The recent worldwide pandemic of COVID-19 has had a detrimental worldwide impact on people of all ages. Although data from China and the United States indicate that pediatric cases often have a mild course and are less severe in comparison to adults, there have been several cases of kidney failure and multisystem inflammatory syndrome reported. As such, we believe that the world should be prepared if the severity of cases begins to further increase within the pediatric population. Therefore, we provide here a position paper centered on emergency preparation with resource allocation for critical COVID-19 cases within the pediatric population, specifically where renal conditions worsen due to the onset of AKI.

About Dr.

Dr. Sidharth Kumar Sethi
Kidney & Urology Institute
He was trained as a Fellow (International Pediatric Nephrology Association Fellowship) and Senior Resident in Pediatric Nephrology at All India Institute of Medical Sciences and Division of Pediatric Nephrology and Transplant Immunology, Cedars Sinai Medical Centre, Los Angeles, California. He has been actively involved in the care of children with all kinds of complex renal disorders, including nephrotic syndrome, tubular disorders, urinary tract infections, hypertension, chronic kidney disease, and renal transplantation. He has been a part of 8-member writing committee for the guidelines of Steroid Sensitive Nephrotic Syndrome and Expert committee involved in the formulation of guidelines of Pediatric Renal Disorders including Steroid Resistant Nephrotic Syndrome and urinary tract infections. He has more than 30 indexed publications in Pediatric Nephrology and chapters in reputed textbooks including Essential Pediatrics (Editors O.P. Ghai) and “Pediatric Nephrology� (Editors A Bagga, RN Srivastava). He is a part of Editorial Board of “World Journal of Nephrology� and “eAJKD- Web version of American Journal of Kidney Diseases�. He is a reviewer for Pediatric Nephrology related content for various Pediatric and Nephrology journals

For more information = http://www.pediatricnephrologyindia.com/

A cyst that grows on the surface of the kidneys or inside the kidneys is known as a kidney cyst or a renal cyst. These cysts can be described as fluid-filled sacs that cause the kidneys to be enlarged and reduce their functioning capacity.

Symptoms of Polycystic Kidney Disease

Dull aching in loins.
Vague abdominal pain.
Frequent urination.
Haematuria.
Headache.
Drowsiness.
Anorexia.
Signs

Anaemia: moderate to severe.
Blood pressure: raised.
On palpation abdomen
Enlarged irregular kidneys.
Large knobby renal masses.
Enlarged polycystic liver (50% cases).
If not addressed in time, renal cysts can lead to kidney failure and hence be fatal. Thankfully, with homoeopathy, you can treat these cysts with negligible side effects. Some of the most well-known homoeopathic remedies for renal cysts are:

Apis mellifica: This homoeopathic remedy is often prescribed for acute forms of renal cysts. In such cases, the patient usually experiences swelling of the face, hands and feet, headaches and back pain. They may also experience a dull pain in the kidneys and have scanty urine. A study of the urine typically reveals high amounts of albumen along with blood corpuscles. The patient may also complain of a feeling of suffocation.
Arsenicum: Arsenicum is a common remedy for Kidney cysts. It is especially effective in cases where the cysts cause a waxen appearance, paleness, excessive thirst, diarrhoea and dropsy. Patients who benefit from arsenicum typically have dark urine with high amounts of albumen. They may also complain of dyspnoea attacks that are aggravated by lying down and relieved by expectorating mucus.
Phosphorus: Characteristic symptoms of kidney cysts that can be treated with phosphorus include tiredness and muscle pain all over the body, increased drowsiness and having very cold hands and feet. Unlike other ailments in this case the patient usually feels most tired on waking up. He may also complain of internal body heat without having an urge to drink water. Forgetfulness, giddiness and headaches are other symptoms that can be addressed by phosphorus. He may also find it difficult to lie on his side and complain of nausea and vomiting.
Digitalis: Kidney cysts that are accompanied by cardiovascular symptoms such as a feeble pulse can be treated with this homoeopathic remedy. It can also be sued to address dark and scanty urine, rheumatic pains, weak circulation and faintness of the stomach.
Other homoeopathic remedies for kidney cysts include belladonna, plumbum, glonoine, apocynum and cantharis. Homoeopathy addresses the body as a whole and not just the symptoms presented and hence is considered a holistic form of treatment. It is also favoured by many since it has negligible side effects. However, that should not imply that homoeopathy is safe to self-medicate with. With homoeopathy, what works for one person may not work for another, Hence. if you begin experiencing pain in your kidneys or any of the other symptoms associated with this condition, you must consult a homoeopathic doctor to get the right medication.

