What are the symptoms of Chronic Cystitis?

Frequent urination

In most cases although is the sole or the predominant symptom might be hardly recognised by the patient. This happens because the increasing frequency of urination rises slowly and gradually, so that it is almost “customary” as a normal condition. Thus, the 3-4 times that are normal to someone urinating throughout the day may become a lot more (e.g., 6-9 times daily), without understanding that this is a problem. It sure is an abnormal situation and wants attention. The patient suffering from chronic cystitis is specifically trying to ”get adapted” to this situation, learning to do certain actions such as:

• Going to urinate before leaving home to avoid getting forced to desperately look for where to urinate while being outdoors.
• Looking to find directly where the toilets are when in a room.
• Sitting in the outer seats in the rows of seats in the theatre or cinema in order to have easy access to toilets.
• When travelling, trying to make several stops in between to urinate.

Burning urination

Burning sensation during urination is a symptom that usually refers to what we all call urinary tract infection. It is often transient and perhaps relatively moderate. Sometimes appears all of a sudden giving us the impression that perhaps a small stone passed. So, if burning doesn’t stay for long, maybe we can thing that it is not something to worry about. We should pay attention at this ailment. I have encountered women who had reached in a state of intense psychosomatic disorders, due to intensity and persistence of this discomfort. Especially those women who had undergone multiple drug therapies to no avail.

Turbid urine & repulsive smell

It is a phenomenon which is often mentioned by the patients:

• The observation of the loss of clarity of the urine.
• The simultaneous presence of a relatively strong and in many cases repellent odour of urine.

Both are elements which indicate the likelihood of urinary tract infection (UTI).

Urgent urination

These are moments where the patient feels a very strong or even irresistible urge to urinate. Most of the times the patient is not able to control it either. At that time, she has the feeling that if she doesn’t find the toilet in order to urinate immediately, it is possible to even have loss of urine. It does not appear in all cases, but when it exists, it indicates:

• The chronicity of the disease.
• That the bladder wall has suffered severe inflammation.

The symptom of urgent urination requires appropriate attention for its medical identification.

Urinary incontinence

Feeling sometimes very intensely the need to urinate, the patient doesn’t have the time to get to the toilet and has loss of a few drops or a much larger quantity of urine. It is a very aggravating symptom for the psychological balance and quality of life of the patient. This usually occurs in advanced cases, with great history of urinary infections.

Hematuria (Blood in urine)

This may be:

• Μicroscopic (i.e. we only find erythrocytes after urinalysis).
• Μacroscopic, meaning that the colour of urine is made by deep dark until light red, usually when we have sharp or acute recurrent infection.

It is also a symptom of chronic cystitis which usually causes extreme anxiety. In most cases coexists with one or more of the other symptoms and usually shows the area of origin and/or the cause. For more information please see the dedicated page for blood in the urine.

Feeling of incomplete emptying

This symptom refers to the feeling of urine quantity inside the bladder after the urination. In some cases, the patients feel the need:

• To stay longer in the bathroom.
• To go back to the bathroom very quickly.

This is in order to empty the remaining urine amount that we feel has remained in the bladder, but often in vain (i.e. urination does not occur).

Suprapubic pain or heaviness

This is the sensation of pressure or tightness, or even pain low in the abdomen. Usually it becomes very intense when we feel that we have a lot of urine. The intensity of the pain may go away for a while after urination but then it appears again after some time.

Feeling of lumbar heaviness or pain

Small or moderate pain which occurs in the region that we believe are the kidneys. This symptom happens in several situations chronic cystitis syndrome, though it is usually confused with pain supposedly from the waist. The patient often thinks that the problem:

• May be located in the spine, especially when the pain or the numbness is reflected to the legs.
• May be something in the kidneys (i.e. potentially stones or microcrystals).
• May be a disease of the intestines or the gall bladder.

Particular attention to this symptom is needed (with differential diagnosis) as it may be indicating a chronic cystitis underneath.

Atypical gastrointestinal discomfort

There are several times when a sense of flatulence (bloating) in the abdomen or constipation without clear justification is found. Checking thoroughly the gastrointestinal system (e.g. gastroscopy or colonoscopy) and finding nothing organic, usually is incorrectly diagnosed as irritable bowel syndrome. It is eventually proven to be a symptom coming from chronic bladder inflammatory disease.

Genital system symptoms

The genital system is directly related to the urinary system in women. This is why infections in the vagina, the cervix and the uterus, most often cause a problem in the bladder. Particular attention should be paid to:

• The recurrent fungal vaginitis, which is generally accompanied by other infections in the vaginal mucosa.
• Any liquid from the vagina more in quantity and of different smell than usual.
• Itching on the lips of the vulva or inside the vagina.
• Severe pain during menstruation (period), especially for cases where taking medication (anticonvulsant or anti-inflammatory) is necessary for the reduction.
• Feeling of pain (dyspareunia) in the genital area during or immediately after sexual intercourse.

What patients should know is that infections in the genital system, are accompanied by more than 80% of urinary infections. Most of the infections in the female urinary system (up to 95%) are located in the bladder. We should treat them all at the same time, in order to give a definitive solution to the problem without relapse.