Cystitis is the inflammation of the urinary bladder, acute or chronic.
* The common bacterial agents are Escherichia coli, Proteus, Klebsiella and Enterobacter.
* Less common infectious agents are Mycobacteria, Candida, Schistosoma, Chlamydia and virus.
* Chemotherapeutic agents-
* Cyclophosphamide and busulfan may cause cystitis.
* Radiation therapy-
* It will cause chronic cystitis.
The pathogenesis of chronic cystitis is diverse based on different etiologies.
The epidemiology is diverse, dependent upon the inciting agent. Bacterial cystitis is more frequent in women than men. It is due to the differences in urethral anatomy.
GENERAL GROSS DESCRIPTION
The bladder may show no significant gross abnormalities. On cystoscopy, the mucosa may appear red, granular or ulcerated. Long standing chronic inflammation may cause the bladder to become thickened and fibrotic.
GENERAL MICROSCOPIC DESCRIPTION
The urothelial mucosa of the bladder shows chronic inflammatory cells in the lamina propria. Long standing cases may show varying degrees of fibrosis.
Most of the inflammatory cells seen are lymphocytes, which occasionally form aggregates and develop germinal centers. The urothelium may show varying degrees of denudation and ulceration.
CLINICAL CORRELATION AND SYMPTOMS
Clinically, signs and symptoms are not particularly reliable. Patients may be asymptomatic, or may experience dysuria, frequency, urgency and suprapubic pain.
Urine may be grossly cloudy.
SOME DRUGS THAT CAUSE AND CURE CYSTITIS
-The remedy par excellence of cystitis. Violent tenesmus and strangury (Lil. tigr.).
-Painful discharge of a few drops of bloody urine with very severe pain, as if a red-hot iron were passed along urethra.
-Violent burning, cutting, stabbing pain in neck of bladder. -worse before and after urinating.
-Urging to urinate, from smallest quantity urine in bladder (Puls.).
-Must double up and scream from the pain.
Urine only drop by drop (Apis.) with extreme pain.
- FARRINGTON : “Cures acute cystitis more frequently than all other remedies put together”.
-GUERNSEY : “It is a singular fact, that if there be frequent micturition attended with burning, cutting pain, or if burning and cutting attend the flow, Canth. is almost always the remedy for whatever other suffering there may be, even in inflammation of brain or lungs”.
KENT : “The most important feature of this medicine is the rapidity with which it develops a gangrenous state… The patient is violently sick in a great hurry…. The bladder and genitals are inflamed, and the excitement and congestion often arouse the sexual instinct to sexual thoughts, and even sexual frenzy…. Intensity and rapidity are its features. A state of pain and excitement found in no other remedy”.
-Cystitis with high fever, gastric derangement; excruciating pains and impossibility to pass a drop of urine. Bladder seems swollen and hard. Great spasmodic tenesmus.
-Passes by drops a dark-red, brown, fetid urine, with gravel-like sediment.
-Excessive restlessness : hurried and fidgety: rolls from side to side.
-Atrocious pains with strangury.
-Constant urging : violent pain extorts screams.
-Must get down on hand and knees to urinate : almost touches floor with forehead, in order to be able to pass urine. (Comp. Chimaph., Sarsa.).
-Pains down thighs in efforts to urinate.
-Passes stringy white mucus, or red sand .
-Excessive pain in region of bladder.
-Frequent, painful, scanty, bloody urination.
-Much straining, then a few drops : dribbles a little hot bloody urine (Canth.).
-Urine almost suppressed.
-Scanty urine in little boys, with foreskin enormously distended, or hydrocele.
-When call comes to urinate, will shriek, because he remembers the pain last time (Acon.).
-Whole urinary tract irritated, like (Canth.) : – “these two, antidote one another”.
-Agony in voiding urine. Retention in nursing infants. KENT says : “Old women knew, long before Apis was proved, that when the new-born babe did not pass its water, they could find a cure by catching bees, over which they poured hot water, and gave the baby a teaspoonful”.
-The pains of Apis are burning, stinging.
-Apis is worse from heat : better from cold.
-Has plenty of oedema. Is thirstless (Rev. of Acon.).
-No remedy has a greater irritation of bladder and along urinary tract.
-Urging to urinate constant. Urine dribbles : burns intensely along length of urethra.
-Bladder sensitive to pressure : to jar.
