Understanding Chronic Cystitis

The different clinical forms of cystitis

Frequent urination, imperative urge to urinate and burning pain are the most common symptoms of chronic cystitis (bladder infection).

Normally, the urinary bladder is protected by a fine mucus layer, the glycosaminoglycan (GAG) layer, lining the inside of the urinary bladder. However, in chronic cystitis, this layer is defective. Toxic and irritant substances from the urine (such as potassium ions) can penetrate the bladder wall, because this becomes permeable to irritants.

Clinical forms

Interstitial cystitis (IC)

Severe urinary urgency, frequent voiding – in extreme cases up to 100 times a day – and often intolerable pain (in the lower abdomen, pelvis and/or genital region) are characteristic symptoms resembling cystitis.

Interstitial cystitis (IC) is a chronic, non-bacterial inflammation of the bladder wall and therefore cannot be treated by administration of antibiotics.

It is mostly women who suffer from interstitial cystitis (90%). IC is a condition that is diagnosed by exclusion. This means that the treating physician must first exclude from the diagnosis all conditions that might be suggested by the symptoms.

Chemocystitis and radiation cystitis

Radiation cystitis (radiogenic cystitis)

Radiation cystitis can occur following radiotherapy of the pelvic region. The onset and also the severity of the condition are dependent on the dose of radiation.

Chronic abacterial cystitis

Sufferers from chronic, non-bacterial cystitis have an increased urge to urinate, frequent urination and sometimes also pain on urinating. If bacteria can be excluded as causative agents of the inflammatory reaction and other causes of the symptoms can also be ruled out, GAG replacement therapy can restore the natural glycosaminoglycan (GAG) layer in the bladder. The protective layer of the bladder prevents bacteria and irritants from the urine from penetrating the bladder wall and causing painful inflammatory reactions.

Chronic recurrent urinary tract infections

If acute cystitis occurs four or more times in a year, this is then referred to as a chronic recurrent urinary tract infection.

Bacterial cystitis manifests as a constant urge to urinate, associated with frequent urination (pollakiuria) and pain on urinating or in the lower abdomen. In chronic recurrent cystitis, bacteria and inflammatory cells are repeatedly detected in the urine despite treatment.

GAG replacement therapy with Instillamed® can temporarily replace the damaged mucous membrane with the result that bacteria do not adhere so easily and thus to a certain extent offers a protective shield against re-infection.

Similar clinical forms

OAB (overactive bladder) = "irritable bladder"

OAB is not an inflammation of the bladder, but is associated with similar symptoms: "overactive bladder" is a syndrome that manifests as a considerably intensified urinary urge, usually associated with frequent (pollakiuria) and nocturnal (nycturia) urination. Pain can occur but does not play a primary role. In some of the patients, uncontrolled loss of urine occurs during urge episodes (incontinence). There are a variety of causes. In addition, the overlapping of the clinical forms makes a diagnosis even more difficult.

OAB is treated by bladder training, behavioural changes and administration of drugs, with what are known as anticholinergic agents (drugs that relax the bladder) being used first of all.

Chronic pelvic pain

Chronic pelvic pain is a condition that is characterised by recurrent or persistent pain (over at least six months) in the lower abdomen. CPPS (Chronic Pelvic Pain Syndrome) is difficult to distinguish from other similar conditions simply on the basis of symptoms and therefore cannot always be diagnosed unequivocally.

Instillamed® against urinary tract infections

Studies have shown that in patients who suffer from frequently recurring urinary tract infections the time to onset of the next urinary tract infection was markedly prolonged by an average of 133 days by treatment with a chondroitin sulphate-hyaluronic acid solution with the same concentration. 2


Reference product: Instillation of 50 mL of hyaluronic acid (1.6%) and chondroitin sulphate (2.0%); weekly instillation over four weeks, thereafter one instillation monthly for five months Damiano et al. 2011

Instillamed®: Instillation of 50 mL hyaluronic acid (1.6%) and chondroitin sulphate (2.0%), recommendation: depending on the course of symptoms, weekly instillation over four weeks, thereafter one instillation monthly for up to six months