If you are suffering from a multiple sclerosis, then you must consume vitamin D3, as it can boost up your immune system.

The research undertaken by researchers of Johns Hopkins Medicine have found that taking a high dose of vitamin D3 is safe for people with multiple sclerosis as it may help regulate the body's hyperactive immune response.

Lead researcher Prof Peter Calabresi, M.D., director of the Johns Hopkins Multiple Sclerosis Center and professor neurology at the Johns Hopkins University School of Medicine said that the vitamin D has the potential to be an inexpensive, safe and convenient treatment for people with multiple sclerosis (MS).

He added that the Low levels of vitamin D in the blood are tied to an increased risk of developing MS. People who have MS and low levels of vitamin D are more likely to have greater disability and more disease activity.

The research concluded that the side effects from the vitamin supplements were minor and were not different between the people taking the high dose and the people taking the low dose.

The study is published in the Journal of Neurology.

Introduction
A urinary tract infection (UTI) is a common infection that occurs in the urinary tract (any part of the body used to make and get rid of urine).
Symptoms of a UTI in babies and infants include:
Vomiting
High temperature of or above 38°C (100.4°F)
Irritability
Appearing lazy and sluggish (lethargic)
Symptoms of a UTI in older children include:
frequent passing of urine
complaining of pain or a burning sensation when passing urine
When to seek medical advice
Always contact Dr. B C Shah if you think your child has a UTI. This is not usually a serious type of infection but it does need to be properly diagnosed and treated by a doctor.
Treatment
Most cases of UTIs can be successfully treated with antibiotics.
As a precaution, babies under three months old are usually admitted to hospital, as are children with more severe symptoms.
Many older children can be treated safely at home.
What is the urinary tract?
The urinary tract is where our bodies make and get rid of urine. It is made up of:
The kidneys: two bean-shaped organs that make urine out of waste materials from the blood
The ureters: tubes that run from the kidneys to the bladder
The bladder: where urine is stored until we go to the toilet
The urethra: the tube through which urine passes out of the body
Causes
UTIs develop when part of the urinary tract becomes infected, usually by bacteria. Bacteria can enter the urinary system through the urethra or, more rarely, through the bloodstream.
In many cases of urinary tract infection in children, there is no apparent cause. However, several factors which increase the risk of a UTI developing include:
Constipation, which can place pressure on the bladder, making it more vulnerable to infection
Dysfunctional voiding: a relatively common childhood condition where a child ‘holds on’ to their urine even though they have an urge to urinate
Types of urinary tract infection
There are two types of UTI:
A lower UTI is an infection of the lower part of the urinary tract, which includes the bladder and the urethra. An infection of the bladder is called cystitis, and an infection of the urethra is known as urethritis.
An upper UTI is an infection of the upper part of the urinary tract, which includes the kidneys and the ureters. Upper UTIs are potentially more serious because there is a risk of kidney damage. An infection of the kidneys is known as pyelonephritis.
Who is affected
UTIs are a relatively common infection during childhood.
During the first year of life they are more common in boys then girls, but this changes as children grow older.
It is estimated that around 1 in 10 girls and 1 in 50 boys will develop a UTI at some point between their first and second birthday.
The frequency of infection drops as children grow older, but can rise in women again once they become sexually active (sexual activity is a risk factor for UTIs in adults).
Outlook
Treatment for UTIs in children is usually very effective, with symptoms cleared up quickly.
It is important to always seek prompt treatment if you think your child has a UTI (or any other type of infection), as if left untreated complications can occur, such as:
Scarring of the kidneys, which in later life can cause high blood pressure
Kidney disease
Symptoms of UTIs in children
Symptoms of childhood urinary tract infections (UTIs) can vary depending on the age of the child.
Babies under three months
In babies under three months, symptoms of a UTI (ranked in order of most common to least common) are:
High temperature of or above 38°C (100.4°F)
Vomiting
Lethargy (lack of energy)
Irritability
Poor feeding
Failure to thrive (not developing at the expected rate)
Abdominal pain
Yellowing of the skin and whites of the eyes (jaundice)
Blood in their urine
Unpleasant smelling urine
Older infants
In infants older than three months but not old enough to talk, symptoms of a UTI (ranked in order of most to least common) are:
High temperature of or above 38°C (100.4°F)
Abdominal pain
A feeling of tenderness around their pelvis
Vomiting
Poor feeding
Lethargy
Irritability
Blood in their urine
Unpleasant smelling urine
Failure to thrive
In children old enough to talk, symptoms of a UTI (ranked in order of most to least common) are:
A frequent need to urinate
Pain or a burning sensation during urination (dysuria)
D51eliberately holding in their urine
A change in their normal toilet habits, such as wetting themselves or wetting the bed
A feeling of tenderness around their pelvis
Fever
A general sense of feeling unwell
Blood in their urine
