This is an inflammation of the wall and lining of the urinary bladder that may be due to bacterial infection or to mechanical abrasion from microcrystals of calcium phosphate in urine. Symptoms of cystitis include frequency, dysuria, cloudy or bloody urine, with pain and tenderness in the lower abdomen. The urine itself may be cloudy because it contains pus or blood and it may also have an unpleasant smell. These symptoms must be distinguished from those caused by vaginitis, sexually transmitted diseases and irritations of the urethra.

Acute urinary tract infections are very common, involving at least 15% of females at some point in their lives. It can occur at any age and is about twenty times more common in women than men. This is because the urethra is much shorter in women than in men, so allowing infective organisms easier access to the bladder. Such ascending infections are usually announced by discomfort at the urethral opening and as the condition progresses, the irritation travels upwards. These infections are usually caused by the rod-shaped bacterium called Escherichia coli. This is a normal bacterium found in the bowel, and after a bowel movement they can be wiped on to the urethral opening. Less commonly, infection from the blood-stream and the kidneys descends into the bladder. These descending infections are usually associated with back-ache, headache, tiredness, and pains in the abdomen.

Many women have bacteriuria (bacteria in the urine), and pyuria in the absence of symptoms, whilst others experience symptoms without clinical signs. Women with no clinical sign of cystitis who complained of recurrent symptoms were diagnosed as having urethral syndrome in the past. Urologists have recognized a variety of cystitis, interstitial cystitis, comprising a group of urethral/bladder disorders in which the mucosa of the bladder has become eroded resulting in ongoing symptoms in the absence of bacteriuria.

Etiological factors:

• Sex: The female urethra is prone to colonization due to its proximity to the anus, its short length (about 4 cm), and its termination inside the labia. Friction during intercourse may cause minor inflammation of the urethra predisposing to infection, and organisms may even be moved into the urethra.
• Pregnancy: Pregnant women may be more susceptible to infection because of hormonal change resulting in dilation and reduction in tone of the ureters. Pressure of the uterus on the bladder and local venous congestion and pressure may also be factors in precipitating cystitis in pregnancy.
• Diabetes: Diabetics and those with high consumption of sugars are predisposed to cystitis.
• Chemical Factors: Antibacterial soaps, sprays, douches, feminine deodorants, contraceptive jellies and creams alter the vaginal environment and may cause irritation that makes the tissue susceptible to infection. In addition, barrier contraceptive devices like the diaphragm may cause mechanical irritation of the urethra. Some forms of interstitial cystitis may be caused by food contaminated with pesticides.
• Retention of Urine: Anatomical deviations, such as uterine malpositions, that result in retention of urine potentiate infection.
• Hormonal Changes: Oral contraceptives may initiate infection in some individuals.
• Antibiotics: Overuse of these potentially life-saving drugs will select for resistant bacteria, often leading to cystitis.
• Stress:Stress results in the production of hormones such as ACTH, glucocorticoids and aldosterone, all of which reduce circulating white blood cell counts and contribute to the susceptibility for infection. Many who experience recurrent infection can relate stress (chemical, physical, emotional) to the onset of symptoms.

Anti-microbials will help the body control and then clear bacterial infection. However, many of the well known anti-microbial remedies (such as Echinacea) do not fulfill the herbalists expectation of them in the case of cystitis. It is important to use plants that are specifically active in the urinary tract. Thus anti-microbials with terpene essential oils are indicated here as the oil is excreted from the body via the kidney, thus directing to the site of infection in the bladder.
Anti-inflammatories will soothe the pain and discomfort. Avoid overemphasizing them in the prescription. The symptomatic relief they produce must be applied in the context of removing the infection that causes the inflammation.
Astringents may be called for if there is any hematuria.
Diuretics will help flush the whole of the tract. Of course it is best to select diuretics that possess the actions mentioned above.
Anti-spasmodics may be necessary if there is much pain.

pregnancy : use the appropriate uterine tonics (refer to the section on pregnancy).
hormonal changes (menopausal or due to the contraceptive pill) : Vitex plus appropriate uterine tonics (refer to the sections in the next chapter).
diabetes : endocrine support with bitters (refer to the section on diabetes).
immune system weakness : both deep and surface immune support (refer to the section on the immune system).
stress : adaptogens and appropriate nervines.

Zea mays --- --- --- 2 parts
Arctostaphylos uva-ursi --- --- --- 2 parts
Barosma betulina --- --- --- 1 part

5ml. of tincture taken 3 times a day.