1. Pressure in the lower pelvis, daytime frequency and nocturia
Interstitial cystitis is is characterized by over 6 months of chronic pain, pressure and discomfort felt in the lower pelvis or bladder. It is often relieved with voiding, along with daytime frequency and nocturia in the absence of an urinary tract infection(1).
2. Painful urination (dysuria)
A slight majority of women with interstitial cystitis/painful bladder syndrome (IC/PBS) reported dysuria at onset of their IC/PBS symptoms. The available laboratory data have suggested that dysuria may be a sensitive indicator of urinary tract infection at the onset of IC/PBS(2).
3. Frequent urination (polyuria) or urgent need to urinate (urinary urgency)
It can be caused by overactive bladder as a result of irritation due to inflammatory cystitis
There is a report of a case of uncomplicated urinary tract infection due to Corynebacterium striatum in an ambulatory patient without any other predisponent risk factors(3).
5. Bladder/pelvic pain
6. Dark, cloudy or strong-smelling urine
B. Causes and risk factor
Cystitis is caused by
1. Bacterial infection
Streptococcus agalactiae or group B streptococcus is a Gram-positive pathogen that is typically associated with neonatal disease and infection in pregnant women. Group B streptococcus also causes invasive infections in non-pregnant adults including urinary tract infections(5). Other researchers found that in 85.7% of cases following non-clostridial anaerobic (NCA) bacteria were identified in biopsy samples: Propionibacterium sp. (41.8%), Peptococcus sp. (35.7%), Eubacterium sp. (28.6%), Peptostreptococcus sp. (14.3%), and Bacteroides sp. (14.3%). Aerobic-anaerobic associations were observed in 7.1% of samples(6).
2. Nonbacterial infection
a. Viral cystitis
BK-virus is a very common polyomavirus in the global population, similar to the JC-virus responsible for Progressive Multifocal Leukoencephalopathy. BK-virus infections are an important diagnostic and therapeutic challenge in immuno-compromised patients, including: bone marrow transplant pediatric recipients in whom it may cause hemorrhagic cystitis(7).
b. Mycobacterial infection
There is a review of a to review clinical features, diagnosis and treatment of renal mycobacteriosis, illustrated by presentation of a case of pyelonephritis and cystitis caused by Mycobacterium chelonei(8).
c. Chlamydial infection
In the study of Male guinea pigs infected with the chlamydial agent of guinea pig inclusion conjunctivitis (GPIC) by intraurethral injection of chlamydiae or by placement of a drop of chlamydial suspension on the meatus of the extruded penis, researchers found that when infected animals were immunosuppressed with cyclophosphamide, the number of guinea pigs with cystitis was increased, and chlamydiae could be detected in the bladder for as long as 50 days after infection(9).
d. Fungal infection
There is a report of 4 cases of fungal cystitis. All patients had severe urgency, frequency and nocturia with sterile pyuria and microhematuria. Significant fungal growth was observed on routine blood agar cultur. Bladder biopsy was necessary to rule out tumor(10).
e. Schistosomal infection
In the study to evaluate the immunoreactivity for p53 and c-erbB-2 proteins in 31 schistosomal urinary bladder carcinomas and 21 cases of schistosomal cystitis with hyperplastic, metaplastic and/or dysplastic (premalignant) lesions and compare with 30 carcinomas and 21 premalignant lesions of the urinary bladder without schistosomiasis showed that abnormal nuclear p53 protein accumulation was found in 17/31 schistosomal and in 15/30 non-schistosomal carcinomas and in 8/21 schistosomal cystitis with premalignant lesions of which five showed hyperplasia(11).
3. Noninfection and Bladder syndrome/interstitial cystitis (PBS/IC)
In the study to describe the practice patterns among primary care physicians' (PCPs) managing patients with symptoms suggestive of interstitial cystitis/painful bladder syndrome (IC/PBS), indicated that of 290 completed questionnaires (response rate, 52%), regarding etiology, 90% correctly indicated that IC/PBS was a noninfectious disease((radiation cystitis, autoimmune, hypersensitivity), 76% correctly reported that it was not caused by a sexually transmitted infection, and 61% correctly indicated that it was not caused by a psychiatric illness(12).
B.1. Risk factors
1. Immune deficiency
In the study of Different risk factors related to adenovirus- or BK virus-associated hemorrhagic cystitis following allogeneic stem cell transplantation, showed that of profound immune deficiency is more likely to be associated with ADV-HC, whereas immune hyperactivity might play a key role in BKV-HC(13).
