Bacteria usually reach the bladder ascending through the urethra. Most bladder infections develop by this route. Rarely, some specific bacteria like tuberculosis may reach the bladder, kidneys, prostate via blood vessels and may lead to the development of specific types of cystitis.

Female urethra is shorter than the male urethra so in females, bacteria can reach the bladder much more easily. This makes cystitis a more common disease among females than the males. This general rule changes in elderly people, especially in the population over age 60. The reason is an enlarged prostate which may obstruct the urethra and lead to the retainment of urine in the bladder. Residual urine serves as a nourishing medium for the bacteria.

Bacterial invasion of the bladder leads to the development of sudden complaints like burning sensation at urination, frequent urination in small amounts, pain at the lower part of the abdomen. Sometimes blood in the urine may accompany these symptoms, this condition is named as hemorrhagic cystitis.

The classical laboratory finding of a cystitis is large amount of white blood cells (WBC’s) in the urine. This reflects the reaction of the body against the bacteria. Sometimes red blood cells (RBC’S) may also be observed together with the WBC’s. Urine culture is mandatory for exact diagnosis, because this test will reveal the type of causative bacteria and the type of antibiotic it is sensitive. With proper antibiotics, simple cystitis can be cured easily. If it persists or recurs, The possibilities are wrong antibiotic selection, insufficient course of treatment or an underlying disease that requires detailed medical investigation.

Endoscopic appearance of a
bladder mucosa with cystitis
a- Initial phase, dilated vessels
b- Small bleeding foci, engorged mucosa
(angry-looking bladder)

Main reason of cystitis in a female is the short urethra which facilitates the bacterial invasion of the bladder. In male, main reason is the obstruction of the urethra by an enlarged prostate which leads to the retainment of urine in the bladder.