Acute Cystitis – Symptoms and Treatment

Disease Definition and Causes

Acute cystitis is an acute inflammatory process in the wall of the urinary bladder, primarily involving the mucous membrane. However, there are also rare non-infectious forms of the disease associated with physical influences, such as repeated exposure to radiation during radiation therapy, which can be a common cause of acute radiation cystitis.
In the typical course of the disease, the patient’s general condition remains acceptable, with many patients continuing their daily lives normally.

Key Symptoms:

  • Lower abdominal pain
  • Painful and frequent urination
  • Presence of blood in the urine
  • Cloudiness and dark coloration of urine

Cystitis in Women

Women primarily suffer from acute cystitis. It mostly occurs in non-pregnant girls before menopause who do not have anatomical or functional disorders in the urinary tract, and also in cases of good health. Transient urinary symptoms in elderly women are not necessarily due to cystitis.
Why is this disease more common in women? This is related to the anatomical and physiological structure of the female body, where the female urethra is shorter, and the external urethral orifice is closer to the rectum than in males. Half of the women worldwide experience cystitis at least once in their lifetime.

Causes and Risk Factors of Acute Cystitis
In most cases, bacterial activity leads to the development of acute cystitis:

  • Escherichia coli (E. coli) – 70-95%
  • Occasionally Staphylococcus spp. – 10-20%
  • Klebsiella pneumoniae
  • Proteus mirabilis

Factors contributing to the occurrence of acute cystitis include:

  • Injury to the mucous lining of the bladder.
  • Venous dilation in the pelvic area and venous congestion as a result.
  • Hormonal imbalance in the body.
  • General cooling (catching a cold).
  • Diabetes mellitus.
  • Sexually transmitted infections.
  • Weak physical activity.
  • Obesity.
  • Urinary stone disease.
  • Anomaly in the structure of the urinary tract.
  • Prolonged standing with a urinary catheter.

Pregnancy also increases the risk of acute cystitis – the effect of progesterone hormone and pressure on the bladder by the uterus hinder the emptying process of the bladder, leading to its enlargement and urine retention. During pregnancy, the amount of blood passing through the kidney filters increases daily, and the pressure on the kidney tubules becomes excessive, leading to a deterioration in glucose absorption (transferring glucose from urine to blood), creating a suitable environment for bacterial growth.

In the case of men, acute cystitis rarely occurs and is often a complication of another disease, such as urethritis or prostatitis, and also as a result of prostate enlargement.

Symptoms of Acute Cystitis
The onset of acute cystitis symptoms is sudden, as the disease can develop within a few hours.

Most common manifestations of acute cystitis include:

  • Painful and frequent urination (more than 6-8 times a day)
  • Urinating in small amounts
  • False urge to urinate
  • Itching during urination
  • Lower abdominal pain, above the pubic area in the bladder region, sometimes radiating to the perineum
  • Rarely/sometimes presence of blood spots in the urine
  • Rarely/sometimes a slight increase in body temperature (37-37.5°C)
  • Cloudy urine with a foul odor

Often, symptoms of acute cystitis in young women may be associated with sexual activity, the appearance of a new sexual partner, the use of chemical contraceptives, kidney stones, urinary tract abnormalities, diabetes, and others.

Classification and stages of acute cystitis development:

  • Infection: bacterial, viral, fungal
  • Non-infectious: medicinal, radiation, toxic, chemical, parasitic, allergic

Inflammatory Process:

  • Acute
  • Recurrent: up to three times within six months
  • Chronic (periods of exacerbation and remission): usually detected with only one symptom – frequent urination


  • Inflammatory (superficial): limited inflammation in the mucosal layer.
  • Ulcerative-fibrinous: deeper damage to the mucosal layer with ulcer formation.
  • Hemorrhagic: primarily affects the small vessels in the inner layer of the mucosa.
  • Gangrenous (necrotic): a rare form that occurs with decay in the bladder wall.

