菌所造成的膀胱發炎。由於急性膀胱炎會造成相當不舒服的症狀，因此大部份的婦女有了這種症狀便會去看醫生。尿液分析可以看見尿中有大量的白血球以及紅血球，有時也會看到一些明顯的桿菌存在。如果作細菌培養，更可以發現這些細菌通常是跟自己的腸內菌一樣的大腸桿菌。
 　　 急性膀胱發炎通常在婦女較常見，男性病人也會有，但是常常發生在老年人。婦女的急性膀胱發炎常常是跟性生活有關，但很多停經後的婦女，由於尿道缺乏荷爾蒙，導致黏膜萎縮，也容易造成細菌侵入，而產生急性膀胱發炎。很多婦女因為害怕頻尿，因此常常會不喝水，使得膀胱裡面尿液減少，如果有細菌侵入膀胱，由於尿液較少、不常排尿，因此細菌容易在裡面有繁殖的機會。當病人有糖尿病，不常排尿或是身體較虛弱的時候，這些細菌就很容易侵入膀胱壁，破壞膀胱表皮細胞而產生急性發炎的症狀。
 　　 大部份婦女的急性膀胱炎，常常是來自於不常喝水、憋尿以及便泌的習慣。不常喝水會使得尿液減少，因此膀胱表面沖洗的機會也會減少，如果碰到經期來潮或是在夫妻行房之後，細菌趁虛而入進入膀胱，便容易造成膀胱發炎。憋尿是一個不好的習慣，憋尿會使得膀胱裡面有很多尿液卻沒有排出。當膀胱過度澎脹、膀胱內壓上升，很容易使得表皮細胞外面的保護膜受到破壞，因此如果有細菌侵入便很容易造成膀胱發炎。便泌在婦女也是相當常見的一種腸胃症狀，由於便泌會造成糞便滯留在直腸裡面時間增長，因此，腸內的細菌繁殖量也會增多。加上便泌會使得直腸擴張，相對的會使得肛門括約肌也會變得較緊，整個骨盆底肌肉也因此而變得緊縮、放鬆不良，因此同樣會造成排尿的時候有尿道外括約肌放鬆不良的情形。這種尿道外括約肌放鬆不良，會使得排尿呈現間歇狀，而在尿道外括約肌收縮的同時，會使得尿液回流，因此病人常常在排尿後，仍然有一些殘尿留在膀胱裡面。而排尿最後括約肌提前收縮，也會使得存留在前段尿道的細菌因此被捲入膀胱裡面，加上膀胱裡有一些殘尿，就會容易產生急性膀胱炎。如果病人又有糖尿病，尿中的糖份增加，更容易使得細菌有機會在裡面繁殖生長，進而產生膀胱發炎。
 　　 急性膀胱炎並不是婦女的專利，有一些男性也會有急性膀胱炎發生，但是這些男性通常是在中年以後，由於膀胱頸功能異常，或是有前列腺腫大，而導致排尿時候膀胱內壓上升，或是排尿後有一些排尿存在。再加上很多中年以上的男性病人也會有糖尿病，因此容易造成尿中細菌得到良好的培養基而繼續繁殖生長，進而產生膀胱炎。
 　　 膀胱發炎，一定要有幾個主要的因素，第一、宿主的抵抗力降低，使得細菌容易破壞身體的防衛機轉，侵入膀胱表面而造成膀胱發炎。第二、排尿時候有較高的壓力，或是排尿後仍然有殘尿存在。第三、不常喝水或者是常常憋尿的習慣。第四、病人不常食用酸性食物，使得尿中呈現鹼性，加上一些導尿管或是膀胱內的結構性改變，都會使得細菌容易有繁殖的機會，進而產生膀胱發炎。
 　　 有些小孩子也會產生膀胱發炎，小孩子的膀胱發炎也常常與排尿習慣不良，或者是有功能障礙型排尿。部份有便泌習慣的小孩子，也容易因為尿道外括約肌較為緊張，而產生排尿後的殘尿，或是排尿時的高壓，進而造成細菌的感染。當然，很多小孩子的膀胱發炎也會伴隨著有膀胱輸尿管尿液逆流而產生急性腎盂腎炎。對於小孩子的膀胱發炎，我們也要進一步去研究是否具有解剖學上的異常，或是膀胱出口功能性的異常所造成。
 　　 急性膀胱發炎除了會產生頻尿、急尿、排尿疼痛，以及排尿後出血等症狀之外，病人也常常會感覺腰酸，或是下腹疼痛的現象。這常常是由於膀胱在發炎的時候會產生腫脹的情形，因此使得輸尿管開口也會造成閉鎖不良。排尿的時候，容易造成輸尿管逆流，或是因為輸尿管開口腫脹，而使得腎臟在輸送尿液的時候得到較高的阻力，而產生腎臟酸痛的現象。
 　　 有了急性膀胱發炎，最好的治療方法便是大量的喝水，並且趕緊就醫，使用抗生素治療。急性膀胱炎的抗生素治療一定要服用藥物七天，才能夠使得膀胱表皮得到復原的機會，以避免反覆膀胱炎的產生。更重要的是，應該要改變生活習慣，多喝水、少憋尿，而且要多食用水果，讓排便順暢。如果有反覆性的急性膀胱炎發作，一定要請醫師詳細檢查是否具有解剖學上或是功能上的異常，只有徹底修正這些不正常的排尿功能及下尿路功能異常，才能避免急性膀胱炎的復發。多食用讓尿液酸化的食物，例如：西瓜、梅類、蔓越梅，也可以減少急性膀胱炎發生的次數。如果病人在一年之內有兩次以上的急性膀胱炎發作，我們一定要進行預防性的治療，每天晚上服用抗菌藥物連續三個月。如果病人同時有膀胱表皮功能異常時，更應該服用藥物來保護膀胱表皮，以避免急性膀胱炎的反覆再發，一再破壞膀胱及造成膀胱壁的纖維化，避免反覆膀胱炎後產生一個攣縮性的膀胱。
泌尿道感染與發燒
 執筆/ 書田泌尿科診所主任 吳國鈞
       在眾多泌尿疾病當中，能引發病患發燒的情形，如果與呼吸道疾病所引發的發燒，相對而言是少了許多。臨床上，常可見到急性上呼吸道感染，當細菌或病毒散佈至血中，或因其釋放之內外毒素，引起患者體溫急劇升高。而尿路疾病，少有因病毒侵入而致病，所以會引起發燒的情況也較少，但如一旦發燒多為高燒且伴隨畏寒、疼痛等症狀，使病患相當痛苦，究竟那些急性泌尿道感染會引起發燒呢？又因男女生殖泌尿系統在解剖學上的差異而有所不同。
       女性因尿道短，生殖、泌尿器官相近，又離肛門不遠，加上因場合限制、月經、性交，常罹患膀胱炎或尿道炎，尤其是出血性膀胱炎，病患會主訴，解血尿甚至血塊，幾乎嚇壞了所有女性病患，然而盡管是疼痛、頻尿、膀胱不適，卻鮮有伴隨發燒，唯一會引發身體過熱，且女性比男性多的疾病就是急性腎盂腎炎了，俗稱腰子發炎，這種情形多先有膀胱、尿道炎未經治療，延誤就醫，使得細菌經淋巴系統來到腎臟，造成臨床上病患單邊或兩側腎臟疼痛，發燒畏寒，全身虛軟等症狀。此時，尿液檢查會出現大量白血球，膿細胞及蛋白尿，發燒的形態也多為陣發性高燒，間雜發冷，燒燒退退，折騰病患數天之久，需立即住院，予以靜脈抗生素治療，加上充分臥床休息，才會逐漸退燒，但口服抗生素必須持續使用約1至2星期，才能治癒。
       男性一樣也會發生急性腎盂腎炎，合併發燒，但臨床症狀較不劇烈，其原因單純因細菌上行性感染較少，多因結石，尿路狹窄引起，治療方式除去其因之外，住院、休息、抗生素治療，療程大體上是相同的，與女性不同的是男性有攝護腺炎，睪丸及副睪丸，嚴格說來，這些非屬泌尿器官，而屬生殖系統，但大都是因泌尿道感染而波及攝護腺本身或因先有尿道炎，細菌由尿道經射精管，儲精囊沿輸精管進入副睪丸造成副睪炎，嚴重時睪丸也一併發炎，上述這些器官急性發炎時也會引發高燒，所不同的是急性攝護腺炎時，因腺體腫脹導至排尿十分困難，甚至在年紀大的病患會有急性尿瀦留而需放置導尿管，肛門指診時會觸摸到一腫大，發燙的攝護腺輕壓就可能產生劇痛，有些病患甚至因劇痛無法接受肛診。
       急性副睪、睪丸炎時，病患的陰囊會比平日大2-3倍，陰囊皮膚紅腫發燙，身體檢查時也會因懼怕疼痛向後閃躲，異常腫大的副睪硬硬的，不太能碰，有時候因睪丸也波及，半邊的陰囊紅腫，熱痛，無法分出睪丸、副睪(副睪的位置是在睪丸的後外側方)。上述病患也多會伴隨發燒、急性疼痛，也都需住院給予靜脈輸液及抗生素治療。
       男性的急性尿道炎，如淋菌性尿道炎，症狀也挺嚇人，除了尿道灼熱疼痛外，也會有白色、黃色甚至楬色分泌流出，但一如女性出血性膀胱炎，症狀雖明顯，令人害怕，但少有發燒。
       總結以上所言，當病患有尿路感染合併發燒時，在女性先考慮是否為急性腎盂腎炎，而男性除了該症之外，應檢查肛門是否有急性攝護腺炎，或叫病患脫褲，看看陰囊是否有副睪、睪丸炎，再者不論男女，有發炎便是警訊，不論是何種急性感染，大多需住院治療，病患千萬勿輕忽，否則會因急性發炎不治引起腎功能減損，或危及生殖系統，造成慢性攝護腺炎，不孕等麻煩疾病。

