What is cystitis?

Cystitis is the inflammation and irritation of the bladder. It is a very common infection for women fortunately for men it is rarer. It can also be known as the honeymoon disease, or a UTI (urinary tract infection).

The organs which are involved with producing and excreting urine consist of your kidneys, which filter the waste (urine) from the blood, tubes which then carry the urine from your kidneys to the bladder. This is where the urine is stored you will know when you need to excrete the urine when your bladder feels full. The urine leaves the body via the urethra this in men is much longer than in women which is why women tend to get cystitis. The bacteria usually caused by E.Coli (Escherichia coli) which is found around the anus and genital area, can travel up the urethra and begin to multiply. Normally urine is sterile and does not have any harmful bacteria in it; once the bacteria have invaded the bladder it multiplies quickly causing all the symptoms of bacterial cystitis.

Occasionally other factors can imitate the irritation of cystitis Thrush can cause mild pain when passing urine. Bubble baths, douching, highly perfumed soaps and deodorants may all cause irritation and inflammation.

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• Only lasts a few days
  
  
• Frequency and pain when emptying the bladder
  
  
• Bacteria shows up on urine test
  
  
• Antibiotics are used to treat this condition
  

• This condition is ongoing with no breaks or relief
  
  
• Pain and discomfort, continuously aware of  bladder
  
  
• Brief relief when passing urine
  
  
• Never-ending frequency
  
  
• Short term antibiotics have no affect

• Frequent urge to pass urine(empty the bladder)
• A burning sensation when passing urine
• Pain when urinating ( called dysuria)
• A pressing urgent need to pass urine
• Blood in the urine (called haematuria)
• Cloudy urine
• Strong smelling urine
• Low pelvic dragging pressure
• Passing only small amount of urine
• Painful sexual intercourse
• A mild temperature
• General tiredness and feeling unwell

• Urinalysis: This is the analysing of a specimen of urine in the laboratory to detect specific substances, to assist the doctor in the diagnosis.
• Urine Culture: This is done to grow and identify the bacteria present in the urine
• Urine Cytology: This is a test in a laboratory, which is done to detect cancer cells, which may indicate if you have a bladder, ureteral (the tubes which carry the urine from you kidneys to your bladder) or Kidney cancer.
• Urodynamics: This is a test which is done with a continence advisor to assess and measure the bladder’s ability to hold and release urine.
• A Cystoscopy: This is an examination which is carried out with a local anaesthetic or with a general anaesthetic a flexible cystoscope can be used with a local anaesthetic and a rigid cystoscope with a general anaesthetic.
  
  
• A flexible cystoscopy procedure: is usually done as a day case or outpatient procedure which means you usually do not have to remain in hospital overnight. The procedure only takes about ten minutes to complete. You will be asked to either change into a gown or to remove your clothes from the waist down and then asked to get on to a theatre trolley or procedure couch you will be covered with a blanket or sheet  to maintain your dignity until the procedure commences.
  
  You will be positioned as if you are having a smear test if you are women and lying on your back if a man. The procedure involves the doctor cleaning the genital area with a mild antiseptic solution, and a local gel anaesthetic inserted into the urethra (the tube from your bladder to outside your body).
  
  The cystoscope is like a long flexible tube which has a fiberoptic light source allowing the doctor to see inside your bladder. The width of the scope is about the size of a pencil and can pass into the urethra and then into the bladder with ease. Some men find it a bit of a toe curler as it passes through the area surrounded with the prostate gland. Once the scope is in the bladder the doctor may fill the bladder with warm fluid and will be able to assess the condition of your bladder and take biopsies if necessary to be sent to the laboratory for analysis. 

• A rigid cystoscopy operation: This examination is carried out under a general anaesthetic and usually undertaken after a flexible cystoscopy has been done, or the consultant has decided this would be the best course of action for you. Perhaps the urine cytology has suggested that their may be cancer cells present in which case a rigid cystoscopy would be done initially to  be able to examine, take biopsies and treat if appropriate in the one procedure. You will be asked not to eat or drink anything prior to arriving at the hospital for this operation, and then once admitted to the ward or day case unit will be asked to change into a gown. You will have already spoken to the surgeon previously with regards to your consent for the operation but if you have any further questions or clarification needed they will be more than happy to speak to you.
  
