What can cystitis in men indicate?
It is generally uncommon
It can indicate:
- Underlying bladder or prostate infection
- An obstruction of tumour
- An enlarged prostate
If it is left untreated it can lead to damage of the kidney or prostate
What is cystitis?
Inflammation of the bladder (and urethra) caused by infection, irritation or damage
What are the symptoms of uncomplicated cystitis?
- Dysuria (painful urination, burning, stinging)
- Urinary frequency & urgency but only passing small amounts of urine
- Nocturia
- Haematuria (dark and strong smelling urine)
- Pain above pubic bone, lower back or abdomen
- Some women may feel systemically unwell
What are the referral symptoms for cystitis?
- Children under 12
- Diabetics
- Duration longer than 7 days
- Immuno-compromised patients
- Men
- Patients with associated fever, nausea, vomiting
- Pregnancy
- Abnormal vaginal discharge
What can you use to treat cystitis?
- OTC treatment is limited.
- Aim to make urine alkaline, relieving symptoms of dysuria
- Limited evidence of efficacy (Cystopurin, Cymalon, Cystemme, Canesten Oasis)
- Cranberry Juice
What advice can you give to a patient with cystitis?
- Paracetamol or ibuprofen can help reduce discomfort and any associated fever
- Drink plenty of water, avoid alcohol
- Avoid intercourse until symptoms resolve
- Avoid perfumed cosmetics and bubble bath etc
- Avoid ignoring call to urinate
- Good hygiene
- Urinate after sex/use of lubricants
What are the most common causes of vaginal discharge?
- Vulvovaginal candidiasis (thrush, curd-like discharge, little of no odour)
- Bacterial vaginosis (white discharge, strong fishy odour)
- Trichomoniasis (malodorous, green-yellow in colour)
What are the clinical features of thrush?
- Itching
- Sudden onset of symptoms
- Curd-like discharge with little or no smell
What are the referral symptoms for thrush?
- First case
- Diabetes
- Discharge with strong smell
- OTC Medicine failure
- Pregnant women
- Recurrent attacks
- Women under 16 and over 60
- STIs
What can be used to treat Thrush?
- Topical imidazoles (clotrimazole)
- Systemic antifungal (fluconazole)
What time of day should internal preparations for thrush be used?
At night
When should Fluconazole not be used?
- Pregnancy or change the patient is pregnant
What advice would you give to a patient with thrush?
- Live yogurt can be effective
- Avoid tight clothing, perfumed soap etc
- Symptoms should resolve within 3 days, see GP if no improvement within 7 days
- Treat partner if they are also showing symptoms
- Advise patient on how to insert pessaries
What is OTC Tamsulosin used to treat?
Benign Prostatic Hyperplasia (BPH)
How long does tamsulosin take to show an improvement?
1 month
What are the conditions for supply of tamsulosin?
- Licensed for men aged 45-75
- Must have been suffering for at least 3 months
How much tamsulosin is given to the patient?
- Two week initial supply with a further four weeks being supplied if symptoms have improved
- Must see GP by week 6 if further OTC supplies are to be made
What is OTC tranexamic acid indicated for?
Menorrhagia (heavy periods)
Who is tranexamic acid suitable for?
- Women aged 18-45
- Heavy menstrual loss over several cycles
- Have a regular cycle of 21-35 days