2. Prolonged use of bladder catheters
Patients who prolonged use of bladder catheters are at greater risk to develop cystitis as a result of infection.
3. Bladder stone or calcified bladder tumour
There is a report of a 79-year-old woman suffered from microscopic haematuria following a symptomatic cystitis. Abdominal ultrasound investigation suggested a bladder stone. Cystoscopy revealed a calcified bladder tumour(14).
4. Multiple sex partners
People with multiple sex partners are at increased risk of sexual transmitting diseases causes of cystitis
C.1. The do and do not's list
1. Void high amount of sugar
Process sugar can decrease the immune system by delaying the immune white blood cells's function for up to 5 hours. According to the quote of "Role of sugars in human neutrophilic phagocytosis" and posted in Dangers of Sugar Intake. Suppressing the immune system over prolonged period of time increases the risk of infection, including urinary tract infection.
2. Avoid excessive intake of Coffee
Can coffee promotes the risk of infection?, according to the study of in 15 men and women, showed that the responses to PHA and Con A were about one-third lower during coffee drinking compared to a period of abstinence from coffee (117335, 99856 and 181236, 153315, P less than 0.004, 0.009 respectively)., conducted by Department of Pediatrics, Rokach Hospital, posted in PubMed, researchers indicated that chemotaxis was higher in the coffee period at all concentrations. This exploratory study suggests that coffee intake modifies various measures of the immune function.
3. Avoid excessive intake of Caffeine
According to the article of How caffeine affects the immune system, posted in Caffeine addiction affect, the author wrote that The stimulating effects of caffeine are very much similar to body’s own response under stress and chronic stress weakens our immune system.
4. Avoid excessive alcohol drinking
Moderate alcohol consumption are beneficial to the immune system compared to alcohol abuse or abstinence, but excessive drinking can cause damage to the liver and can directly suppress a wide range of immune responses. According to the abstract of study of "Moderate alcohol consumption and the immune system: a review" by Romeo J, Wärnberg J, Nova E, Díaz LE, Gómez-Martinez S, Marcos A., posted in PubMed.
5. Don't hold it when you need to urinate
It is common sense, if you hold your urine, when you needs to, you can damage the auto response of the bladder muscles and increase the risk of bladder infection as urinary is also help to flush up the bacteria presented in your urinary tract.
6. Drinking equated amount of water
Water can help to flush out the bacteria presented any where in your urinary tract and dehydration, frequently, and incompletely empty the bladder increase the risk of urinary infection. According to the study of "Mild dehydration: a risk factor of urinary tract infection?" by Beetz R., posted in PubMed.
7. Shower instead of bath can be helpful
As the water goes down, it washes always the bacteria, instead holding them in the water.
8. Wipe your bottom front to back
It is avoid the bacteria from anus from entering the vaginal.
Douching increases the risk of irritation and can lead to urinary bladder inflammation as a result of imbalance of good and bad bacteria as well as reducing the state of acidity to prevent bacteria and yeast invasion.
10. Avoid sexual transmitting diseases
By limiting numbers of sexual partners and known their medical history. No anal sex.
Diet is important to enhance immune system in fighting against forming of free radicals and invasion of bacteria and virus.
1. Foods contain high amount of antioxidant scavenger
Vitamin A, C, E are classified as antioxidant can be found abundantly in fruits and vegetable. they not only promte the immune function in free radicals scavenging but also protect our body against infection and inflammation. For more information visit Antioxidants
According to the study of "Cranberry and urinary tract infections" by Guay DR , posted in PubMed, researcher indicated that the findings of the Cochrane Collaboration support the potential use of cranberry products in the prophylaxis of recurrent UTIs in young and middle-aged women. However, in light of the heterogeneity of clinical study designs and the lack of consensus regarding the dosage regimen and formulation to use, cranberry products cannot be recommended for the prophylaxis of recurrent UTIs at this time. For other health benefits of foods, visit 100+ Healthy Foods Classification
probiotics enhance the balance of good and bad bacteria in the digestive tract and other related organs such as vagina. According to the study of "Role of probiotics in urogenital healthcare" by Waigankar SS, Patel V., posted in PubMed, researchers found that the value of a probiotics cannot be taken at face value. Probiotics must not be considered a panacea for treating urogenital infections. However, the available data promises that it will be a strong option in improving and maintaining urogenital health.
