Chronic Cystitis and Trigonitis:

Cystitis means inflammation of the bladder in Latin. It describes a broad range of diseases with diverse etiology and pathologic mechanisms but with similar clinical presentations. 
The most common symptoms are frequency, urgency, burning with urniantion and suprapubic pain. However, these symptoms are nonspecific and may also be associated with infection of the lower genitourinary tract (urethra, vagina) or with noninfectious conditions such as bladder cancer, urethral diverticulum, or kidney/bladder stones. 
Even vaginal infections or tissue changes with menopause can cause bladder symptoms. The incidence of different types of cystitis varies wildly by cause and the affected patient population.

TRIGONITIS AND CHRONIC CYSTITIS

The trigone is a triangular region of the bladder floor, where the three points of the triangle correspond to the locations at which the urethra and ureters connect. The trigone is the structure that allows the body to detect when the bladder is full. This flat, smooth region is highly sensitive, and as the bladder fills and expands, this area is stretched as well. When it gets big enough, the bladder signals to the brain that it needs to be emptied; the more the trigone expands, the stronger the signals become. 

Trigonitis is inflammation or "chronic cystitis" that is localized to the trigone region of the bladder. This inflamed patch of bladder wall acts like a bladder "ulcer" where chemicals and toxins in the urine are able to seep into the otherwise protected bladder muscle, causing irritability of the bladder muscle. These effects together then create the symptoms that mimic a UTI. Inflammation of this trigone region, whether it is from a bacterial infection or chronic cystitis, will produce hypersensitivity and bladder spasm causing increased frequency and urgency, burning with urination, painful intercourse, bladder pain, blood in the urine, and often pelvic and back pain.


CAUSES OF TRIGONITIS AND CHRONIC CYSTITIS:

There are multiple theories as to what causes this bladder wall inflammation and ulceration. Trigonitis occurs most often in women of childbearing age, but occasionally men develop it too. For this reason, the cause is thought by some researchers to be related to levels of the hormone estrogen. Some studies suggest there is a correlation between family or childhood history of bladder infections and the occurrence of chronic cystitis, however, so others believe that repeated infections might lead to chronic inflammation of the vesical trigone region. It's exact cause is still unknown, and there is no standardized treatment plan. There are, however, several medications and treatments that can help control the symptoms. 



SYMPTOMS:

Trigonitis and chronic cystitis can cause severe bladder pain and burning, pelvic pain and pressure, reduced bladder capacity, an increase in the frequency and urge to urinate, particularly at night, blood in the urine and urinary incontinence. For some, the problem can lead to increased pain when sitting in certain positions or discomfort during sex. In addition, some people experience sensitivity to certain foods, and eating them can trigger symptoms.


DIAGNOSIS:

The symptoms of this disease are almost identical to those of true UTI as well as another bladder syndrome called interstitial cystitis. These similarities means that trigonitis is often misdiagnosed. The main difference between the two is that the inflamed vesical trigone of a person with trigonitis takes on a cobblestone pattern that is absent in someone with interstitial cystitis.

Confirmation of diagnosis requires a cystoscopic examination. During this process, a lens fixed to a long hollow tube is inserted into the bladder via the urethra. With the lens, the doctor is able to examine the examine the inside of the bladder and see if the relevant area is inflamed. Cystoscopy is most often comfortably performed in the office and takes less than a few minutes. There is no preparation required for an in office cystoscopy aside from taking the prescribed antibiotic the morning of the procedure to prevent an infection. 


MICROSCOPIC FINDINGS:

Although urine is easily accessible for cytologic examination, its use in the differentiation of the different types of cystitis is limited. The main utility of urine cytology is to rule out malignancy; it can also be very useful in guiding the clinician to the correct diagnosis of certain infectious processes. A tissue biopsy is useful to document cystitis and also rule out dysplasia, or precancerous cells and malignancy. 


TREATMENT:

There is no standard treatment for trigonitis, and what is effective for one person might not work for another. Pain relief options include muscle relaxants to relieve bladder spasms, anti-inflammatories, and antidepressants, some of which can reduce pain when taken at low doses. Antibiotics are prescribed when infection accompanies the bladder inflammation. 

Fulguration of trigonitis and chronic cystitis using Laser Therapy is the use of heat through an electric current to cauterize the inflamed tissue or ulceration. Laser therapy desensitizes the local nerves in the area which causes pain, and causes the inflammatory tissue to slough off, thus allowing the regions of cystitis to heal over. The integrity of the protective bladder lining is renewed after a 6 to 12 week healing phase. Symptoms may not improve dramatically until the bladder wall is well healed.   

More than 90% of patients report at least a 50% improvement in pain after the procedure with some lasting for years. Chronic cystitis is a disease of the lining of the bladder so patchy inflammation can recur in other areas. Additional treatment may be required. 
 
Another type of treatment, called a bladder coating or instillation, is sometimes used to provide fast pain relief. A bladder coating is applied to the bladder via a catheter and is typically a cocktail of medications used to control pain and inflammation, and to help the bladder heal. 


BLADDER DIET:

For some people, medication can provide a permanent cure for this disease, but it is much more common for trigonitis to become a chronic condition in which symptoms are controllable, with occasional flare-ups of pain and urinary problems. Exploring self-care options can enhance the relief that medication, instillation and fulguration provides and help a person with the disease feel more in control of her symptoms.

Many people find that eliminating certain foods from the diet can help to reduce the frequency and severity of flare-ups. Trigger foods are not the same for everybody, but often include citrus fruits and juices, chocolate, grains, caffeine, alcohol and carbonated drinks. Click on the link below to view a complete Bladder Diet. The most important diet change is to stay well hydrated to maintain dilute urine. More concentrated urine can be more caustic to the tissues. Also, the bladder diet has many healthy foods listed. You may still eat anything on the list in moderation.