The 6 Types of Cystitis

There are many types of cystitis, and their classification can be made based on the causative agent. Bacterial is the most common.

Written and verified by el biólogo Samuel Antonio Sánchez Amador.

Last update: 15 July, 2023

Urinary tract infections (UTIs) are very common in general society. The prevalence of these conditions increases considerably with age, as the percentage of women affected is 20% at 65 years of age, compared to 11% globally. Knowing the types of cystitis and other UTIs is essential in order to treat them and prevent complications.

There are several types of cystitis depending on the causative agent and the severity of the condition. As you can imagine, a urinary tract infection caused by bacteria will be treated very differently than one triggered by drug abuse. If you want to know more about this set of diseases and how to detect it before it’s too late, keep reading.

What are urinary tract infections?

Before describing the types of cystitis and their characteristics, we see it necessary to explore the pathological group of which they’re a part: Urinary tract infections (or UTIs). According to the Elsevier medical website, a UTI is defined as “the colonization and multiplication of microorganisms, usually bacteria, in the urinary system.”

The urinary system is mainly closed to favor the drainage of urine from the kidneys to the bladder and, finally, out through the urethra. There are many physiological measures that maintain this aseptic environment, but sometimes they fail, and microorganisms colonize the tubules and pathways responsible for releasing urine.

Here are some interesting data on the prevalence of UTIS at a global level:

• Urinary tract infections are much more common in women than in men. The ratio is 4 female patients for every male.
• An estimated 1/3 of the adult female population has had cystitis (a type of urinary tract infection) in their lifetime. Of this fraction, a not inconsiderable percentage will present recurrent cystitis.
• 81% of UTIs pictures occur in women. Of this total, 27% of patients have another episode in the following 6 months and 48% in the following 12 months.
• In the United States alone, more than 7 million uncomplicated UTIs occur each year.
• The incidence of cystitis in women is 5-7 cases per 100,000 inhabitants per year.

As you can see, UTIS are clinical entities that are very present in society, especially in sexually active women or with other associated health problems (with immunosuppression, diabetes, and catheters). Therefore, it’s important to know their typology and symptoms before they become serious. Cystitis is one of the most common and is divided into various types.

What are the types of cystitis?

The National Cancer Institute defines cystitis as “an inflammation of the lining of the bladder.” Cystitis represents one of the most common urinary tract infections (UTIs), but not all conditions of this type respond to bacterial overgrowth. Simply put: Not all UTIs are cystitis, and not all cystitis are UTISs.

The symptoms of the different types of cystitis are common to some extent, but each variant has certain differential clinical signs. Next, we’ll show you the 6 types of cystitis and their clinical characteristics. Keep reading!

1. Bacterial cystitis

As indicated by the Statpearls medical website, cystitis usually occurs due to the colonization of the periurethral mucosa by bacteria that inhabit the vagina or are present in fecal material. The microorganisms that cause this clinical picture are known as uropathogens and usually have microbial virulence factors that allow them to “bypass” the host’s defenses.

Uropathogens are less able to colonize the male urethra, as it’s longer and drier and prostate fluid contains bactericidal properties. Therefore, the incidence of bacterial cystitis in men is very low. In any case, it’s possible for males to experience this condition (especially young, uncircumcised people who practice anal sex).

The vast majority of cases of bacterial cystitis are caused by the bacterium Escherichia coli (this is the cause of 75% to 95% of cases). This bacterium is part of the natural flora of the human intestine and, therefore, is excreted with feces in normal situations.

The symptoms of bacterial cystitis

The following symptoms are common to all types of cystitis:

• Polyuria: This term refers to an increase in the frequency of urination. According to the MSD Manuals portal, a person is considered to have polyuria when they excrete more than 3 liters of urine a day.
• Intense pain in the suprapubic region, that is, in the place where the bladder is located.
• Dysuria: Pain or discomfort when urinating, generally described as intense burning.
• Hematuria: The presence of blood in the urine.
• A sensation of pressure in the lower abdomen.

In cases of bacterial cystitis, it’s also common for the patient to have a fever above 37 ° C. It’s important to highlight this clinical sign, as it’s a differential feature between this and another of the types of cystitis that we’ll look at later.

As indicated by the Universidad Clínica Navarra, cystitis by itself never leads to a fever. However, it’s common in this condition for bacteria to spread to other regions if it’s not treated, such as the prostate (acute prostatitis) or the kidneys (acute pyelonephritis). Therefore, if the patient has a fever, it is almost certain that they’re experiencing acute bacterial cystitis that has spread to other organs.

How do bacteria get into the urinary tract?

The proximity of the anus and urethra in the female sex makes the transfer of E. coli from the stool to the vaginal environment relatively easy. In the following list, we’ll show you some of the causes of infectious cystitis:

• Poor hygiene in the bathroom: Cleaning after a bowel movement from back to front makes it much easier for bacteria to enter the female urethra.
• Sex: The mechanical action of the sexual act makes it easier for microorganisms to pass from the external vaginal environment into the female genital tract.
• The use of contraceptive pills: As indicated by the Healthline website, contraceptives can promote the elimination of beneficial bacterial flora in the vagina. This facilitates the establishment of uropathogens in the long term.
• Pregnancy: Hormonal changes during pregnancy create imbalances in the internal bacterial flora of women.