4. Moderate alcohol consumption
In a study conducted by Department of Metabolism and Nutrition, Consejo Superior de Investigaciones Cientificas (CSIC), posted in PubMed, researchers wrote that moderate alcohol consumption seems to have a beneficial impact on the immune system compared to alcohol abuse or abstinence. Therefore, the link between alcohol consumption, immune response, as well as infectious and inflammatory processes remains not completely understood.
5. Water Consumption and UTIs
According to the study of "Mild dehydration: a risk factor of urinary tract infection?" by Beetz R., posted in PubMed., researchers found that the combination of the behaviourally determined aspects of host defence and not simply increasing fluid intake is important in therapy and prophylaxis of UTI.
C.3. Nutritional supplements
1. Vitamin A, E, C, D
a. Vitamin A
Vitamin A occurs in the form retinol and is best known for its function in maintaining the health of cell membrane, hair, skin, bone, teeth and eyes. It also plays an important role as an antioxidant as it scavenges free radicals in the lining of the mouth and lungs; prevents its depletion in fighting the increased free radicals activity by radiation; boosts immune system in controlling of free radicals; prevents oxidation of LDL and enhances the productions of insulin pancreas.
b. Vitamin C
Vitamin C beside plays an important role in formation and maintenance of body tissues, it as an antioxidant and water soluble vitamin, vitamin C can be easily carry in blood, operate in much of the part of body. By restoring vitamin E, it helps to fight against forming of free radicals. By enhancing the immune system, it promotes against the microbial and viral and irregular cell growth causes of infection and inflammation.
Vitamin C also is a scavenger in inhibiting pollution cause of oxidation.
c. Vitamin E
Vitamin E is used to refer to a group of fat-soluble compounds that include both tocopherols and tocotrienols discovered by researchers Herbert Evans and Katherine Bishop. It beside is important in protecting muscle weakness, repair damage tissues, lower blood pressure and inducing blood clotting in healing wound, etc, it also is one of powerful antioxidant, by moving into the fatty medium to prevent lipid peroxidation, resulting in lessening the risk of chain reactions by curtailing them before they can starts.
Carotenoids are organic pigments, occurring in the chloroplasts and chromoplasts of plants and some other photosynthetic organisms like algae, some bacteria.
Beta-Carotene, an organic compound and classified as a terpenoid, a strongly-coloured red-orange pigment in plants and fruits.
a.1. It is not toxic and stored in liver for the production of vitamin A that inhibits cancer cell in experiment. Beta-carotene also neutralize singlet oxygen before giving rise of free radicals which can damage of DNA, leading to improper cell DNA replication, causing cancers.
a.2. Cell communication
Researcher found that beta-carotene enhances the communication between cell can reduce the risk of cancer by making cells division more reliable.
a.3. Immune system
Beta-carotene promotes the immune system in identifying the foreign invasion such as virus and bacteria by increasing the quality of MHC2 protein in maintaining optimal function of white cells.
a.4. Polyunsaturated fat
Researchers found that beta-carotene also inhibits the oxidation of polyunsaturated fat and lipoprotein in the blood that reduce the risk of plaques build up onto the arterial walls, causing heart diseases and stroke.
a.5. There are more benefits of beta-carotene.
Flavonoids also known as Vitamin P and citrin are a yellow pigments having a structure similar to that of flavones occurred in varies plants. it has been in human history for over thousands of years and discovered by A. S. Szent-Gyorgi in 1930. As he used vitamin C and flavonoids to heal the breakage of capillaries, which caused swelling and obstruction of blood flow. Most plants have more than one group or type act as predominate.
Flavonoids process a property as antioxidants. it helps to neutralize many of reactive oxygen species (ROS), including singlet oxygen, hydroxyl and superoxide radicals. Although nitric oxide is considered a free radical produced by immune system to destroy bacteria and cancerous cells, but when it is over produced, it causes the production peroxynitrite which may attack protein, lipid and DNA, Flavonoids inhibit NO production of peroxynitrite due to reduction of enzyme expression.
Manganese is an essential trace nutrient in all forms of life. It is well known for its role in helping the body to maintain healthy skin and bone structure, but also acts as cofactors for a number of enzymes in higher organisms, where they are essential in detoxification of superoxide (O2−, with one unpaired electron) free radicals.
Although superoxide is biologically quite toxic and is deployed by the immune system to kill invading microorganisms by utilizing the enzyme NADPH oxidase. Any Mutations in the gene coding for the NADPH oxidase cause an immunodeficiency syndrome.
