Urinary tract infections (UTIs) are very common and often mild. Often, UTIs even resolve on their own without treatment. However, a rare type of UTI called emphysematous cystitis (EC) is much more serious.

This type of infection causes gases to build up around the bladder walls. It requires treatment with antibiotics, and surgery is sometimes needed. Without treatment, EC can lead to severe complications, such as bladder rupture and sepsis, and can even be fatal.

EC is a rare type of UTI that causes gas to build up around the bladder wall. It’s commonly associated with three types of bacteria:

  • Escherichia coli bacteria
  • Klebsiella pneumoniae bacteria
  • types of Enterobacter bacteria

However, doctors don’t completely understand why these bacteria sometimes cause gas to build up. Generally, EC can be treated with antibiotics. In severe cases, EC can lead to complications such as bladder rupture and sepsis.

EC is rare, and researchers don’t know exactly what causes it. However, there are some known risk factors. These include:

  • Age: EC is more common in people over 60.
  • Weakened immune system: People with a weakened immune system, from medications or medical conditions, are at increased risk of EC.
  • Diabetes: Diabetes is considered the largest risk factor for EC. Research shows that more than half of people with EC also have diabetes.
  • Lack of bladder control: Some spinal cord, nerve, and brain health conditions can cause a lack of bladder control. This is a risk factor for EC.
  • Obstructed urinary flow: A condition called obstructive uropathy can block the flow of your urinary tract and increase the risk of EC.
  • Chronic UTIs: Recurring or ongoing UTIs increase your risk of EC.
  • Urethral catheter: Catheters increase the risk of all UTIs, including EC.

Can EC be cured?

Yes. With antibiotic treatment, EC can be cured in about 4 weeks. The antibiotics resolve the infection. Once they do, your body reabsorbs the gas. This stops all symptoms.

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EC doesn’t always cause symptoms. When it does, the symptoms can often appear similar to the symptoms of other conditions. It’s important to make a medical appointment right away if you have any of these symptoms, especially if you’ve had them for more than a week or so.

EC is very treatable, but prompt diagnosis and early treatment are important. Symptoms of EC include:

It’s very important to treat and diagnose EC early. A medical appointment is the first step in getting treatment. During your appointment, a doctor or healthcare professional will discuss your symptoms and go over your medical history.

You’ll likely have a urinalysis done to test for blood and bacteria in the urine. This confirms the presence of infection. You’ll also have imaging tests done to confirm an EC diagnosis. Imaging tests can show the gas buildup around the bladder walls and might include:

Radiology examples for EC

You can see examples of how EC appears on imaging tests in the pictures below.

The primary treatment for EC is antibiotics. You’ll sometimes be prescribed a broad antibiotic, but doctors often choose the antibiotic based on the type of bacteria found in your urinalysis. Common antibiotics used to treat EC include:

You’ll normally need to take antibiotics for around 4 weeks to treat EC. As the antibiotics treat the infection, your body will reabsorb the gas. A doctor might also want to address any underlying issues contributing to your EC as part of your treatment such as managing diabetes or recurring UTIs.

In more severe cases, you might need additional treatments. For instance, a urinary catheter can sometimes help drain your bladder. A surgical procedure called a suprapubic cystostomy is sometimes done to insert a catheter tube directly into the bladder through a small cut in the abdomen. However, more than 90% of people with EC can be treated without this procedure.

Treatment timeline for EC

The standard antibiotic course for EC is 4 weeks. Your personal medical history and the severity of your case will affect your treatment timeline.

It’s very important to take your antibiotics for exactly as long as a doctor directs. If you stop taking your antibiotics too soon, it could cause your EC to recur. For maximum absorption, you should also avoid taking them at the same time as a fiber or vitamin supplement.

The primary treatment for EC is antibiotics. Insurance plans, including Medicare Part D, offer coverage for antibiotic treatments. You might need to pay a copayment or coinsurance amount.

Many antibiotics are available in generic forms as well. These are often much cheaper and will likely have a much smaller copayment. You can ask a doctor if a generic is available for your antibiotic.

If you need additional treatments, such as a catheter, surgery, or a hospital stay, it will also likely be covered by your insurance plan. These treatments for EC are medically necessary and are often an emergency. Your exact cost will depend on factors such as your deductible, your copayments, and the details of your plan.

EC can successfully be treated with antibiotics, but it’s a serious condition. Without treatment, it can lead to serious complications and can even be fatal. Complications of EC include:

The outlook for people EC is extremely positive when it’s diagnosed and treated early. In most cases, EC can be treated with antibiotics and resolved. However, EC can be life threatening when it isn’t treated and the infection spreads.

It has a reported mortality of around 7%, according to an older 2014 literature review. That’s why it’s so important to get medical care if you have any symptoms of EC.

EC is a rare but serious type of UTI that can lead to severe complications without treatment. The condition causes gases to build up around the walls of the bladder and is most common in people with diabetes.

The most common treatment for EC is 4 weeks of antibiotic treatment. Early treatment is very important. It can prevent life threatening complications and greatly improve the treatment outlook.