Acute Cystitis (急性膀胱炎)
MedilinePlus
       Acute cystitis is an infection of the bladder or lower urinary tract. Acute means that the infection begins suddenly.
Causes
       Cystitis is caused by germs, most often bacteria. These organisms enter the urethra and then the bladder and can cause an infection. The infection commonly develops in the bladder. It can also spread to the kidneys.
       Most of the time, your body can get rid of these bacteria when you urinate. But, the bacteria can stick to the wall of the urethra or bladder, or grow so fast that some stay in the bladder.
       Women tend to get infections more often than men. This happens because their urethra is shorter and closer to the anus. Women are more likely to get an infection after sexual intercourse or when using a diaphragm for birth control. Menopause also increases the risk for a urinary tract infection.
       The following also increase your chances of having cystitis:
● A tube called a urinary catheter inserted in your bladder
● Blockage of the bladder or urethra
● Diabetes
● Enlarged prostate, narrowed urethra, or anything that blocks the flow of urine
● Loss of bowel control (bowel incontinence)
● Older age (especially in people who live in nursing homes)
● Pregnancy
● Problems fully emptying your bladder (urinary retention)
● Procedures that involve the urinary tract
● Staying still (immobile) for a long period of time (for example, when you are recovering from a hip fracture)
       Most cases are caused by Escherichia coli (E. coli), a type of bacteria found in the intestines.