Selenium , a trace mineral plays an important and indirect role as an antioxidant by fulfilling its function as a necessary constituent of glutathione peroxidase and in production of glutathione, that inhibits the damage caused by oxidation of free radical hydrogen peroxide, leading to aging effects.
a. Immune system
Selenium enhances the immune function that fighting off the attack of AID virus by promoting the function of interleukin 2 and T-cells.
Study showed that levels pf selenium in blood test is associated with high rate of cancer, including skin cancer.
D. Diagnosis and treatment in convention medicine perspective
1. Acute uncomplicated cystitis
In the diagnosis and treatment of acute uncomplicated cystitis, researchers at the University of Maryland School of Medicine, Baltimore, showed that Most urinary tract infections are acute uncomplicated cystitis. Identifiers of acute uncomplicated cystitis are frequency and dysuria in an immunocompetent woman of childbearing age who has no comorbidities or urologic abnormalities. Physical examination is typically normal or positive for suprapubic tenderness. A urinalysis, but not urine culture, is recommended in making the diagnosis. Guidelines recommend three options for first-line treatment of acute uncomplicated cystitis: fosfomycin, nitrofurantoin, and trimethoprim/sulfamethoxazole (in regions where the prevalence of Escherichia coli resistance does not exceed 20 percent). Beta-lactam antibiotics, amoxicillin/clavulanate, cefaclor, cefdinir, and cefpodoxime are not recommended for initial treatment because of concerns about resistance. Urine cultures are recommended in women with suspected pyelonephritis, women with symptoms that do not resolve or that recur within two to four weeks after completing treatment, and women who present with atypical symptoms(16).
2. Interstitial cystitis
In the study of Interstitial cystitis/painful bladder syndrome, researchers at the University of Toledo College of Medicine, indicated that tests and tools commonly used to diagnose interstitial cystitis/painful bladder syndrome include specific questionnaires developed to assess the condition, the potassium sensitivity test, the anesthetic bladder challenge, and cystoscopy with hydrodistension. Treatment options include oral medications, intravesical instillations, and dietary changes and supplements. Oral medications include pentosan polysulfate sodium, antihistamines, tricyclic antidepressants, and immune modulators. Intravesical medications include dimethyl sulfoxide, pentosan polysulfate sodium, and heparin. Pentosan polysulfate sodium is the only oral therapy and dimethyl sulfoxide is the only intravesical therapy with U.S. Food and Drug Administration approval for the treatment of interstitial cystitis/painful bladder syndrome(17).
Other researchers also suggested the use of intravesical pentosan polysulfate sodium simultaneously with oral pentosan polysulfate sodium is a safe and effective therapeutic option. It will open a new option for patients with interstitial cystitis to reduce their severely devastating symptoms and to improve their quality of life and well-being(18).
E. Treatment in herbal medicine perspective
Bearberry also best known as Uva Ursi, has diuretic, astringent and antiseptic properties. and been used as tea in herbal medicine to treat urinary tract infection. In a study of "Natural approaches to prevention and treatment of infections of the lower urinary tract" by Head KA., posted in PubMed, researchers indicated that botanicals that can be effective at the first sign of an infection and for short-term prophylaxis include berberine and uva ursi. Estriol cream and vitamins A and C have also been shown to prevent UTIs, while potassium salts can alkalinize the urine and reduce dysuria.
Gloden-seal is said contains antimicrobial properties of which can be used to treated urinary tract infection, according to the article of "Golden-seal" posted in University of Maryland Medical Center, the author wrote that It (Golden-seal root) is commonly used to treat several skin, eye, and mucous membrane inflammatory and infectious conditions (such as sinusitis, conjunctivitis, and urinary tract infections). It is also available in mouthwashes for sore throats and canker sores.
F. Treatment in traditional Chinese medicine perspective.
3. Green tea
According to the study of "Selective microbiologic effects of tea extract on certain antibiotics against Escherichia coli in vitro" by Neyestani TR, Khalaji N, Gharavi A., posted in PubMed, researchers found that the microbiologic effects of both black tea and green tea extracts on certain antibiotics against E. coli may vary, depending on the type of the tea extract (i.e., black vs. green), the amount of the extract, and the antibiotic being used.
