1. Definition of cystitis:
    • Inflammation of the bladder.
    • The causes can be multifactorial but the most common cause is due to a bacterial infection (UTI – urinary tract infection)
  2. Why is the incidence of cystitis greater in women vs men?
    Due to the shorter length of the urethra and the proximity of it to the anus. Both things make it more prone to invading pathogens.
  3. Cystitis is rare in healthy men, so what underlying condition could it be a result of?
    • Prostate disease
    • incontinence
    • some other condition.
  4. Cystitis risk factors:
    • Sexual activity 
    • Douching and washing habits
    • Diabetes
    • Pregnancy
    • Childlbirth 
    • Catheter
    • Antibiotic use
    • Incomplete voiding of bladder
  5. Most common symptoms of Cystits
    • Dysuria
    • Urinary urgency and frequency
    • Sensation of bladder fullness or lower abdominal discomfort
    • Suprapubic tenderness
    • Flank pain
    • Blood in the urine
    • Fevers, chills, vomiting, nausea and lower back pain (RF for kidney infection)
  6. Diagnosis and treatment of cystitis:
    • Urine analysis with dipstick or culture
    • Microscopic may show high levels of white blood cells (WBCs) and bacteria, haematuria  and/or low-grade proteinuria
    • Recurrent infections may require further investigation to rule out functional pathologies
    • Treatment = antibiotics
  7. Natural support for Cystitis:
    • Enhance flow of urine with proper hydration.
    • Promote a pH that inhibits the growth of the organism.
    • Preventing bacterial adherence to the endothelial cells of the bladder.
    • Enhancing the immune system.
    • Improving microflora balance – both in the vagina and large intestine
    • Evaluate and remove possible mechanical or hygiene causes
  8. Nutritional protocol for Cystitis:
    • Eliminate refined foods, caffeine, alcohol, and sugar
    • Avoid sexual activity until infection is resolved.
    • Drink 2L water /day. 
    • Reduce pro-inflammatory foods and emphasise foods high in antioxidants, phytonutrients, bioflavonoids and anti-inflammatory essential fatty acids such as oily fish and nuts / seeds.
    • Stress management techniques should be implemented.
    • Improve microbial balance though probiotic and prebiotic food
  9. How does cranberry work for cystitis?
    • Cranberries contain high levels of Vitamin C, fructose, and proanthocyanins 
    • PAC and fructose increase the bacterial anti-adhesion activity of urine 
    • Preventing the adhesion of E-coli to the urothelium
    • However better for prevention than for curing active infection
    • Contraindications - May cause stomach distress and diarrhoea, increase the risk of kidney stones
    • Use cautiously with anticoagulants, medications that affect the liver, aspirin, those with altered hepatic function or in those taking cytochrome P450-metabolised agents.
  10. What it D-Mannose and how does it work for cystitis?
    • Simple sugar found in blackcurrants and redcurrants, gooseberries, aloe vera, soy beans and vegetables including cabbage, eggplant and tomatoes.
    • Supplemental mannose can bind bacteria and prevent attachment to the urinary tract lining.
    • Use in caution with diabetics
  11. What are the main differences between Cystitis and Interstitial Cystitis?
    • The main difference is that it is a chronic irritation of the bladder and urine is normal and sterile 
    • Cause and pathogenesis are still undetermined
    • Diagnosis is essentially one of exclusion
    • Pain is the most common symptom
    • Association systemic lupus erythematosus, irritable bowel syndrome, and fibromyalgia
  12. Pathogenesis of Interstitial Cystitis:
    • Leaky urothelium
    • Irritant chemicals in urine (from micro-organisms, metabolites or food intolerance)
    • Autoimmune diseases and antibody complexes that irritate the bladder lining
    • An initial infection that sets up an post-infection inflammation
    • Lymphatic/vascular obstruction
    • Reduced nitric oxide synthase (NOS) activity
    • Neurogenic inflammation involving mast cells.
  13. Nutritional protocol for Interstitial Cystitis
    • 1. Working on leaky urothelium theory, it is wise to consider a grand elimination diet and food diary as food allergens can make the underlying nerves sensitive to Ka+.
    • 2. Due to links with other autoimmune diseases and IBS, immune support and gut support may also be required.
    • 3. Stress management
  14. Nutrients for Interstitial Cystitis:
    • Arginine – source of nitrogen for NO production; NOS have antibacterial, smooth muscle relaxant, hormone-releasing, and immune-modulating
    • Chondroitin sulphate – repair mucosal damage 
    • Glucosamine – repair mucosal damage Methylsulfonylmethane (MSM) – anti-inflammatory.
    • Quercetin -inhibits histamine release from mast cells and has anti-inflammatory and antioxidant properties
    • Gotu Kola - improve integrity of connective tissue
    • Probiotics may be helpful but avoid fermented foods
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