-After urination sits and strains : intense torment.
-Sometimes bloody urination : or blood in bladder comes away in little clots.
-Urine strongly acid. Fiery red urine.
-Bell. has quick sensations and motion.
-Pains come suddenly, and go suddenly.
-Bell. in fever, craves lemons. Is usually hot, and red. Tends to violent delirium.
-Inflammation of bladder and kidneys; bloody urine. Violent burning in bladder.
-Urine scanty, suppressed or retained. From shock.
-Cystitis; cutting, tearing pains : burning. Urine hot, dark, red; clear or bloody.
-Retention from cold. In children urging; crying; fear of the pain (Apis).
-”Inflammation of bladder, in adults or infants : with the Aconite anxiety; restlessness; fear”. KENT.
-Acon. is thirsty : Apis. thirstless.
-Unbearable pain at end of urination (Equiset.).
-Tenderness and distension of bladder.
-Cannot pass urine when sitting : it passes freely when standing.
-Dribbles while sitting.
-Floods the bed at night; by day can only pass it standing.
-”Passes enormous quantities of sand. In one case, this mitigated the catarrh and kept bladder comfortable”. KENT.
-Also, “Urine passed without sensation”.
-Violent burning and cutting in bladder, alternating with similar pain in umbilicus < at rest >> walking in open air. (Comp. Puls.).
-Sensitive in hypogastrium; tenesmus, bladder.
-Spasmodic tenesmus, urging and pressing while sitting : pain streaks up to kidneys.
-Haematuria : albuminuria : urine cloudy, smoky. (A great haemorrhagic remedy).
-Smooth, glossy, red tongue (Pyrog., Crot.).
-Urine smells strongly of violets.
-Tereb. has also excessive tympanites. Ecchymoses : purpura (A less acute Canth.).
-Dull pain in bladder, as from distension.
-Constant desire to urinate and pass large quantities of pale urine without relief.
-HERING’S case : – “General paralysis in an old woman in whom control over stools and urine, long completely lost, was rapidly restored”.
-Has severe pain at end of urination (Sarsa.).
-Cystitis with offensive mucus, tending to putrescence. “The more the offensiveness, the more it is Lach.”
-Sensitiveness over abdomen. Can hardly allow her clothes to touch her.
-Urine blackish, or dark brown : foamy : or has little black spots like soot floating in it.
-Feeling as of a ball rolling about in bladder or abdomen.
-Ineffectual urging; Violent burning when it does pass.
-No urine : no stool.
-Always has to urinate after lying down : especially after sleep.
-Typically Lach. is purple : loquacious : suspicious : sleeps into an aggravation, or is worse after sleep.
-Is hypersensitive to heat and touch.
-Cystitis with great quantities of ropy bloody mucus in urine : muco-purulent : foul, scanty.
-Curious sensation of swelling in perineum, or near anus, “as if sitting on a ball”.
-Must stand, feet wide apart to urinate. (Comp. Sarsa.).
-”Prostatic troubles” NASH.
-Acute inflammation in urinary tract.
-Wonderful tenesmus : extremely painful, bloody, burning, smarting urine : scarcely a drop collects in bladder, but it must be expelled (Canth.).
-Cannot lie on back, without desire to urinate.
-Dribbling urine : on slightest provocation – coughing, sneezing, (comp.-Caust.), surprise, joy, laughing, the slam of a door (Sep.).
-Great urgency : impossible to delay : when going to urinate, sensation as if it will gush away.
-Tenesmus vesicae : cystitis or catarrh. As if bladder too full.
-Must keep mind constantly on bladder, or she will lose her urine (Sepia).
-Flows away in sleep (Lyc., Caust., etc.).
-In the Pulsatilla patient : changeable, extremely touchy and weepy.
-Heat and stuffiness unbearable. (Comp. Terebinth.).
-Sticking pain in neck of bladder when not urinating : burning pain, when urinating.
-Ineffectual urging, with anguish : smarting or burning in urethra when urinating.
-Urine hot, scanty, turbid; red as blood.
-But with the Cham. mentality:- Piteous moaning, in child : because he cannot have what he wants.
-Wants this and that, then pushes it away.
-Snappish : uncivil : irritable : impatient.
-Oversensitve to pain : “cannot bear it”.
-KENT says, “Staphisagria is very comforting to the young wife”.
