Inflammation of the bladder. Cystitis is most commonly caused by bacteria that enter through the urethra and infect the bladder, producing cloudy, bloody, or strong-smelling urine. Other symptoms include low fever, pain or burning with urination, pressure or cramping in the lower abdomen or back, and frequent urination.

People at greatest risk for bacterial cystitis include those who have had a urinary catheter in the bladder or blockage of the bladder or urethra; people with diabetes, enlarged prostate, anything that blocks the flow of urine, or bowel incontinence; and older individuals. Bacterial cystitis is treated with antibiotics.

Some people have interstitial cystitis (IC), in which no bacterial infection is detected. No one knows what causes IC, so doctors try to treat the symptoms. They may distend (expand) the bladder with liquid or gas. In bladder instillation, they use a catheter to temporarily fill the bladder with dimethyl sulfoxide, which may reduce inflammation, block pain, and prevent muscle spasms.

Oral medications may also help. Pentosan polysulfate sodium (Elmiron) improves symptoms in some patients. Other drugs used to treat IC include aspirin, ibuprofen, acetaminophen, and other painkillers, the tricyclic antidepressant amitriptyline (Elavil), and antihistamines.

Transcutaneous electrical nerve stimulation (TENS) may be applied to the lower back or just above the pelvis to relieve pain. Some patients find that avoiding alcohol, tomatoes, spices, and caffeinated beverages may help relieve symptoms.

This column is written by Robert S. Dinsmoor, a medical writer and editor based in Massachusetts.

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