From the Guidelines
Back pain is not typically a symptom of simple cystitis, and its presence may indicate a more serious condition like pyelonephritis. Simple cystitis, which is a bladder infection, usually presents with lower urinary tract symptoms such as frequent urination, burning during urination, urgency, and sometimes lower abdominal discomfort 1. If you're experiencing back pain with urinary symptoms, this could indicate a more serious condition like pyelonephritis (kidney infection) rather than simple cystitis. Pyelonephritis often causes flank pain (pain in the side and back below the ribs), fever, chills, nausea, and vomiting along with the typical cystitis symptoms 1. This requires prompt medical attention and typically more aggressive antibiotic treatment. For simple cystitis, common antibiotics include nitrofurantoin (Macrobid) 100mg twice daily for 5 days, trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days, or fosfomycin (Monurol) as a single 3-gram dose. However, if back pain is present, you should seek medical evaluation immediately as you may need different antibiotics, possibly intravenously, and potentially imaging studies to rule out complications. The back pain occurs in kidney infections because the infection causes inflammation of the kidney tissue and stretching of the kidney capsule, which contains pain receptors that signal through nerves supplying the flank area. Some key points to consider include:
- Simple cystitis is usually treated empirically and responds to appropriate antimicrobial therapy 1
- Pyelonephritis is a more serious condition that requires prompt medical attention and aggressive antibiotic treatment 1
- Back pain is not a typical symptom of simple cystitis, but it can be a symptom of pyelonephritis 1
- Imaging studies may be necessary to rule out complications in patients with back pain and urinary symptoms 1
From the Research
Association between Back Pain and Simple Cystitis
- Back pain is not typically associated with simple cystitis (urinary tract infection), as simple cystitis is usually manifested by dysuria, frequency, and/or urgency without fever 2, 3.
- Pyelonephritis (kidney infection), on the other hand, is usually manifested by fever and back pain/costovertebral angle tenderness 2.
- The presence of back pain may indicate a more complicated urinary tract infection, such as pyelonephritis, rather than simple cystitis 2, 4.
- The diagnosis of simple cystitis is usually made based on clinical presentation, including symptoms such as dysuria, frequency, and urgency, without the presence of fever or back pain 4, 3.
Diagnostic Considerations
- A urinalysis, but not urine culture, is recommended in making the diagnosis of simple cystitis 4.
- Urine cultures are recommended in women with suspected pyelonephritis, women with symptoms that do not resolve or that recur within two to four weeks after completing treatment, and women who present with atypical symptoms 4.
- The absence of pyuria (pus in the urine) suggests that another condition may be causing the patient's symptoms 2.