The diagnosis of urinary infection rests on the urinalysis and urine culture results. The presence of moderate to large numbers of white blood cells, along with at least 100,000 colonies of any one type of bacteria in a culture, provides conclusive evidence of infection.

Not infrequently, it is difficult to determine which part of the urinary tract is infected, or if there is infection at all. In women, some white blood cells and bacteria are usually present at the opening of the urethra. Therefore, in order to keep the urine specimen free of these contaminants, a midstream specimen is usually requested. The first spurt of urine is thought to wash away the urethral contaminants, and the rest of the urine sample is then normally uncontaminated.

For the vast majority of cases of simple cystitis, this procedure is adequate; however, if a question exists as to the validity of the specimen or if for some reason the specimen must be absolutely free of contaminants, a catheter (thin, flexible tube) may be inserted into the bladder through the urethra.

In women, this is an easy procedure and eliminates vaginal and anal contaminants. If the catheter-obtained specimen is free of pus and bacteria, the symptoms are the result of another condition -- commonly vaginitis or urethritis.

In a man, the procedure is somewhat more difficult and often not necessary. If prostatitis is the suspected cause of the infection, the physician can insert a gloved finger into the anus and feel the gland directly. A specimen of prostatic fluid is usually obtained (by massaging the gland at the time of examination) through the urethra for culture.

In difficult chronic cases of cystitis in both men and women, in which the cause of recurring infection may be an obstruction (such as from a kidney stone) or a drainage problem, special X-ray studies are necessary; contrast material is placed in the bladder by means of a catheter, and X-ray pictures are taken of the bladder and the urethra during urination. With such studies, narrowing of any portion of the urethra, the presence of kidney stones, and incomplete emptying of the bladder (which promotes cystitis) can be detected. The bladder can also be examined through cystoscopy (examination by means of a flexible, lighted, tubelike instrument called a cystoscope, which is inserted through the urethra). These procedures may be preceded by imaging studies, such as ultrasound scans, computed tomography (CT) scans, or magnetic resonance imaging (MRI).

Treatment

Treatment of first-time cystitis is usually by means of oral antibiotic medications. Recurrences may be treated in the same way if they are caused by a different organism. If the same organism is causing the trouble again, the condition may require larger doses of the medication or long-term treatment. (Daily doses of medications may be necessary for six months or more.) It is important that dosage instructions be followed exactly, because a person is vulnerable to a new infection or reinfection if the entire course of recommended drug therapy is not completed.

Some individuals are prone to repeated episodes of cystitis or upper urinary tract infections. If there is an anatomic defect, such as a narrowed urethra, dilation (enlarging) of it may be needed. If stones are present, they may have to be removed. If the source of infection is the prostate gland, antibiotics are usually tried first; surgery is a last resort. If no obvious cause of recurrent cystitis is found, low doses of antibiotics may be prescribed for long periods of time (this is called prophylactic, or preventive, therapy).

Prevention

Women may be able to guard against recurrent cystitis by front-to-back wiping with toilet tissue and by cleansing with soap and water after each bowel movement. They should also try to urinate immediately after sexual intercourse to wash away infecting bacteria that might enter the urethra. Loose, absorbent underclothes allow evaporation and absorption of body fluids and thus help prevent infection. Both men and women should drink plenty of fluids and urinate frequently, completely emptying the bladder each time.

Now that we have reviewed the specifics of cystitis, you can be more informed if you need to speak to a medical professional.

Publications International, Ltd.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.