Herbalist view cranberry as primary herbs for diuretic and in preventing and treating urinary tract infection by by inhibiting bacterial attachment to the urinary tract lining of the bladder and urethra, according to the article of "How Cranberry Juice Can Prevent Urinary Tract Infections" post in Science daily, writer wrote that Cranberry juice had no discernible effect on E. coli bacteria without fimbriae, suggesting that compounds in the juice may act directly on the molecular structure of the fimbriae themselves.
F. Treatment in traditional Chinese medicine perspective
Traditional Chinese medicine view urinary tract infection including bladder inflammation as a result of the of damp heat accumulation that lead to symptoms of a frequent urination, burning sensation, painful duirng sexual intercourse; cloudy or yellow-milky urine, etc.
F.1. Damp heat accumulation
1. Long dan cao (Gentian)
Besides it is used to treat liver heat caused by dampness accumulation due to spleen' inability in materials absorption, It also enhances the liver and the gallbladder function in draining damp heat in the body through kidney urinary secretion.
2. Huang qin (Scullcap)
Huang qin is important to enhance the lung function by moistening the qi, thus reducing the risk of fever, irritability, thirst, cough. It also improves the stomach function in absorbing vital vitamins and minerals by clearing the heat caused extreme dampness that causes diarrhea and thirst with no desire to drink.
3. Zhi zi (Gardenia)
It improves the circulatory function by clearing the liver heat due to constrained liver and heat caused by infection or inflammation as a result of fluids accumulated in body for a prolong period of time.
4. Mu tong (Akebia)
Mu tong besides increases the kidney in clearing dampness through urinary secretion, it also enhances the blood function by draining the blood heat caused by blood stagnation.
5. Gan cao (licorice root)
Gan cao reduces damp heat accumulated in the body in many different ways
a) It moistens the lung, thus reducing the lung dryness causing symptoms of coughing and promoting the smooth qi movement.
b) It reduces the heat caused by toxins in the body by eliminating them through urinary secretion.
c) It enhances the heart in regulating the movement of blood by strengthening the blood that stop the irregular pulse.
d) It increases the liver function in regulating the abdominal muscles, thus reducing the menstrual cramps and pain.
F.2. Spleen and kidney deficiency
Spleen is considered as the prenatal organ in traditional Chinese medicine. It means what you have is what you get. depletion of kidney Jing can have a serious effect in your health. Spleen is the organ responsible for distribution of Qi and nutrition to the body organ, including kidney and lung. Deficiency of kidney and spleen may result in the symptoms of urinary tract infection, including dribbling urination; frequent urination during the night; dull pain during urination; sporadic urination, recurrence of infection, lower back pain, etc.
1. Wu Bi Shan Yao Wan (Incomparable Dioscorea Pill)
The pill has been been used in TCM to treat urinary tract infection by nourishing the Yin enhancing the Yang and the Qi and Strengthens the Kidneys. It is one of the patent formula in a collection of 355 efficient valuable and most famous prescriptions among Chinese patent drugs. according to Chinese Patent Medicines (English Edition) Editor-in-Chief: Chen Keji, MD. Editors: Chen Kai MD, Zhang Qunhao MD, Wang Wei MD, Lin Yuxiong MD, Hsia I-Szu Ph.D. Published by Hunan Science & Technology Press, 1997
a. Shan Yao
Main uses; Tonifies Qi Kidney Yin and Spleen,nourishes the Stomach Yin.
b. Rou Cong Rong
Main uses; Tonifies the Kidneys, strengthens the Yang, benefits Kidney Jing and bone marrow
c. Wu Wei Zi
main uses; Tonifies the Kidneys, benefits Jing
d. Du Zhong
Main sues; Tonifies Yang, Kidneys and Liver
e. Niu Xi
main uses; Invigorates the Blood, nourishes the Liver and Kidney Yin
f. Sheng Di Huang
Main uses; Clears Heat, cools Blood, nourishes Yin and generates fluids
g. Ze Xie
Mian uses; Promotes urination, drains Kidney Fire and Dampness
h. Shan Zhu Yu
Main uses; Tonifies Liver and Kidney Yin, benefits Kidney Yang
k. Ba Ji Tian
Main sues; Tonifies Kidneys and strengthens Yang.
l. Chi Shi Zhi
Mian uses; Enhances the Intestines functions and stops diarrhea.
m. Tu Si Zi
main uses; Tonifies the Kidneys and Spleen, strengthens Yang, enhances Yin
n. Fu Shen
Main uses; Nourishes the Heart and calms the Shen
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