Unpleasant smelling urine
Cloudy urine
When to seek medical advice
You should always contact Dr. B C Shah if your child develops any symptoms listed above.
Most UTIs that occur during childhood are mild and are not a cause for concern, but do usually require treatment with antibiotics to reduce the duration of infection and any risk of complications.
Causes of UTI
Most urinary tract infections (UTIs) are caused by bacteria that live in the digestive system. If these bacteria get into the urethra (the tube through which urine passes), they can cause infection.
In young children this can often occur when they wipe their bottom after going to the toilet, and soiled toilet paper comes in contact with their genitals.
Young girls are more at risk than boys from UTIs because there is less distance between their bottom and their urethra.
Babies who soil their nappies can also sometimes get small particles of stool into their urethra. Modern nappies are designed to prevent this, but it can occur by accident if a baby squirms a lot when being changed.
There are also several conditions that can increase the risk of UTIs occurring. These are outlined below.
Constipation
Constipation does not usually have obvious causes, but can sometimes result from lack of fibre in a child’s diet. Constipation is a relatively common condition among children.
Constipation can cause the rectum (the part of the large intestine that connects to the anus) to swell, which can put pressure on the bladder, preventing it from emptying normally. The remaining urine can then become infected by bacteria.
Read more about constipation in children.
Dysfunctional voiding
Dysfunctional voiding is a relatively common condition among children. It occurs when a child ‘holds on’ to their urine even though they have the urge to urinate. This can occur as a result of nerve damage, but can also be due to habit, which may be difficult for the child to break.
For example, young children at playschool or primary school may be nervous or embarrassed about asking to use the toilet, so they may hold onto their urine until they go home.
Children usually grow out of dysfunctional voiding as they start to adopt more regular bathroom habits. However, some children may need special training.
Vesicoureteral reflux
Vesicoureteral reflux is an uncommon condition in which urine leaks back up from the bladder into the ureters and kidneys. It is estimated that one in 50 girls and one in 200 boys under the age of 12 are affected by vesicoureteral reflux.
There are two types of vesicoureteral reflux:
Primary vesicoureteral reflux is caused by a defect present before birth. There is usually a valve between the bladder and the ureters that prevents urine leaking back out of the bladder. In children who have primary vesicoureteral reflux, the valve does not function properly, and urine is able to flow out of the bladder and back up the ureter to the kidney.
Secondary vesicoureteral reflux is caused by a condition that occurs after birth. For example, urine flow from the bladder may be blocked, or a lower UTI may cause the ureters to become so inflamed and swollen that the one-way valves in the ureters fail, allowing urine to flow both ways.
The danger with vesicoureteral reflux is that a lower UTI can quickly turn into a more dangerous upper UTI, because infected urine can move out of the bladder and back into the ureters and kidneys.
Primary vesicoureteral reflux usually clears up in children as they get older. However, if it is felt a child has a high risk of developing upper UTIs, they may be prescribed an antibiotic to take in the long-term.
Although UTIs can easily be treated with antibiotics and risk of complications is low, if left untreated they can cause kidney scarring. Scarring can occur over time when there is a backup of urine that exposes the kidneys to higher-than-normal pressure. Extensive scarring may lead to high blood pressure and end-stage kidney disease (also known as kidney failure), where kidneys lose most or all of their functioning abilities.
If a child has severe, persistent or recurring vesicoureteral reflux, then surgery is sometimes a treatment option.
Diagnosing UTIs
Children with symptoms of a urinary tract infection (UTI) should always have their urine tested because an accurate diagnosis is important for treatment.
An exception may be made for girls over three years of age who have typical symptoms of cystitis (infection of the bladder), such as urinating more frequently and pain when passing urine.
Urine sample
A urine test is also useful for ruling out other conditions that can cause similar symptoms, such as type 1 diabetes.
If your child has a temperature of 38°C (100.4°F) or above (a fever), and the doctor is unable to find an obvious cause, your child’s urine should be tested within 24 hours.
If your child does not have a fever but has other symptoms of a UTI, a urine test will still be required. However, the urine test does not need to be carried out as quickly, and it might be reasonable to wait more than 24 hours to have it done.
In young children, it is very important to make an accurate diagnosis. However, it can be difficult to obtain a clean urine sample from young children because they are often unable to pass urine into a specimen bottle. Also, if the inside rim of the specimen bottle is touched, it will affect the quality of the sample. Therefore, it may be necessary to carry out the test in hospital where health professionals with skill in obtaining a sample are available.
