Women are prone to recurrent urinary tract infections throughout their lives. One of the most common, which affects women 50 times more than men, is cystitis. This inflammation of the bladder affects nearly 50% of women on multiple occasions. It usually manifests itself by pain in the bladder. What causes this issue? How can it be treated? The team at Cliniques Marois has outlined everything you need to know about bladder pain in women and suggests the best possible treatments.

What’s bladder inflammation?

Cystitis, characterized by inflammation of the bladder, can stem from bacterial or non-bacterial causes. Non-bacterial interstitial cystitis or painful bladder syndrome presents as a chronic, noninfectious inflammation of the bladder. While relatively rare, it affects 5 to 10 times more women than men. It can occur in women from the age of 18.

Bacterial cystine or acute cystitis is the most common form of bladder inflammation. It manifests itself as a urinary tract infection in the bladder. Caused by bacteria, it can cured quickly with appropriate treatment.

Causes of bladder pain in women

The causes of cystitis can vary depending on the form the patient is suffering from.

  • Causes of interstitial cystitis

    To date, the causes of interstitial cystitis are unknown. However, some scientists speculate connections to factors like radiation exposure to pelvic organs or damage to the bladder wall. This damage to the bladder wall can make the bladder more vulnerable to various substances in the urine. These often harmful substances can easily irritate the bladder.

    Interstitial cystine may also be caused by:

    • An ineffective intravesical protective layer
    • Inflammation of a pelvic organ near the bladder
    • Local inflammation in the bladder (autoimmune reaction in the bladder wall)

    Other researchers also link the onset of non-bacterial cystitis to childbirth or surgery. It’s a multifactorial disease that could also be caused by genetic, allergic or environmental factors.

  • Causes of acute cystitis

    Acute cystitis is usually caused by a bacterial infection. In about 90% of cases, it’s caused by Escherichia coli. The remaining 10% of cases are caused by microorganisms or other bacteria. Escherichia coli is a bacterium that naturally occurs in the digestive tract. It causes cystitis when it enters the urethra and travels up the bladder to proliferate.

    Certain factors, such as the size of the woman’s urethra, can also contribute to the development of acute cystitis. Typically small, the urethra may facilitate the introduction of certain microorganisms into the bladder. Urinary and genital prolapse in women is also a risk factor for this condition. Patients with this condition are unable to empty their bladders completely, which puts them at risk of a urinary tract infection.

    The use of spermicides during sex can also increase the risk of cystitis. This infectious inflammation of the bladder can be caused by estrogen deficiency, particularly during menopause, or from bladder compression and hormonal fluctuations during pregnancy. These factors often make it hard to empty the bladder or lead to urinary stasis (where urine gets trapped inside the bladder).

Les causes de la cystite aiguë

The symptoms of bladder inflammation in women

One of the main symptoms of cystitis is bladder pain. Some women experience moderate bladder pain, while others experience very severe pain. Here are other common symptoms of bladder inflammation, both infectious and non-bacterial:

  • A burning sensation or pain at the end of urination
  • Pain in the lower abdomen,
  • A heavy feeling, especially in the bladder area,
  • Urinary urgency with a feeling of not being able to hold it (urinary incontinence)
  • Frequent and persistent need to urinate without being able to evacuate a significant amount of urine (pollakiuria)
  • Dyspareunia.

Dyspareunia refers to the pain experienced by a woman before, during or after penetration.

The symptoms of cystitis typically worsen as the bladder fills. In severe cases, women affected by this condition may only produce small drops of urine.  Cloudy urine with an unusual odour or traces of blood can indicate bladder inflammation.

Symptoms of the condition can worsen during menstruation or ovulation. Symptoms can also worsen because of physical stress, seasonal allergies, eating potassium-rich foods and consuming alcohol and tobacco.

When to consult a doctor

Some women with non-bacterial bladder inflammation don’t exhibit symptoms of the disease. Therefore, it may be silent or manifest suddenly. In most cases, clinical signs appear gradually and become more intense as the bladder lining becomes increasingly affected.

At the first signs of bladder inflammation, it’s important to drink enough water and consult your doctor. While waiting for your doctor’s appointment, don’t hold back the need to urinate. Go to the bathroom as soon as you feel the need. It’s also safest to avoid sexual intercourse until the symptoms have completely disappeared.