  You will be seen by the anaesthetist who will ask you a variety of questions to ensure you are fit enough for the anaesthetic.  If you have any existing problems with your hips or knees please inform the nursing staff prior to the procedure commencing. When it is time you will be taken into the anaesthetic room and anaesthetised. You will be positioned on the operating table once you are anaesthetised with your legs up in lithotomy position (lying on your back with your hips and knees flexed with feet held in supports) This allows the surgeon to be able to get a good view of your bladder with the cystoscope.
  
  During the procedure the surgeon will be able to see if there is any narrowing or obstructions in men’s urethra, check that the  lining of the bladder is not damaged, is inflamed or has any growths, tumours or calculi (stones) present. They are able to measure your bladder capacity (how much urine you can hold), take bladder biopsies (tissue samples), and able distend your bladder (to increase your bladder capacity). Once the operation is over you will be taken into the recovery room where you will slowly recover. You may have a catheter (a thin flexible tube) in your bladder after the operation to wash the bladder out.

• After the procedure Once you have had either a rigid or flexible cystoscope you may experience burning or stinging when you empty your bladder and you may notice blood in your urine. Both of these will pass in time, if the bleeding becomes heavy or does not stop after twenty four hours, or it becomes difficult to empty your bladder you must contact the hospital where you had the procedure done or your own doctor.
  
  You will be advised to drink plenty of fluids and may be given antibiotics to take to prevent any infection which you may occur. You can rest after the procedure for a while and if you’re lucky you will be offered a cup of tea, whilst the nursing staff organise your discharge letter for your GP and any medications which you may need to take home with you.
  
  You should not return to work after this procedure but take it easy at home resting for the day. If you have had a general anaesthetic you should not drive, operate machinery or make any important decisions for at least for 24hrs.

• It is best to take the sample after you have bathed or showered or alternatively wash the penis or vulva (fleshy folds or lips) area with mild soap and water and dry prior to taking the sample ( this helps to prevent the specimen becoming contaminated)
  
  
• Make sure you understand your instructions for specimen collection i.e. if you need to fill the pot to a certain level, or if it needs to be collected at a certain time in the day.
  
  
• Do not open the pot until you are ready to use it- to reduce the chance of it becoming contaminated
  
  
• Try to arrange for the specimen to be given in to the doctor’s surgery within one to two hours of it being taken.
  
• Keep the specimen in the fridge in a plastic bag if you are not able to take it straight away.

• After you have cleaned/washed the vulval area
  
• Wash your hands
  
• Open the sterile container remembering not to touch the inside
  
• Sit right back on the toilet seat with legs apart
  
• Open your vulval lips with one hand keep them apart throughout collection of sample
  
• Begin to empty your bladder into the toilet
  
• With your other hand hold the specimen pot at an angle about an inch away from the urethra  and collect your sample in the middle of the  flow of urine
  
• Release the folds of your vulva and finish urinating in the toilet
  
• Screw the lid on the container
  
• Wash your hands again
  
• If not taking the specimen to the doctors surgery right away place in a plastic bag in your fridge.

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• After you have washed the head of your penis (you will need to retract your foreskin if you have one)
• wash your hands
• Open the sterile container remembering not to touch the inside
• Retract the foreskin
• begin to empty your bladder into the toilet
• Pick up the container and holding it at an angle about an inch away from the end of the penis collect your sample of urine whilst urinating.
• Finish emptying your bladder
• Screw the lid securely on the container
• Wash your hands again
• If not taking the specimen to the doctors surgery right away place in a plastic bag in your fridge
  

• Taking showers rather than baths
• Washing your genital region daily with mild soap and water dry well, to prevent soreness
• Not using spermicides or feminine hygiene sprays as these can irritate
• After having your bowels open make sure you wipe from front to the back to prevent the bacteria entering the urethra.
• Drinking plenty of fluids is good as dehydration is one of the main problems of people with cystitis. The Food Standards Agency advise that the average adult should take in 1.5-2 litres of water in a typical day, this would equate to 6-8 (250ml) glasses or 4 x 500ml sports water bottles per day. This also depends on you age weight and the weather conditions; if it is hot you will need to drink more.
• Not waiting or hanging on before going to the toilet to empty your bladder
• Once you have had sexual intercourse try and empty your bladder to flush out any bacteria which may have entered the urethra.