Chemical cystitis

Alternative names 
Abacterial cystitis; Radiation cystitis; Cystitis - noninfectious; Urethral syndrome - acute

Definition

Noninfectious cystitis is an irritation of the bladder not caused by a urinary tract infection. Causes include radiation therapy to the pelvis area, chemotherapy with certain types of medications, and other irritants. Symptoms are similar to those caused by a urinary tract infection.

Diagnosis of noninfectious cystitis is usually made when no bacteria can be identified as the cause of the symptoms.

Causes, incidence, and risk factors

Noninfectious cystitis is most common in women of childbearing years. The exact cause of noninfectious cystitis is often unknown. However, use of bubble baths, feminine hygiene sprays, sanitary napkins, and spermicidal jellies may be possible causes.

Radiation therapy of the pelvic organs or chemotherapy medications may also cause noninfectious cystitis.

See also Interstitial cystitis.

Symptoms

     
  • Pressure in the lower pelvis  
  • Urination, painful (dysuria)  
  • Frequent need to urinate (frequency)  
  • Urgent need to urinate (urgency)  
  • Decreased ability to hold urine  
  • Need to urinate at night  
  • Abnormal urine color - cloudy  
  • Blood in the urine (hematuria)  
  • Foul or strong urine odor

Additional symptoms that may be associated with this disease:

     
  • Pain during sexual intercourse  
  • Penile pain  
  • Flank pain  
  • Fatigue

Signs and tests

A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs).

A urine culture (clean catch) or catheterized urine specimen will not reveal any bacteria in the urine.

Treatment

Treatment of noninfectious cystitis centers on management of symptoms rather than providing a cure.

MEDICATIONS:
Noninfectious cystitis is often treated with anti-cholinergic drugs that improve bladder contraction and emptying. Possible side effects include slowed heart rate, low blood pressure, increased thirst, and stomach discomfort.

Sometimes muscle relaxants (such as diazepam) and alpha 1-blockers (prazosin) may be used to decrease the symptoms of urgency (strong urge to urinate) and frequency (need to urinate frequently).

SURGERY:
Surgery is rarely performed unless an individual experiences severe urinary retention, or significant hematuria (blood in the urine).

DIET:
Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and caffeine.

OTHER THERAPY:
Bladder retraining exercises to re-establish a pattern of regular and complete urination may be recommended. Bladder re-training is achieved by developing a schedule of times when you should try to urinate, while trying consciously to delay urination in between these times. One method is to force yourself to urinate every 1 to 1 and 1/2 hours, despite any leakage or urge to urinate in between these times. As you become skilled at waiting this long, gradually increase the time intervals by 1/2 hour until you are urinating every 3 to 4 hours.

Pelvic muscle strengthening exercises called Kegel exercises are used primarily to treat people with stress incontinence. However, these exercises may also be beneficial in relieving the symptoms of urgency related to chronic noninfectious cystitis. The success of Kegel exercises depends on proper technique and adherence to a regular exercise program.

Electrical stimulation to the pelvis may be used as a treatment for noninfectious cystitis, but this is controversial.

MONITORING:
If the cystitis is related to radiation therapy or chemotherapy, serial urinalysis and cystoscopy (use of lighted instrument to look inside the bladder) exams may be necessary to evaluate possible complications of the initial treatment.

Expectations (prognosis)
Although most cases of cystitis are uncomfortable, they usually resolve over time.

Complications

     
  • Ulceration of bladder wall  
  • Urethral stricture  
  • Diminished bladder capacity  
  • Bladder cancer  
  • Anemia

Calling your health care provider
Call your health care provider if symptoms indicate that cystitis may be present, symptoms worsen, or new symptoms develop, especially fever, back or flank pain, and vomiting.

Prevention
Avoid using items that may be irritants, such as bubble baths, feminine hygiene sprays, sanitary napkins or tampons (especially scented products), and spermicidal jellies. If you need to use such products, try to find those that do not cause irritation for you.

Johns Hopkins patient information

Last revised: December 3, 2012
by Levon Ter-Markosyan, D.M.D.

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