Considering the development of complications:

  • Uncomplicated: no problems with urine drainage and overall health is not affected.
  • Complicated: cystitis occurs as a result of other diseases (such as kidney stones, tumors, urinary tuberculosis, and others).

Cystitis is distinguished into hospital-acquired and community-acquired: characterized by the presence of bacteria resistant to antibiotics.

There is an independent type of cystitis – interstitial cystitis.

  • Interstitial cystitis: inflammation of the muscular layer in the bladder. The cause of this type of cystitis is often an acute disorder in the protective mucosal layer of the bladder. With the penetration of aggressive substances like potassium and others from the urine into the depth of the bladder wall, there is activation of sensitive nerves and damage to smooth muscles. Over time, there is fibrotic scarring of the mucosal layer of the bladder, leading to reduced storage capacity. Urination frequency increases until loss of control, with incomplete emptying of the bladder.

Complications of Acute Cystitis:
Acute Pyelonephritis: Kidney inflammation resulting from an infectious agent causing damage to kidney tissue, renal tubules, and connecting fibers.
Chronic Cystitis: Recurrence with severe symptoms similar to acute cystitis, but the symptoms are milder and often not associated with a fever.

Hemorrhagic Cystitis: When bacteria penetrate deeper layers (the inner mucosal layer), it leads to damage to the microvascular network, appearing as bleeding.

Diagnosis of Acute Cystitis:

  • Physical Examination: Symptoms and medical history collection.
  • Urinalysis: General urine test revealing white blood cells, bacteria, and protein.
  • Urine Culture: A urine sample is taken and cultured to identify the causative bacteria and their sensitivity to antibiotics.
  • Ultrasonography: Ultrasound examination is recommended to evaluate the condition of the kidneys and bladder.
  • Cystoscopy: To examine the mucous membrane of the bladder.

Treatment of Acute Cystitis:

  • Increased Fluid Intake: Consumption of at least 1.5 liters of fluids daily.
  • Avoidance of Sexual Contacts: Exclude sexual contacts throughout the illness.
  • Antibiotic Therapy: Based on urine culture results in case of recurrent cystitis.

Commonly used antibiotics include:

  • Fosfomycin: An antibiotic that works against most bacteria including E. coli, Klebsiella, and many other bacterial species.
  • Nitrofurantoin Group: Includes Nitrofurantoin and Furazidin salt, effective against E. coli, Klebsiella, and fungi such as Candida.
  • Probiotic Therapy (with Bacteriophage): Probiotics (Bacteriophage) are preferred as a safe alternative to antibiotics, but a bacteriological urine examination should be performed to determine the causative agent and its sensitivity to Bacteriophage.

Surgical Treatment for Recurrent Cystitis Cases:

  • Surgical treatment is used for women with recurrent infections associated with sexual intercourse and who suffer from urinary outlet narrowing (post-coital cystitis).
  • Pathogenic Treatment: Using the oral vaccine “Uro-Vaxom” to protect against E. coli infection and stimulate immune response.

Dietary Supplements (D-Mannose): Use of D-Mannose to block bacterial adherence in the bladder.

  1. Alternative Hormonal Therapy: After menopause, hormonal therapy can be used as an aid.
  2. Use of Medicinal Herbs (Kanefron): “Kanefron” can be used as an adjunct with its diuretic and anti-inflammatory effects.
  3. Treatment of Hematuria (Bleeding):
  • Treatment with anticoagulants such as aminocaproic acid and tranexamic acid to control bleeding.
  1. Surgical Treatment for Complex Cases: In case of urinary drainage obstruction.
  2. Symptomatic Relief Treatment:
  • Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and other medications to reduce pain and inflammation.


  • Maintain good health, and avoid exposure to potential factors for cystitis, such as maintaining hygiene in the sensitive area and avoiding irritation.
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  2. “Antibiotics – Killers: The History of Discovery, Benefits and Harms, Contraindications, Seeking Alternatives When There Is No Way Out.” (2007).
  3. “Antimicrobial Therapy and Prevention of Kidney, Urinary Tract, and Male Genital Infections. Russian National Recommendations.