The term cystitis means inflammation of the bladder which is confined to the mucous in minor cases, but which involves all the layers of the bladder wall in the most serious cases.
Symptoms include urinary frequency, a burning sensation during urination, pelvic pain and sometimes gross haematuria.
A urological check-up is recommended in frequently recurring cases. The urologist performs tests, including a urine test with assessment of sediment and urine culture and, if necessary, an antibiogram to decide whether further investigation is required (urinary system ultrasound, image contrast radiology, etc.) and then identify a therapeutic strategy.
A specific type of cystitis, often without the onset of a full-blown infection, is chronic and often debilitating interstitial cystitis. Symptoms include pelvic pain and perineal pain often accompanied by urinary frequency and urinary urgency.
Specifically the pain is located in the lower abdomen, urethra, lumbar region, buttocks and the vagina. Sometimes the pain is so strong it has a negative impact on the quality of life.
The cause is unknown but appears to be the result of various factors: infection of the urinary tract, bladder emptying dysfunction, pelvic floor dysfunction, urethral dysfunction.
One evocative theory suggests a link with reduced barrier function.
In the urothelium, glycosaminoglycans (hyaluronate, heparin sulfate, keratin sulfate, chondroitin sulfate) are the main barrier mechanism between the cell walls and the solutes dissolved in the urine. Dysfunction or discontinuity of this barrier causes the urine to enter the fibres of the bladder muscles and stimulation of the nerve ends resulting in urinary urgency and pain.
On the basis of this theory some remission of symptoms has been achieved by administering hyaluronic acid and chondroitin sulfate using endovesical instillation.
The treatment is more effective the earlier it is administered and therefore the important thing is to restore the protective layer of the urothelium as early as possible.
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