If there is an urgent need to obtain a sample then a small plastic tube, called a catheter, can be placed into your child’s urethra (the tube through which urine passes out of the body). The catheter will be guided up into the bladder and used to drain out a small sample of urine for testing.
This tends to only be used in more serious cases as children can find the experience upsetting.
Further testing
Further testing is usually only required if your child's UTI symptoms are different from common symptoms (atypical). Examples of atypical symptoms include:
Being seriously ill
Reduced urine flow
A noticeable lump or mass in their abdomen (stomach) or bladder
Testing which shows the bacteria has spread from their urinary tract to their blood
They failed to respond to antibiotic treatment within 48 hours
The infection was caused by bacteria other than the Eschericia coli (E. coli) bacteria
Further testing is also required if your child has previously had:
Two or more upper UTIs
One upper UTI, plus one or more lower UTIs
Three or more lower UTIs
A typical symptoms and recurring UTIs could be due to underlying problems with your child’s urinary tract infection that will require further investigation.
Tests and procedures commonly used to investigate the urinary tract are described below.
Ultrasound scan
An ultrasound scan is usually the first procedure used to assess the urinary tract. The ultrasound scan uses sound waves to build up a picture of the inside of your child's body.
An ultrasound scan is a useful way of assessing whether there are any obvious abnormalities in your child’s urinary tract, such as an unusually narrow ureter (the tube that runs from the kidneys to the bladder) a bladder stone, or kidney stone.
DMSA Scan
A dimercaptosuccinic acid (DMSA) scan is used to assess the state of the kidney. A DMSA scan is usually carried out six months after an acute atypical UTI (a UTI with unusual symptoms) or after the last episode of a series of recurring UTIs.
A DMSA scan is used to assess whether your child’s kidneys have been damaged, or if there are any abnormalities with the kidneys that are making them vulnerable to recurring UTIs. DMSA is a mildly radioactive substance that shows up on a special camera, known as a gamma camera.
During the procedure, your child will be injected with DMSA. After an hour, the DMSA will build up inside the kidneys. DMSA only attaches itself to healthy tissue, so is a useful method of locating any damaged kidney tissue.
The gamma camera is used to take a series of pictures of your child’s kidneys. It usually takes about 30 minutes to complete the scan. During this time it is important for your child to remain as still as possible, so it may be a good idea to bring their favourite book or toy to help them relax during the scan.
A DMSA scan is not painful because local anaesthetic is used to numb the site of the injection. However, the gamma camera is quite large, so younger children may find the experience upsetting. Explaining exactly what will happen and what to expect before the scan may help reassure your child.
After the scan, the DMSA will pass harmlessly out of your child’s body in their urine. Their urine will be slightly radioactive, but is not harmful to your child or other people. However, as a precaution, it is recommended you wash your hands after changing your child’s nappy, and dispose their nappies in a sealed plastic bag.
Micturating cystourethrogram (MCUG)
Micturating cystourethrogram (MCUG) is a procedure used to study the bladder rather than the kidneys.
MCUG is used to check your child does not have vesicoureteral reflux (a condition where urine leaks back up from the bladder towards the kidneys). As with a DMSA scan, it is important for your child to stay as still as possible during the MCUG procedure. Very young children and babies may need to be wrapped tightly in blankets to help prevent them moving during the procedure.
During MCUG, your child will lie on a bed or treatment table and a catheter will be used to pass a special type of liquid, known as a contrast agent, into their bladder. Like DMSA, the contrast agent shows up very clearly on an X-ray.
An X-ray film will then be taken as the contrast agent is passed out of your child’s bladder, in the same way that their urine passes out.
If the X-ray film shows some of the contrast agent leaking back out of the bladder towards the kidneys, it is likely that your child has vesicoureteral reflux.
Most cases of vesicoureteral reflux resolve without the need for treatment as a child gets older. Your child may be prescribed a long-term course of low-dose antibiotics to help prevent them from developing another UTI, until the condition resolves.
The MCUG procedure is not painful and takes around 30 minutes to complete. However, it is likely your child will feel mild discomfort when the catheter is first inserted into their urethra.
The X-rays will expose your child to a low dose of radiation that is entirely safe. The levels of radiation used are the same as the amount of radiation your child would be exposed to by natural sources (background radiation) over the course of three to six months.
Treating UTIs
If your child is younger than three months old, they will be referred to a doctor who specialises in the care of children (paediatrician).
Your baby will usually be treated in hospital using an intravenous drip (where a tube containing antibiotics is directly connected to their vein). They should recover from the UTI within 24 to 48 hours.
Children over three months old
If your child is over three months old and it is felt they are at risk of serious complications, then you can contact Dr. B C Shah.
Signs that indicate your child may develop serious complications from a UTI include:
A recurring high temperature of 38°C (100.4°F) or above
Dehydration, which can cause them to appear drowsy and have few or no tears when crying
Being sick
A known condition that affects their urinary system
A history of kidney disease in your family
If your child is very young, Dr. B C Shah may decide to refer them for hospital treatment, even if there is not an obvious risk they will develop serious complications.
If it is felt there is no risk of serious complications developing, or if the risk is low, you may be able to treat your child at home. The infection can be treated using oral antibiotics, and paracetamol can be used to treat symptoms of fever or discomfort.
For lower UTIs, a three-day course of antibiotics is usually recommended. For upper UTIs, a seven-day course of antibiotics is usually recommended. Children who are unable to swallow tablets or capsules can be given antibiotics and paracetamol in liquid form.
Your child should recover from the UTI within 24 to 48 hours. However, it is very important they finish the prescribed course of antibiotics to prevent the infection recurring.
After taking antibiotics, some children may experience side effects. However, any side effects will usually pass after your child stops taking the antibiotics. Side effects may include:
Feeling sick (nausea)
Vomiting
Upset stomach
Diarrhoea
Loss of appetite
A very small number of children (less than one in 5,000) may experience a severe allergic reaction (anaphylaxis) to antibiotics that contain penicillin. Symptoms of an allergic reaction to penicillin include:
A rash
Swelling of the hands, feet and face
Shortness of breath
If your child experiences these symptoms, you should immediately dial 999 for an ambulance and tell the operator you think anaphylaxis has occurred.
Treating constipation
It is important to treat constipation in children promptly because it is a major risk factor for developing UTIs.
As with babies and adults, children with constipation will first be advised to change their diet. If this fails, laxatives can be prescribed. An osmotic laxative is usually prescribed, followed if necessary by a stimulant laxative.
Osmotic laxatives increase the amount of fluid in your child’s bowels. This helps to soften your child’s stools, making it easier for them to pass them out of their body.
Stimulant laxatives stimulate the muscles that line the digestive tract, helping to move stools along your child’s large intestine to their anus (the point at which waste products leave the body).
As well as eating plenty of fruit, older children should have a well balanced diet that contains vegetables and wholegrain foods, such as wholemeal bread and pasta.
Surgery
Surgery is usually only recommended if :
Your child has severe, persistent or recurring vesicoureteral reflux (where urine leaks back up from the bladder and into the ureters and kidneys), and
They are having reoccurring UTIs that could result in permanent scarring of their kidneys
Surgery aims to repair the valve between the bladder and each affected ureter that keeps it from closing and stopping urine from flowing backward. The two types of surgery used are:
Open surgery. This type of surgery is performed under general anaesthetic and your child will usually need to stay in hospital for a few days. A catheter may be used to drain your child's bladder. The risks of open surgery can include infection, blood clots and bleeding.
Endoscopic surgery. This type of surgery is less invasive compared to open surgery but is not always as effective. A cystoscopy allows the doctor to see inside your child's bladder and inject a bulking agent to try to strengthen the defective valve. Endoscopic surgery is also performed under general anaesthetic, but can usually be performed as an outpatient procedure rather than needing an overnight stay.
Preventing UTIs
It is not possible to prevent all childhood urinary tract infections (UTIs), but the advice listed below may help reduce their frequency.
Breastfeeding your baby may lower the risk of them developing a UTI. However, the effect takes time to build up, only providing protection after three months of breastfeeding.
Encourage your child to wipe their bottom from front to back. This will help to minimise the chances of bacteria entering the urethra (the tube through which urine passes).
Encourage boys to clean around their foreskin regularly. Bacteria can build up there and enter the urethra. If your child’s foreskin is still fixed (does not retract), you should not attempt to clean under it because doing so may damage the surrounding area.
Encourage children to go to the toilet regularly – at least every four hours, and before having a bath and going to bed.
Avoid nylon and other types of synthetic underwear. These can help promote the growth of bacteria. Loose-fitting cotton underwear should be worn instead.
Drinking cranberry juice can help prevent UTIs, but be careful to limit the amount your child drinks because too much can cause diarrhoea. Three glasses of low-sugar cranberry juice a day is a safe amount for most children. Cranberry juice is not suitable for children with diabetes, or for those taking warfarin (a blood-thinning medicine). Higher-strength cranberry capsules are also available, but are not suitable for children aged under 12.
Recurrent urinary tract infections
A small number of children have recurring UTIs. If your child has previously had a UTI, it is important both of you watch for the return of any associated symptoms.
Tell Dr. B C Shah of any symptoms as soon as possible so a diagnosis can be confirmed and treatment can begin.