Symptoms
       The symptoms of a bladder infection include:
● Cloudy or bloody urine
● Strong or foul smelling urine
● Low fever (not everyone will have a fever)
● Pain or burning with urination
● Pressure or cramping in the lower middle abdomen or back
● Strong need to urinate often, even right after the bladder has been emptied
       Often in an elderly person, mental changes or confusion are the only signs of a possible urinary tract infection.

Exams and Tests
       In most cases, a urine sample is collected to do the following tests:
● Urinalysis. This test is done to look for white blood cells, red blood cells, bacteria, and to check for certain chemicals, such as nitrites in the urine. Most of the time, your health care provider can diagnose an infection using a urinalysis.
● Urine culture. A clean catch urine sample may be needed to identify the bacteria in the urine and decide on the correct antibiotic.

Treatment
       Antibiotics taken by mouth are most often given to prevent the infection from spreading to the kidneys.
● For a simple bladder infection, you will take antibiotics for 3 days (women) or 7 - 14 days (men). For a bladder infection with complications such as pregnancy or diabetes, or a mild kidney infection, you will most often take antibiotics for 7 - 14 days.
● It is important that you finish all the antibiotics prescribed, even if you feel better before the end of your treatment. People who do not finish their antibiotics may develop an infection that is harder to treat.
● Your health care provider will also want to know if you are pregnant.

       Your health care provider may prescribe medicines to ease discomfort. Phenazopyridine hydrochloride (Pyridium) is the most common of this type of drug. You will still need to take antibiotics.
       Everyone with a bladder infection should drink plenty of water.
       Some women have repeat bladder infections. Your health care provider may suggest treatments such as:
•Taking a single dose of an antibiotic after sexual contact may prevent these infections if they occur after sexual activity.
•Keeping a 3-day course of antibiotics at home to use for infections, based on their symptoms.
•Taking a single, daily dose of an antibiotic to prevent infections.

       Over-the-counter products that increase acid in the urine, such as ascorbic acid or cranberry juice, may be recommended. These medicines lower the concentration of bacteria in the urine.
       Follow-up may include urine cultures to make sure the bacterial infection is gone.
       Lifestyle changes may help prevent some urinary tract infections.