If symptoms appear, you must see doctor within the same day if you:

  • Are pregnant because of the high risk of urinary tract infections during this time
  • Have an immune deficiency or chronic illness, like diabetes or chronic kidney disease
  • Are prone to urinary tract problems
  • Are 75 years old

You may also need to see a doctor as soon as possible if you have a fever or localized pain in the back. If pain in the lower abdomen becomes intense, it’s essential to see a doctor immediately.

Diagnosing bladder inflammation

Diagnosis is an essential step that allows the patient to identify the specific type of cystitis they have. With this information, the specialist can recommend the most appropriate and effective treatment to eliminate the disease.

Depending on the patient’s symptoms, the specialist may perform a urinalysis, cytobacteriological examination of urine (CBEU), a cystoscopy or a biopsy.

First, the doctor may perform a urine test using a urine dipstick. The purpose of this test is to detect the presence of nitrites and white blood cells (leukocytes), which are usually produced during a urinary tract infection.

The CBEU is performed to complement strip analysis or systematically for hospitalized patients. Performed in a laboratory, this analysis confirms cystitis and, importantly, identifies the specific bacteria responsible for the infection. It’s usually done in the morning, because the urine sample must be taken at least 4 hours after the previous urination. This allows sufficient time for bacteria to accumulate in the bladder if a urinary infection is present.

If this test is negative, the specialist may then order a cystoscopy. This procedure consists of exploring the inner wall of the urethra and/or bladder to diagnose lesions. It’s performed with an endoscope that’s inserted into the urinary tract.

A bladder biopsy is often recommended to diagnose interstitial cystitis.

Diagnostics de l'inflammation de la vessie

Treatment options for bladder inflammation

Treatments may vary depending on the type of cystitis the patient has.

  • Treatments for bacterial cystitis

    After confirming the diagnosis of infectious cystitis, characterized by the  presence of bacteria or leukocytes in the urine, the doctor may prescribe antibiotics and anti-inflammatory drugs to treat it. The patient is typically cured within a few days.

    If the patient doesn’t get treatment as soon as possible, the bacteria that causes the infection can colonize in the urinary tract and migrate to the kidneys. This increases the risk of pyelonephritis.

  • Treatments for non-bacterial cystitis

    There’s no specific treatment to completely eradicate interstitial cystitis. In most cases, treatment is used to relieve the symptoms of the disease.

    The urologist may prescribe various medications based on the patient’s symptoms, including:

    • Analgesics or anti-inflammatory drugs to relieve pain and reduce inflammation
    • Relaxant and antispasmodic drugs (anticonvulsants, antidepressants, antihistamines)
    • Pentosan (the only medication taken orally) to relieve  bladder pain

    The effectiveness of these medications can vary from person to person. It’s also possible to use other treatments such as bladder injections and TENS.

  • Bladder injections

    Botulina injections are generally used to control bladder contractions that lead to frequent or urgent urges to urinate, common symptoms of cystitis. They target the nerve endings in the bladder wall. These bladder injections are often recommended when oral medications are ineffective or poorly tolerated.

    Patients generally feel the effects of Botulina within 2 to 10 days after the injection. The duration of its efficacy varies from patient to patient, lasting anywhere from 6 to 9 months. Bladder injections are offered at Cliniques Marois.

  • TENS, the reference in perineal rehabilitation

    Transcutaneous electrical neurostimulation (TENS) treatment is often used if a woman’s symptoms become intense at night. TENS treatment can be used to reduce the frequency of urination and pain in some patients.

    This perineal rehabilitation treatment offered at Cliniques Marois is performed with the help of a device that emits a low-intensity electrical current. This device is connected to electrodes placed in the perineal area.

    Cystitis, whether bacterial or non-bacterial, must be treated by a specialist. Cliniques Marois specializes in urology and sexual health and is staffed with qualified urologists and healthcare professionals dedicated to helping you manage various urinary disorders. With expertise in new and innovative treatments, our specialists will provide you with the best treatment adapted to your disease. Don’t hesitate to contact us for all your sexual health concerns.