- See more at: http://drbcshah.com/urinary-tract-infection/#sthash.vcyWQQsv.dpuf

Introduction
Cystitis is inflammation of the bladder. It's usually caused by an infection in the bladder, but can also be caused by irritation or damage (from friction during sex, for example).
Symptoms of cystitis are:
An urgent need to urinate often
Pain or stinging when you urinate
Cystitis usually passes within a few days, or sometimes may need treatment with antibiotics.
Untreated bladder infections can cause kidney infections.
Cystitis in women
Cystitis is more common in women because women have a short urethra (the tube that carries urine from the bladder out of the body). The urethra's opening is also located very close to the anus (bottom), which makes it easy for bacteria from the anus to reach the bladder and cause an infection.
Almost all women will have cystitis at least once in their lifetime. Around one in five women who have had cystitis will get it again (known as recurrent cystitis). Cystitis can occur at any age, but it is more common in:
Pregnant women
Sexually active women
Post-menopausal women (women who have been through menopause)
Cystitis in men
Cystitis is less common in men. It can be more serious in men because it could be caused by:
An underlying bladder or prostate infection, such as prostatitis
An obstruction in the urinary tract, such as a tumour, or an enlarged prostate (the gland located between the penis and the bladder)
Male cystitis is not usually serious if treated quickly, but it can be very painful. Sexually active gay men are more likely to get cystitis than other males.
Outlook
Mild cystitis usually clears up within 4-9 days. You can treat it at home by drinking plenty of water (around 1.2 litres or 6-8 glasses every day) and taking painkillers, such as paracetamol or ibuprofen. More severe cystitis can also cause abdominal pain or fever, and may need treatment with antibiotics.
Seeing Dr. B C Shah
Children and men should always see Dr. B C Shah if they have symptoms of cystitis. Women should always see Dr. B C Shah the first time they have the symptoms of cystitis. They should also return to him if they have the condition ore than three times in one year.
Symptoms of cystitis
Children and adults can get cystitis, and the symptoms can be different.
Symptoms in men and women
Cystitis in men and women can cause:
Pain, burning or stinging when you urinate
Needing to urinate often and urgently but passing only small amounts of urine
Urine that's dark, cloudy or strong smelling
Urine that contains traces of blood (haematuria)
Pain low in your belly (directly above the pubic bone), or in the lower back or abdomen
Feeling unwell, weak or feverish
Symptoms in children
Symptoms of cystitis in children may include:
Weakness
Irritability
Reduced appetite
Vomiting
Pain when urinating
Cystitis is usually treated easily.
Seeing Dr. B C Shah
The usual symptoms of cystitis could also be caused by other conditions, so it's important to see Dr. B C Shah the first time you have any of these symptoms. This means you can be treated correctly for whatever is causing your symptoms.
The symptoms caused by cystitis could also be caused by:
Sexually transmitted infections (STIs), such as gonorrhoea or chlamydia
Being infected with bacterium such as E-coli
Vaginal thrush, also known as candida (a yeast infection)
Inflammation of the urethra (urethritis)
Urethral syndrome (women only)
Inflammation of the prostate gland, also known as prostatitis (men only)
Causes of cystitis
The most common cause of cystitis is a bacterial infection. If bacteria reach the bladder, they can multiply and irritate the bladder lining, causing the symptoms of cystitis.
Cystitis can also result from damage or irritation around the urethra. The urethra is the tube that carries urine from the bladder out of the body. In men, the urethral opening (where urine leaves the body) is at the tip of the penis. In women it's just below the clitoris.
Bacterial infection
This happens when bacteria get into the bladder and multiply. It can happen if you don't empty your bladder properly. Try to empty your bladder fully each time you go to the toilet, to help prevent bacterial infection.
You may not be able to empty your bladder fully if:
You have a blockage somewhere in your urinary system: this could be caused by a tumour or, in men, an enlarged prostate (a gland located between the penis and the bladder)
You are pregnant, as pregnancy puts pressure on the pelvic area and the bladder
Bacterial infection can also happen when bacteria from the anus are transferred to the urethra. This is more common in women than in men, as the urethra is closer to the anus in women than it is in men.
In women, transferring bacteria in this way can happen when you are:
Having sex
Wiping after going to the toilet (you're less likely to transfer bacteria in this way if you wipe from front to back)
Inserting a tampon
Using a diaphragm (a soft dome made of latex or silicone) for contraception
