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Cystitis

In cystitis, a bacterial infection causes your bladder to become inflamed. It happens when bacteria enter your bladder through your urethra, the tube that carries urine out of your body.

Cystitis is a common type of lower urinary tract infection. Your urinary tract consists of your kidneys, two ureters (the tubes that connect each kidney to your bladder), your bladder and your urethra. 

Cystitis is caused by a bacterial infection from a variety of sources. It may also be triggered by having sex. It's most common in women, but it can affect men and young children. Doctors believe it’s less common in men because they have longer urethras and bacteria have further to travel to reach the bladder. Up to four in 10 women will have a bout of cystitis at some point during their lifetime.

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Details

  • Symptoms Symptoms of cystitis

    Common symptoms of cystitis include:

    • pain when you pass urine
    • a frequent, urgent need to urinate, but you only pass small amounts or no urine
    • cloudy, dark or strong smelling urine
    • blood in your urine – this may not always be visible, but can be found by testing the urine
    • pain during sex
    • pain in your lower abdomen (tummy) or lower back
    • feeling tired or generally unwell
    • a mild fever

    Overall, the symptoms of cystitis are similar for men and women. Some children may develop a fever, have a reduced appetite and may have bouts of vomiting. However, young children may feel generally unwell but have no other symptoms. If your child has a fever or you think he or she might have cystitis, contact your GP for advice. It’s important to seek medical help as soon as possible because these symptoms may be caused by other, more serious conditions.

    These symptoms can also be caused by conditions other than cystitis in adults. If your symptoms don’t get better after two to three days, contact your GP. He or she will be able to rule out any other conditions that could be causing your symptoms.

  • Diagnosis Diagnosis of cystitis

    Cystitis usually clears up on its own. You will usually be able to manage your cystitis at home, especially if you’re a woman and have had it before. However, if you’re a man or your child has symptoms of cystitis, it’s a good idea to contact your GP.

    If your symptoms get worse or don’t improve within two to three days, contact your GP for advice. He or she will be able to rule out any other conditions that could be causing your symptoms.

    Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP will usually be able to diagnose cystitis based on your symptoms. A sample of your urine might be tested using a ‘dipstick’. Depending on the results, a sample of your urine may be sent to a laboratory for further tests.

    You can sometimes have cystitis but have no symptoms. This is particularly common if you’re older. Your cystitis may only be discovered when you have a urine test for other reasons, or you develop a kidney infection or fever.

  • Treatment Treatment of cystitis

    Self-help

    Cystitis usually clears up by itself, without the need for treatment. However, there are several things you can do to reduce your symptoms and feel better.
    • Taking over-the-counter painkillers, such as paracetamol and ibuprofen, may help to ease your pain. They may also help if you have a fever or a temperature.
    • Increase how much fluid you drink, such as water, to help flush out the infection.
    • Placing a warm hot water bottle on your lower back can help soothe any discomfort in this area.
    • Try to rest as much as possible.

    Medicines

    If your symptoms continue for longer than two to three days, contact your GP. He or she may prescribe you antibiotics to reduce your symptoms and get rid of the infection.

    Trimethoprim and nitrofurantoin are antibiotic medicines that are commonly used to treat cystitis. These can be taken as a tablet. Always ask your GP for advice and read the patient information leaflet that comes with your medicine. With antibiotics, your symptoms will usually clear up within three to eight days. On average, antibiotics shorten the time you have symptoms by about a day.

    If antibiotics don't work, it's possible that you may have a different type of cystitis, called interstitial cystitis. This is a long-term condition in which you have ongoing inflammation in your bladder. This condition isn’t caused by bacteria, so it can’t be treated with antibiotics. For more information, see our frequently asked questions.

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  • Causes Causes of cystitis

    Cystitis is caused by a bacterial infection. A bacterium called Escherichia coli (E.coli), which usually lives harmlessly in your bowel, causes over seven out of 10 bouts of cystitis.

    Bacteria can get into your urinary tract and cause infection in different ways. These can include the following.

