A Text-book of Diseases of Women

by Charles B. Penrose

Infection at catheterization is caused not only by the use of a dirty catheter, but by the conveyance of septic material from the external genitals or the urethra into the bladder. For this reason the nurse or the physician should never pass the catheter by touch, as was sometimes formerly taught. The parts should be exposed to view, and the external genitals, vestibule, and meatus should be cleansed.

Cystitis may also be caused by extension of urethritis; by inflammation of adjacent organs; by abnormal urine; by constitutional diseases, as the exanthemata; by injuries to the bladder and displacement of this organ; and by retention of urine.

Symptoms.—The symptoms of cystitis vary with the stage and the character of the affection. Pain, frequent urination, and tenesmus are usually present.

In the acute stages there may be an elevation of temperature. There is a feeling of fulness in the bladder, with pain in the region of this organ. The pain is increased by motion and by the erect position, which increases the intra-vesical pressure. The pain is constant, and is not relieved by evacuation of the bladder. Pressure upon the base of the bladder through the vagina causes pain. This is a useful diagnostic point. There is a frequent desire to urinate, and the passage of urine is followed by straining efforts or tenesmus. The alteration in the character of the urine has already been mentioned.

In time the general system suffers from secondary renal disease and from absorption, through the bladder, of the ingredients of decomposed urine and septic material from the mucous membrane.

The diagnosis of cystitis is easily made by proper examination. It should always be remembered that not every woman who complains of painful and frequent urination and vesical tenesmus is necessarily suffering with cystitis. These symptoms are often caused by disease of the urethra, by displacement of the uterus, which drags upon the neck of the bladder, by the pressure of a tumor, or by displacement of the bladder such as may follow laceration of the perineum.

Women may often be seen who have been treated for weeks for cystitis without avail, and who are immediately relieved of all symptoms by the replacement of a retroverted uterus or the closure of a torn perineum. These conditions may in time result in cystitis, but the disease usually disappears with the cure of the causative lesion.

It is of the first importance, therefore, for the physician to make a careful pelvic examination, and to exclude all conditions that might cause irritation of the bladder. Microscopic examination of the urine, by revealing the presence of pus and blood and the epithelial cells of the bladder, is of value in making a diagnosis. The urine for examination should be drawn with the catheter, to prevent contamination from vaginal discharges.

Examination of the urine does not, as a rule, enable one to exclude inflammation of the ureters or of the pelves of the kidneys. If there is any doubt, it may be removed by the use of the endoscope, which will reveal the true condition of the bladder-wall.

As has already been said, tenderness upon pressure through the vagina on the base of the bladder is of diagnostic value in determining the presence of cystitis. In the mild forms of chronic cystitis—those characterized by local areas of inflammation—examination of the urine may throw no light upon the condition, as the secretion of pus or mucus is very slight. The diagnosis can then be made only by means of the endoscope.