Outlook (Prognosis)
       Most cases of cystitis are uncomfortable, but go away without complications after treatment.

When to Contact a Medical Professional
       Call your health care provider if:
• You have symptoms of cystitis
• You have already been diagnosed and symptoms get worse
•You develop new symptoms such as fever, back pain, stomach pain, or vomiting.

Alternative Names
       Uncomplicated urinary tract infection; UTI - acute; Acute bladder infection; Acute bacterial cystitis
Acute Infective Cystitis
Healthline
Overview
       Acute infective cystitis is an inflammatory condition in your urinary tract system. It can affect your bladder or the lower portion of your urinary tract. The bladder is a muscular reservoir that holds urine.
Causes
       What Causes Acute Infective Cystitis?
       Normally, harmful organisms leave the body when you urinate. Sometimes these bacterial organisms do not leave the urethra and travel back into your bladder.
       Bacteria are the main cause of acute infective cystitis. Bacteria and other organisms may enter the bladder through the urethra, an opening in the genitals that allows urine to pass out of the body. Infection may spread from the bladder to the kidneys. Acute infections of the bladder and urinary tract cause immediate symptoms.
       Rapid growth of bacteria and other organisms spread throughout the bladder’s tissues. Bacteria stick to the bladder walls. If left untreated, the bacteria can travel up the ureters (tubes connecting the bladder to the kidneys) and attack the tissue of the kidneys.

Risk Factors
       Who Is at Risk for Acute Infective Cystitis?
       If you are female, you are more at risk for infections of the bladder and urethra because your urethra is smaller. It is much closer to the anus as well. Bacteria can travel from the anus to the urethra.
Other common risk factors:
Blockages
       Blockages in the urethra or bladder can keep bacteria inside the body and prevent urine from leaving the body.
Urine Retention
       Urine retention can weaken the muscles of the bladder. A weak bladder may not release enough urine through the urethra and cause problems in the bladder’s tissue. Bacteria can enter the weakened tissue and trigger inflammation.
Prostate Gland Problems
       If you are a male with prostate problems, you may want to speak to your
doctor about ways to prevent bladder infections. An enlarged prostate gland can press against the urethra and cause it to narrow. This can trap bacteria in the urethra.
Symptoms
       The following symptoms are common with acute infective cystitis:
•pain while urinating
•the inability to urinate or the release of only a small amount
•urine that appears cloudy or bloody
•urine that smells strong or bad
•cramps in the pelvis or lower back
•the excessive need to urinate

Diagnosing Acute Infective Cystitis
       A doctor may diagnose acute infections of the bladder and/or urinary tract by first performing a physical examination. The doctor will look for signs of infection such as tenderness at the site and fever.
       Other tests your doctor may do include:
•a urinalysis to check your urine for bacteria and other organisms.
•blood tests to look for increased white blood cells. White blood cells indicate infection in the body.
•a urine culture to analyze the urine for signs of infection. It usually takes 24 to 48 hours for results.

Treatment
       Acute infective cystitis requires medication for treatment.
Medications
       Antibiotics may be prescribed to clear up the infection. Antibiotics may be taken for several days or up to two weeks.
       To treat mild acute infective cystitis:
•If you are female, you may need to take antibiotics for three days.
•If you are male, you may need to take antibiotics for seven to 14 days.
       To treat special cases:
•Pregnancy may require taking antibiotics for seven days or more.
•If you have a special condition like diabetes, you may need medication for a week or more.

Home Care
       You should drink plenty of water to help rid the bladder and/or kidneys of infection. Acidic products, like cranberry juice, may help as well. Bacteria may not thrive well in acidic conditions.
The Long Term
What Is to Be Expected in the Long Term?
       In most cases, acute infections of the bladder may clear up before you finish taking your antibiotics. Be sure to finish all prescribed medications to prevent other infections. Your doctor may request follow-up appointments to make sure an infection is clear.
Prevention
       You may prevent acute infective cystitis by drinking plenty of water on a daily basis. If you are female, strive for eight to 10 glasses a day. If you are male, try to drink 10 to 13 glasses a day.