    • Sex. Bacteria could pass into your bladder when you have sex. Having sex can also bruise your urethra and bladder, which can cause similar symptoms to cystitis.
    • Poor hygiene. Poor hygiene can cause cystitis. Women have shorter urethras than men. If you’re a women, this means that bacteria have a shorter distance to travel before reaching your bladder. The urethra is also closer to the back passage (anus) in women. This makes it easier for bacteria to get transferred from your anus into your urethra.
    • Pregnancy. If you’re pregnant, your womb (uterus) may put extra pressure on your bladder. This could prevent your bladder from emptying completely. Retaining small amounts of urine in your bladder could encourage bacteria to grow.
    • Diabetes. If you have diabetes, your urine can contain more sugar than usual. Passing urine that contains more sugar than usual can encourage bacteria to grow in your bladder and urethra.
    • Menopause. In women, natural changes after the menopause could affect your chances of getting cystitis. After the menopause, the types of bacteria which usually live harmlessly in your vagina (vaginal flora) may change. This could increase your risk of getting cystitis.
    • Having a catheter. Bacteria could get into your bladder if you have a catheter (a long, thin, flexible tube inserted into your bladder). Your bladder and urethra could also get bruised when your catheter is inserted. This could increase your risk of getting a bacterial infection.
    • Contraception. In women, using a diaphragm (a thin, flexible cap inserted into your vagina) may increase your risk of getting cystitis. This is because your diaphragm could prevent your bladder from emptying properly, which can encourage bacteria to grow.
    • Kidney or bladder stones. These can prevent your bladder from emptying fully, which can encourage bacteria to grow. In men, a common cause of cystitis is passing urine less often because the prostate is enlarged.
    • Abnormalities of the urinary tract. Being born with certain conditions which affect the structure of your urinary tract can increase your risk of getting cystitis. For example, if you have a condition called pelviureteric junction obstruction, your flow of urine can become blocked, which can encourage bacteria to grow.
  • Complications Complications of cystitis

    There is a chance that you could develop a kidney infection called pyelonephritis. This can happen if the infection moves from your bladder into your kidneys. Symptoms of kidney infection often include fever, vomiting, feeling unwell and pain in your lower back. You may also develop chills and shivers.

    If you have any of these symptoms, contact your GP. He or she will be able to prescribe you some antibiotics to clear the infection. In men, there is a chance that the infection could travel to the prostate gland. This can cause a condition called prostatitis, which can make you more likely to develop recurrent bouts of cystitis in the future. The condition can be painful, but antibiotics can help to clear the infection.

  • Prevention Prevention of cystitis

    There are several things you can do to help prevent cystitis. Some examples are listed below.

    • Make sure you drink enough fluid.
    • Drinking cranberry juice may reduce the likelihood of recurrent cystitis. You could also try taking tablets which contain a cranberry extract. Some research has shown that cranberry products could help to prevent bacteria from growing. However, don’t take cranberry products if you’re taking warfarin (a blood-thinning medicine).
    • Wear underwear that is made of natural materials, such as cotton or linen – don’t wear thongs.
    • After using the toilet, make sure you wipe from front to back.
    • After a bowel movement, wash the area around your anus.
    • Go to the toilet as soon as you feel the urge.
    • It may be useful to wash your genital area before having sexual intercourse. Try to urinate shortly after having sex to help flush away any bacteria.
    • If you have been through the menopause, using an oestrogen replacement treatment might help to prevent cystitis. This can be a cream or pessary (a small tablet that you insert into your vagina).
    • If you’re a women, using a spermicidal product for contraception can increase your risk. This is because it can destroy good bacteria called, lactobacilli. Talk to your GP or family planning adviser about changing your method of contraception if necessary.

    Prevention of reoccurring cystitis

    If you get cystitis frequently, your GP may prescribe you a low-dose antibiotic to keep at home. You can take this if your cystitis comes back again.

    Your GP will advise you on how often to take them depending on what type of antibiotic you’re prescribed. You may be prescribed trimethoprim, which you can take daily. Another medicine used to treat reoccurring cystitis is called nitrofurantoin. You take this immediately after having sex. If you get reoccurring cystitis, it’s likely that your GP will refer you to a urologist. This is a doctor who specialises in identifying and treating conditions that affect the urinary system. He or she may offer you some further tests.

  • FAQs FAQs

    Is cystitis a sexually transmitted infection?

    Answer

    No, cystitis isn’t a sexually transmitted infection (STI). However, having sex can increase your risk of getting cystitis.

    Explanation

    Cystitis is usually caused by a bacterial infection. In particular, Escherichia coli (E.coli), a bacterium that usually lives harmlessly in your bowel, is a common cause of cystitis. This bacterium causes over seven out of 10 bouts of cystitis.

    Bacteria can get into your bladder when you have sex. Having sex can also bruise your urethra (the tube that carries urine from your bladder out of your body) and bladder. This can cause similar symptoms to cystitis.

    If you’re prone to getting cystitis after having sex, there are several things you can do to reduce your risk of getting it.

    • Pass urine shortly after having sex (within 15 minutes) to help flush away any bacteria.
    • Wash your genital area before having sex (both you and your partner). Remember to wash your hands as well as your genitals.
    • Try using a lubricant during sex to ease friction – this will help reduce irritation and bruising.
    • If you use a diaphragm for contraception, make sure it’s fitted correctly. If it isn’t, your diaphragm could put extra pressure on your bladder. This could prevent your bladder from emptying properly. Retaining small amounts of urine in your bladder can encourage bacteria to grow.

    If you keep getting cystitis after having sex, see your GP. He or she may prescribe you antibiotics, such as nitrofurantoin, that you can keep at home and take immediately after having sex. Your GP will advise you about how often to take them. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your GP for advice.

    Are there any changes I can make to my diet to help prevent cystitis?

    Answer

    Yes, making some changes to your diet may help to relieve your symptoms of cystitis and prevent it coming back.

