It is perhaps advisable in all cases of chronic cystitis to use the endoscope, not only to confirm the diagnosis, but to begin the treatment by making direct local applications.
Treatment.—The treatment of cystitis is general and local. Local treatment should never be used in the acute stages of the disease. Many cases recover completely without any local treatment whatever.
In acute cystitis the woman should be put to bed. The irritation of the bladder is much relieved when the intra-vesical pressure is thus diminished.
The diet should be carefully regulated, all stimulating ingredients being withdrawn. An exclusive milk diet is the best.
Saline laxatives should be administered, and continued to the point of mild purgation. One dram of Rochelle salts every two or three hours, given in half a tumblerful of soda-water, is useful for this purpose. Large quantities of diluent drinks should be given, such as flaxseed tea or Vichy water.
If the urine is acid, citrate of potassium may be administered with the diluent drinks, so that from 1 to 2 drams of the salt are taken during the day. Bicarbonate of potassium in similar doses is also useful.
When the urine becomes ammoniacal, boracic acid, in doses of 10 grains from three to six times a day, is most useful. Benzoic acid, in doses of 10 grains three or four times a day, is also valuable.
A very good method is to make a pint or a quart of flaxseed tea, to dissolve in it the requisite amount of citrate of potassium or of boracic acid (as the urine is acid or alkaline), and to administer this in divided doses during the day. This treatment, with rest in bed, should be continued as long as the vesical pain and tenesmus continue.
If the pain and tenesmus are severe, small doses of opium may be given. It is, however, not advisable to use opium unless the suffering of the woman demands it.
If the disease, as the symptoms become less acute, does not progress satisfactorily toward cure, medicines that have a more stimulating effect upon the mucous membrane should be given, such as cubebs and copaiba, oil of turpentine, oil of eucalyptus, and oil of sandalwood.