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Bladder cystitis is defined as inflammation of the urinary bladder from any cause. Escherichia (E.) coli is responsible for 75 - 90% of uncomplicated cystitis cases in younger women and in more than half the cases in older women (over age 50). Other common causative organisms have also been detected, including Staphylococcus, Klebsiella, etc. In most cases of urinary tract infection (UTI), E. coli, which originates as a harmless microorganism in the intestines, spreads to the vaginal passage, where it invades and colonizes the urinary tract.
Bladder cystitis is a relatively common condition affecting both sexes and all ages, but women are more affected than men. In fact, almost every woman will have had cystitis at least once in her lifetime. The incidence of cystitis is high in women because of the short length of the urethra and because of the proximity of the urethra to the anus. This anatomy makes the female urinary bladder relatively easily accessible to intestinal pathogens. Patients with cystitis may present with symptoms of urgency, frequency, dysuria, hematuria, cloudy and offensive-smelling urine, or suprapubic discomfort. These symptoms may occur singly or in combination. In female patients, a single episode of acute cystitis may usually be treated safely with antibiotics. However, recurrent episodes should be investigated.
Women with recurrent UTI often demonstrate persistent vaginal colonization with E. coli. Since strains of lactobacilli that produce hydrogen peroxide inhibit the growth of E. coli, their absence may predispose to E. coli colonization and to UTI. Lactobacilli also produce bacteriocins with antimicrobial activity against bacteria as well as fungi (vaginal antimicrobial defense system).
Changes in the amount or type of acid within the genital and urinary tracts are major contributors to lowering the resistance to infection. The production of lactic acid by beneficial lactobacilli contributes to the acidic pH of the vagina and urinary tract, an environment known to be inhibitory to several microorganisms, including E. coli. Reductions in their number (which, for example, occurs with estrogen loss after menopause), increases pH and therefore the risk of infection.