In women who have had, or are going through, the menopause, the lining of the urethra and the bladder become thinner. This is due to a lack of the hormone oestrogen. The thin lining is more likely to become infected or damaged. Women also produce fewer vaginal secretions after the menopause, which means that bacteria are more likely to multiply.
Damage or irritation
Cystitis can also be caused by damage or irritation in the area around the urethra in both men and women. This could be the result of:
Damage or bruising caused by vigorous or frequent sex (this is sometimes called honeymoon cystitis)
Wearing tight clothing
Chemical irritants – for example, in perfumed soap or talcum powder
Other bladder or kidney problems, such as a kidney infection or prostatitis
Diabetes (a long-term condition caused by too much glucose in the blood)
Damage caused by a catheter (a tube inserted into the urethra to allow urine to flow into a drainage bag, which is often used after surgery)
Diagnosing cystitis
If you have had cystitis before, you may be able to recognise the symptoms and diagnose the condition yourself.
However, men and children with cystitis symptoms should always see Dr. B C Shah. Men, women and children should see Dr. B C Shah if:
This is the first time you've had cystitis symptoms
There's blood in your urine (haematuria)
You have a high temperature (fever) of 38ºC (100.4ºF)
You're in a lot of pain
You've had cystitis three times in one year
Dr. B C Shah should be able to diagnose cystitis from asking about your symptoms. In some cases, they may also use a dipstick (a chemically treated strip of paper) to test a sample of your urine. The paper will react to certain bacteria by changing colour, showing which kind of infection you have.
Urine culture
Dr. B C Shah may wish to send a sample of your urine to a laboratory for further testing. This sample is called a urine culture. This may be necessary if:
you have recurrent cystitis (more than three times in one year)
it is possible that you may have a kidney infection – cystitis can be a symptom of this
you are on immunosuppressant medication(medication that suppresses your immune system) – these affect your body’s defences so you may be more prone to infection
you have diabetes (a long-term condition caused by too much glucose in the blood) – cystitis can be a complication of diabetes
you may have a sexually transmitted infection(STI) – such as gonorrhoea and chlamydia
it is possible that you have another infection, such as thrush (candida)
The urine culture will confirm which bacteria are causing your cystitis. Alternatively, it may reveal that your cystitis is caused by another condition. Dr. B C Shah can advise you about the most appropriate treatment for you.
Further tests
If you have recurrent cystitis that does not respond to antibiotics, even after a urine culture has been tested,you may need to have some other tests, such as:
An ultrasound scan
An X-ray
A cystoscopy
A cystoscopy is when a tiny fibre-optic camera, called a cystoscope, is used to examine your bladder. The cystoscope is a very thin tube that has a light and a camera at one end. It is inserted into your urethra (the tube that carries urine from your bladder out of your body) and transmits images of the inside of your bladder to a screen.
Any further tests that you need will be explained to you by Dr. B C Shah treating you.
Treating cystitis
Children and men should always see Dr. B C Shah if they have cystitis symptoms. Women should always see Dr. B C Shah the first time they have cystitis symptoms, and also if they have the condition more than three times in one year.
The symptoms of cystitis usually clear up without treatment within 4-9 days. There are some self-help treatments that can ease the discomfort of any symptoms, or Dr. B C Shah may prescribe antibiotics.
Self-help treatments
If you've had cystitis before and you're sure that you have mild cystitis and don't need to see Dr. B C Shah, there are treatments that you can try yourself.
Over-the-counter (OTC) painkillers, such as paracetamol or ibuprofen. These can reduce pain and discomfort. Always read the label and check with your pharmacist first, particularly if you have any other medical condition, you are taking other medicines, or you're pregnant or breastfeeding.
Drinking plenty of water is often recommended as a treatment for cystitis. There's no evidence that this is helpful, although drinking around 1.2 litres (6-8 glasses) of water a day is generally good for your health. Also avoid alcohol.
Don't have sex until your cystitis has cleared up because having sex can make it worse.
Some people find that using urine alkanising agents, such as sodium bicarbonate or potassium citrate, for a short period of time may help to relieve pain when urinating. However, there is currently a lack of clinical evidence for their effectiveness. Check with Dr. B C Shah first if you are taking any other medication.
Drinking cranberry juice is not thought to help relieve pain but may help to prevent outbreaks of recurrent cystitis.
Antibiotics
If your symptoms are moderate or severe, Dr. B C Shah may prescribe a short course of antibiotics. This will usually involve taking a tablet 2-4 times a day, for three days.