Even with proper hygiene, it’s sometimes impossible to avoid an acute condition of bacterial cystitis. In the presence of any of the aforementioned symptoms, it’s essential to visit the doctor, as it’s there’s no need to allow the bacteria to reach other organs.

2. Drug-induced cystitis

We’ve dedicated the bulk of this article to the most common type of cystitis, but it’s important to emphasize that there are many more. For example, drug-induced cystitis occurs when the urinary bladder tissue becomes inflamed due to the action of a chemical compound. As drugs are almost always excreted via the urinary tract, this condition is sometimes unavoidable.

For example, there are 2 drugs used in chemotherapy that have been associated with the development of cystitis. These are the following:

1. Cyclophosphamide: Cyclophosphamide is an alkylating agent that’s used to slow or stop the growth of cancer cells in the body. It’s part of chemotherapy treatment for Hodgkins’ lymphoma, cutaneous T-cell lymphoma, and some types of leukemia. According to studies, up to 7.3% of patients who consume the drug develop hemorrhagic cystitis.
2. Ifosfamide: This is another anticancer drug indicated to treat testicular cancer with germ cell involvement, soft tissue sarcomas, and other types of neoplasms. Hemorrhagic cystitis is another of the most common threats when treating this condition.

3. Radiation cystitis

Radiation therapy can be defined as “a cancer treatment that uses high doses of radiation to destroy malignant cells and shrink tumors.” It’s a cornerstone in the treatment of many types of neoplasms, but it can lead to cystitis in some cases.

When the bladder is exposed to radiation during the treatment of tumors of the pelvic structures by radiotherapy, the bladder tissue is histologically modified and inflamed. The resulting condition is known as radiation cystitis and causes symptoms like irritative voiding dysfunction (with pain, increased urine volume, and urinary urgency) and hematuria (blood in the urine) of very varying intensity.

When the picture becomes very complicated, the patient experiences severe hemorrhagic cystitis. There’s no specific treatment in these borderline situations, but intravesical (hyaluronic acid or endovesical aluminum), systemic (conjugated estrogens or pentosan polysulfate), and physical measures can be taken to stabilize the patient.

4. Foreign body cystitis

This is one of the less common types of cystitis and is caused by the presence of a foreign body at the urethrovesical level. It’s not common for elements to be accidentally inserted into the urethra or bladder, but the practice of certain sexual behaviors or catheterization can promote this clinical picture.

As indicated by clinical sources, the majority of foreign body cystitis outside the hospital setting occurs due to the voluntary introduction of elements into the urethra during sexual intercourse. Patients often delay visiting the doctor out of embarrassment until their pain is chronic, which makes the condition much worse.

5. Chemical cystitis

Chemical cystitis is very similar to that caused by taking drugs, but in this case, the causative chemical compounds are commonly used and aren’t pharmacological. Here’s a list of certain elements that can cause inflammation of the bladder if used too often:

• Spermicidal gels: This contraceptive method is applied inside the vagina near the cervix before sexual intercourse in order to slow down or kill sperm during intercourse. Its repeated use has been associated with an increased chance of developing cystitis.
• Feminine hygiene sprays: Any compound that modifies the pH of the vaginal environment will enhance microbiotic imbalances in the area. As we’ve said, this imbalance in the genital microbiome is associated with a greater probability of cystitis.
• Use of diaphragms with spermicides: The premise is the same as in the previous cases.

As you can see, this is one of the types of cystitis that can be most easily prevented. Consult with your trusted gynecologist regarding the products that you’re going to start using in your intimate area to avoid long-term discomfort.

6. Interstitial cystitis

We close this space with a clinical entity that’s slightly different from the previous ones. Interstitial cystitis (also known as painful bladder syndrome ) is a chronic disease of idiopathic nature characterized by a very marked and frequent need to urinate, in addition to pain.

The prevalence of this condition is highly variable, but it’s estimated to range between 40 and 70 patients per 100,000 inhabitants. Taking into account medical history and slightly looser criteria, the numbers can rise to 865 cases per 100,000 people. Some of the symptoms of this syndrome are the following:

• Pain in the pelvis of a chronic nature.
• Discomfort between the scrotum and the anus (perineum) in men and between the vagina and the anus in women.
• Urgent and persistent need to urinate that’s poorly relieved by urination.
• Frequent and short urination, up to 60 times a day.
• Very marked pain while filling or emptying the bladder and during sexual intercourse.

This condition is idiopathic in nature (its cause is unknown). However, it’s believed that most cases are influenced by a deficiency of glycosaminoglycans in the mucus that lines the bladder tissue. This imbalance would translate into nerve and muscle changes, and in turn, constant pain.

It has also been suggested that patients may secrete toxic substances in the urine, that they have neurogenic hypersensitivity, or that their immune system itself is attacking the bladder tissue. Very little is known about this clinical entity, but its etiology is most likely multifactorial.

The types of cystitis and their medical significance

Most types of cystitis are classified according to the causative agent. Interstitial cystitis is an exception to this rule, but all other conditions respond to the underlying reason. Without a doubt, the most common is the bacterial variant, especially if it’s caused by the microorganism E. coli.

Be that as it may, all cystitis pictures share a series of easy-to-detect symptoms and discomforts. If you’ve seen yourself reflected in any of these lines, go to the doctor promptly. Most likely, it’s not a serious condition, but if it’s an infection, it must be stopped as soon as possible.