    Explanation

    Cystitis is a bacterial infection that affects your bladder. It’s important to keep your immune system healthy, so you’re more able to fight off infections. Making the following changes to your diet could help to boost your immune system and lower your risk of getting cystitis.

    • Try to eat a diet rich in fresh fruit and vegetables.
    • Make sure you drink enough fluid to help flush out any bacteria.
    • Limit your intake of caffeine (for example tea and coffee) and alcohol, as they can make you dehydrated. These drinks may also irritate your bladder.
    • Drinking cranberry juice may reduce the likelihood of recurrent cystitis. Some research has shown that cranberry products could help to prevent bacteria from growing. You may also wish to try taking tablets which contain a cranberry extract.
    • Try to reduce the amount of sugar in your diet. This is because sugar can encourage bacteria to grow. Many foods have a reduced sugar option, so try to eat these instead.

    You may find that certain food or drink triggers cystitis. If this is the case, try to cut it out of your diet or have it in moderation. However, it's important to speak to your GP or dietitian if you’re thinking about making any changes to your diet.

    Can interstitial cystitis be treated?

    Answer

    Yes, there are many treatment options available if you have interstitial cystitis. However, at the moment, there isn’t a specific treatment that works for everyone. This means that you may have to try several different treatments before you find one that works for you.

    Explanation

    Interstitial cystitis is different from bacterial cystitis. It’s a long-term condition in which there is ongoing inflammation in your bladder. 

    Interstitial cystitis is also known as painful bladder syndrome. Symptoms of the condition include:

    • passing urine frequently
    • having an urgent need to pass urine − this can be followed by pain, pressure or spasms in your bladder
    • pain in your lower abdomen (tummy) or vagina, especially when your bladder is full
    • pain when you have sex

    This condition isn’t caused by bacteria, so it can’t be treated with antibiotics. However, there are many other treatment options available for people with interstitial cystitis. These include the following.

    • Over-the-counter anti-inflammatory medicines, such as aspirin or ibuprofen, may help to ease pain. Your GP may prescribe you other, stronger anti-inflammatory medicines if you have severe pain.
    • Your doctor may prescribe antispasmodic medicines to help control your symptoms of bladder spasm. They can reduce your need to pass urine frequently.
    • Your doctor may prescribe you antidepressant medicines, such as amitriptyline. These can help to reduce the amount of pain you may feel.

    Always ask your GP for advice and read the patient information leaflet that comes with your medicine.

    You may find that certain foods make your symptoms worse. Everyone is different and what triggers your interstitial cystitis may not be the same for other people. However, there are certain foods that many people agree can make their symptoms worse. These include:

    • alcohol and drinks containing caffeine
    • fizzy drinks
    • spicy foods
    • chocolate (as it contains caffeine)
    • tomatoes
    • onions
  • Resources Resources

    Further information

    Sources

    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010: 456 ̶ 7
    • Urinary tract infection (lower) ̶ women. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published October 2009
    • Bacterial cystitis. The Cystitis and Overactive Bladder Foundation. www.cobfoundation.org, accessed 18 October 2013
    • Nair M, Peate I, editors. Fundamentals of Applied Pathophysiology: An Essential Guide for Nursing and Healthcare Students. 2nd ed. Chichester: Wiley-Blackwell; 2013: Chapter 8
    • Urinary tract infection (lower) ̶ men. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published January 2010
    • Hematuria. Medscape. www.emedicine.medscape.com, published 25 March 2013
    • Urinary tract infection in children: diagnosis, treatment and long-term management. National Institute for Health and Care Excellence (NICE), 2007. www.nice.org.uk
    • Guidelines on urological infections. European Association of Urology, 2012. www.uroweb.org
    • Joint Formulary Committee. British National Formulary (online) London: BMJ group and Pharmaceutical Press. www.medicinescomplete.com, accessed 21 October 2013 (online version)
    • Prostatitis ̶ acute. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published February 2009
    • McKenney JK, Stephenson AL, Chang SS, editors. The urinary tract: a comprehensive guide to patient diagnosis and management. New York: Springer Science and Business Media; 2012:63 ̶ 5
    • Reynard J, Brewster S, Biers S. Oxford handbook of urology. 3rd ed. Oxford: Oxford University Press; 2013: 183, 412 ̶ 6
    • Cystitis in females treatment & management. Medscape. www.emedicine.medscape.com, published 23 September 2013
    • Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network (SIGN), July 2012. www.sign.ac.uk
    • Management of diabetes. Scottish Intercollegiate Guidelines Network (SIGN), 2010. www.sign.ac.uk
    • Interstitial cystitis/painful bladder syndrome. The Cystitis and Overactive Bladder Foundation. www.cobfoundation.org, accessed 22 October 2013
    • Diagnosis and treatment. Interstitial Cystitis Association. www.ichelp.org, published 15 December 2010
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    Reviewed by Hemali Parekh, Bupa Health Information Team, December 2013.

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