Chronic Cystitis (慢性膀胱炎)
What Are The Causes Of Chronic Cystitis?
      Chronic cystitis is a recurrent bladder infection. Women get it more often than men. The main symptoms are recurring pain when peeing and a constant urge to go to the bathroom. Acute cystitis is usually caused by bacterial infection, but they can also be caused by an underlying disease (e.g. diabetes) .
      Chronic cystitis is more common in women over 30 and even more so in women in their 50s. The problem is that very often, there is no obvious cause for the chronic infection, which makes it difficult to treat. However, the first line treatment for cystitis is the same, regardless of whether it is acute of chronic.
What Causes Chronic Cystitis?
      Bladder infections happen when bacteria such as E. coli, which usually live in the bowel, get into the urethra and migrate to the bladder where they multiply and cause an infection. These bacteria are regularly passed with excrement and can be found on the skin around the anus.
      When women wipe their bottom from back to front (instead of front to back), they move these bacteria closer to the opening of the urethra. Since the urethra in women is very short, it is easy for bacteria to reach the bladder and start an infection in an environment that is normally “germ-free”. However, this is not the only reason that cystitis occurs.

Other Causes Of Chronic Cystitis & Risk Factors
      The natural acidity of the vaginal area normally prevents bacteria from multiplying in this area. However, if this natural defense system is weakened, bacteria can thrive and enter the urethra. A weak immune system can be one of the causes of chronic cystitis, especially if the infection develops and spreads to the kidneys. There are several risk factors which can facilitate recurrent bladder infections:
• Bladder or kidney stones
• Diabetes
• Congenital abnormalities in the urinary tract that can cause incomplete emptying of the bladder
• Recent urological operations
      It seems that the lower urinary tract (from the bladder to urethra) reacts to oestrogen levels, which may explain why some women get recurrent bladder infections after the menopause – a time during which hormonal changes occur.

How Common Is Chronic Cystitis?
      Chronic cystitis affects 5% of women who seek medical help for cystitis each year. However, about one in five women will get a re-infection, mostly because of poor hygiene or sexual activity. The risk of chronic cystitis increases with age, especially from the age of 60 onwards.

Recurrent Bladder Infections In Men
      There is very little research on the causes of chronic cystitis in men, because it’s a very rare condition. There are, however, some factors which are suspected to contribute to recurrent bladder infections in men:
• Sexually transmitted infections, specifically chlamydia
• Prostate infection (prostatitis) and other issues with the urinary tract that usually appear in men in their 50-60s
• Kidney stones
Please note that DrEd only offers cystitis treatment for women.

Treatment For Chronic Cystitis
      Antibiotics are the most common treatment for chronic bladder infections. If your symptoms are mild, your GP might ask you to wait for the results of a urine test. This way, your doctor can prescribe the most suitable antibiotic for fighting the bacteria which are causing your infection.
      In some cases, women are given antibiotics in advance (usually a 3-day course) so that they can treat their infection without having to visit their doctor. If antibiotics seem to work well for you but your bladder infection keeps on coming back, you doctor may give you a long-term antibiotic treatment which consists of a much lower dose. Some patients need to take this every day for several months (from 6-24 months). You can order trimethoprim or nitrofurantoin online from DrEd. Our online doctor will review your request and confirm whether you can take an antibiotic for your bladder infection.

When Antibiotics Fail
      Sometimes, antibiotics may fail to cure recurrent bladder infections. You should consider consulting your GP if this happens. You may need to undergo further tests before your GP can determine the cause of infection.
      You should follow these recommendations:
• Drink plenty of fluids (preferably water)
• Go to the toilet whenever you need to
• Wipe your bottom from front to back (not from back to front)
• Avoid irritating your anus and vagina while washing – use water and avoid using soap
• Avoid using a diaphragm and spermicide as well as anything that “messes” with your normal vaginal balance
• Pee after sex in order to remove any bacteria transferred during sex

      Many women report, that cranberry juice helps their cystitis. A 2011 study suggests, that you would need quite a lot of cranberry juice to effectively protect your bladder. However, cranberry capsules can be effective in preventing chronic cystitis. Be careful if you are taking blood thinning medication, because cranberry juice can interact with it.
      Women who have had infectious cystitis (with lab tests confirming the presence of bacteria) at least three times in six months should see their doctor or a urologist to establish the cause and find the best treatment.

Causes Of Severe Cystitis
      Sometimes it remains unclear why some women suffer from severe bladder infections. However, severe cystitis can occur when pre-existing conditions worsen or cause the infection. Women who suffer from diabetes, a blockage in the kidney or bladder (e.g. stones, congenital abnormalities) as well as women who have problems emptying their bladder, are more likely to suffer from severe cystitis.
       The symptoms of severe cystitis are largely the same as those of a “normal” cystitis, but often more intense. They include: the urge to urinate very frequently, pain during urination, cloudy and smelly urine, pain in the flanks or back. The treatment options are also similar, although it helps to have a urine sample tested to ensure that your doctor can prescribe the most suitable antibiotic.