-Frequent and painful urging to urinate : urine bloody, involuntary, acrid and corroding, with burning : worse from motion.
-Burning during and after urination.
-NASH says, “our only remedy for burning all the time, between the acts of urinating”.
-A remedy of strong mentality : ailments from indignation about acts of others – or his own.
-Bladder affections after mechanical injuries.
-Constant urging, while urine passes involuntarily by drops.
-Frequent attempts to urinate : has to wait a long time for urine to pass.
-Urination involuntarily during sleep : when running.
-Haematuria from mechanical causes : Urine thick, with much pus.
-Urine very acrid, with increased specific gravity.
-With Arn. the body feels sore and bruised, and the bed too hard.
-Fear of touch : of approach.
-A curious symptom : says she is well, when very ill.
Such pain when he passes urine, as to cause him to shiver and dance round the room in agony.
-Sudden agonizing desire to urinate.
-Tenesmus vesicae with intense burning in urethra; discharge of mucus and blood with urine or after it.
-Micturition frequent : urine in drops with much pain. Scanty : hot; burning; bloody (Canth., Apis.).
-Stools also hot, scanty, bloody, with great straining, not relieved by stool. (Dysentery).
-Ptyalism, with salty taste.
-Skin cold, pale, dripping with sweat.
-A remedy of violent conditions.
-Cystitis, or catarrh of bladder : from changes in the weather : from hot to cold : especially to damp cold.
-If chilled must hurry to urinate.
-”Every time he takes a little cold, urine bloody, with frequency”.
-Constant desire to urinate, felt deep in abdomen.
-Dulc. is a medicine of Autumn; hot days and cold evenings. They bring out sweat, then suppress it.
-”Dulc. is for affections of damp cold, what Acon. is for the same, from dry cold.” NASH.
-Frequent urging, day and night.
- Causticum] -Ineffectual attempts to urinate : when a few drops passed, had violent pain in bladder.
- Causticum] -Urging : had to wait a long time, when only a little passed : urging soon renewed without pain.
-Painful retention, brought on by cold (Acon.).
-Catarrh of bladder.
[-Queer symptom, itching at urethral orifice. KENT says, Caust. has two kinds of paralysis of bladder : one of muscles of expulsion, when urine is retained : one sphincter vesicae, when urine is passed involuntarily.
-Again, paralysis of bladder, from over-distension; after having to delay urination.
-Sepia also, may be compelled to keep her mind on the neck of the bladder, or she will lose her urine (Puls.).
-Enuresis when coughing, laughing, the slam of a door, or when mind is diverted (Puls.).
-Constant urging for a milky urine that burns like fire, and deposits a material hard to wash off the vessel.
-Bloody urine, scanty and suppressed : sudden desire, and tenesmus as if uterus would come out.
-”Sudden desire with cutting like knives, and chill all over the body”.
-More chronic, and in the Sepia patient. Indifferent : cold, mentally : no joy in life. Chilly; sallow; brownish skin. Faint sinking at epigastrium. Wants to get away and be at peace. (Antithesis of Puls.).
-Cystitis : turbid, milky urine, with offensive purulent sediment : dull pressing in bladder and abdomen. Heaviness in bladder.
-Urging to urinate : must wait long before it will pass, with constant bearing down.
-Supports abdomen with hands. (Vulva, Sep.).
-Urging, children cry out and grasp abdomen.
-”Copious red sand in urine, in acute cases : in chronic, when the patient feels best, red sand is found in urine.” KENT.
-Involuntary urination in sleep.
-Polyuria during the night, though normal or even scanty by day.
-Involuntary in sleep.
-Passes enormous quantities of urine, very clear and of light specific gravity.
-Red sand in the baby’s diaper : the urine causes great irritation where left in contact with skin.
-But in the Lyc. patient; more mental than physical development.
-Worse 4-8 p.m.
-Desire for sweets and hot drinks.
-A remedy of great flatulence and fullness after eating but a little.
Dr. Rajneesh Kumar Sharma
Homoeo Cure & Research Centre P. Ltd.
N.H. 74, Moradabad Road, Kashipur? 244713, Uttaranchal, INDIA
Ph. +91 05947- 274338, 277418, 260327, 275535
Cell. 98370-48594, 98371-47000, 94129-59562, Fax +91 5947 274338