HISTORY. Question the patient with cystitis about the presence of urinary symptoms, including frequency, urgency, pain, a sensation of incomplete emptying of the bladder, and possibly, blood or pus in the urine. The patient may have a low-grade fever but generally does not have other systemic symptoms. Consider the patient's previous history of urinary infections, vaginal discharge, chronic conditions such as diabetes mellitus or neurological problems, and recent sexual activity. Ask if the patient has experienced severe lower abdominal or pelvic pain, noc-turia, urinary urgency, and excessive (up to 60 times a day) urinary frequency. Some women describe dyspareunia (painful sexual intercourse).

PHYSICAL EXAMINATION. Generally, the physical examination is unremarkable. Examine the patient to determine the presence of abdominal pain or costovertebral angle tenderness, which may indicate pyelonephritis. The examination should include surveillance for sexually transmitted diseases (STDs).

PSYCHOSOCIAL. Cystitis is typically an acute illness with rapid response to prescribed therapy. The patient usually does not experience a disruption of normal activity. Women with IC, however, need to learn to manage not only a chronic disease but also one that physicians may have either ignored, labeled as "psychosomatic," or related to hormonal changes that occur during menopause.

266 Cystitis

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