For a more complicated case of cystitis, such as cystitis with another underlying infection, you may be given antibiotics for 5-10 days.
If your cystitis symptoms are only mild, Dr. B C Shah may prefer not to prescribe antibiotics to avoid ‘antibiotic resistance’. This is when the bacteria that cause cystitis adapt and learn to survive the antibiotics. Over time, this means that the treatment becomes less effective.
Recurring cystitis
If you keep getting cystitis (known as having recurring cystitis) your doctor may prescribe stand-by antibiotics or continuous antibiotics. A stand-by antibiotic is a prescription for you to take the next time you have cystitis, without needing to visit Dr. B C Shah again.
Continuous antibiotics are antibiotics that you take for several months to prevent further episodes of cystitis. These may be prescribed for two reasons:
If your cystitis usually occurs after having sex, you may be given a prescription for antibiotics to take within two hours of having sex
If your cystitis is not related to having sex, you may be given a low-dose antibiotic to take for a trial period of six months
Complications
Most cases of cystitis clear up on their own or with antibiotics. However, untreated bladder infections can cause kidney infections, which can be serious.
Although cystitis usually clears up on its own or with antibiotics, some people experience almost constant symptoms or recurring episodes. If no cause can be found, and the cystitis doesn't respond to antibiotics, you may have interstitial cystitis.
Interstitial cystitis
Interstitial cystitis causes recurring discomfort in the bladder and pelvic area. Like cystitis, it can cause an urgent and frequent need to urinate. Other symptoms, and the level of pain it causes, can vary from person to person.
Some people may find it more painful when their bladder is full, or more painful when they urinate. Women may find the condition more painful during their period.
How is it treated?
Treatment can include:
Medications, including painkillers and antidepressants
Bladder distension – when the bladder is filled with water to increase its volume
Bladder instillation – the bladder is filled with a solution that includes medication to reduce inflammation of the bladder walls
Surgery, if other treatments haven't worked
If you're diagnosed with interstitial cystitis, Dr. B C Shah will explain the condition and the treatment options in more detail.
Dr. B C Shah may use the term 'painful bladder syndrome' (PBS) to describe a condition that causes pain but doesn't meet the criteria to be diagnosed as interstitial cystitis.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Painkillers
Painkillers (analgesics) are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.
Preventing cystitis
It's not always possible to prevent cystitis, but you can take some steps to help avoid the condition:
Don't use perfumed bubble bath, soap, or talcum powder around your genitals – use plain, unperfumed varieties
Have a shower, rather than a bath, to avoid exposing your genitals to the chemicals in your cleaning products for too long
Always empty your bladder fully when you go to the toilet
Don't wait to go if you need to urinate: delaying it can place extra stress on your bladder and could make it more vulnerable to infection
Wear underwear made from cotton rather than synthetic material such as nylon
Avoid wearing tight jeans and trousers
Always wipe from the front of your genital area to the back, not back to front, when you go to the toilet
Some people find certain types of food and drink make their cystitis worse: for example, coffee, fruit juice or spicy foods. If there is anything that triggers your cystitis, you may wish to avoid it
Cranberry products
Although cranberry products are not effective at treating cystitis, they may help to prevent recurrent attacks. High-strength capsules, which contain 200mg of cranberry extract, are available in shops .
Cranberry capsules may be a more effective treatment than drinking cranberry juice, as you need to drink a lot of juice for it to benefit you, and not everyone likes the taste. Cranberry capsules are not recommended if you are taking warfarin (blood-thinning medication).
Cystitis and sex
Try these tips if your cystitis is triggered by having sex:
Wash your genital area and your hands before and after sex
Use a lubricant during sex to avoid damaging your genital area through friction (use a water-based lubricant if you're using latex condoms, as oil-based lubricant can make latex condoms less effective)
If you're a woman and you use a diaphragm for contraception, you may wish to change to another method of contraception
After having sex, empty your bladder as soon as possible to get rid of unwanted bacteria
There is currently no evidence that oestrogen products, used to treat women after the menopause, can prevent cystitis.
People who have catheters need special advice about how to change them without damaging the area. Ask the healthcare professional who is treating you to show you how to do this.