Cystitis

This factsheet is for people who have cystitis, or who would like information about it including the symptoms, causes and treatments.

Cystitis is inflammation of your bladder. It’s usually caused by bacteria entering your bladder via your urethra (the tube that carries urine from your bladder out of your body).

About cystitis

Cystitis, also known as a lower urinary tract infection, usually only affects your bladder. Your urinary tract consists of your kidneys, two ureters (the tubes that connect each kidney to your bladder), your bladder and your urethra. Sometimes the infection can go higher to your ureters or kidneys – this is known as an upper urinary tract infection and is a more serious illness.

Cystitis is usually caused by a bacterial infection from a variety of sources. It can also be triggered by irritation or bruising of your urinary tract caused by sexual intercourse. It's most common in women. Around one in three women will have at least one bout of cystitis before they are 24 years old. Doctors believe it is less common in men because they have longer urethras and bacteria have further to travel to reach the bladder.

Symptoms of cystitis

Symptoms of cystitis usually develop over several hours or a day. Common symptoms include:

• pain when you pass urine or straight afterwards – this is usually a burning or stinging sensation
• 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 seen under a microscope or by testing the urine
• pain during sexual intercourse
• pain in your lower abdomen (tummy) or lower back

You may also have a fever, feel lethargic or feel generally unwell. The urgent need to urinate may cause an uncontrollable loss of urine (urge incontinence), especially in older people. This can go on to cause confusion and falls in the elderly.

Cystitis can be painful, especially when you pass urine, but it usually clears up within four to nine days without treatment.

You probably won’t need to see your GP if you have these symptoms as you can usually manage them at home. However, if they get worse or don’t improve within two to three days, seek advice from your GP.

These symptoms can sometimes be caused by a sexually transmitted infection (STI), such as chlamydia. If you think you may have an STI, visit your GP or a sexual health clinic.

Causes of cystitis

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

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

• Bacteria are more likely to get into your bladder when you have sex. Sexual intercourse can also bruise your urethra and bladder, which can cause similar symptoms to cystitis.
• Poor hygiene is a common cause if you’re a woman, as women have shorter urethras than men – this means there is a shorter distance for the bacteria to travel to the bladder. The urethra is also closer to the back passage (anus) in women. This makes it easier for bacteria to get transferred from the anus into the urethra.
• Bubble baths and fragranced products can irritate your urethra and bladder.
• If you’re pregnant, extra pressure on your womb (uterus) might mean that your bladder doesn’t empty completely. This can encourage bacteria to grow.
• If you have diabetes, your urine can contain more sugar than usual, which can encourage bacteria to grow.
• Postmenopausal women have lower amounts of certain hormones. This can lower the normal defences of the urethra to allow bacteria to grow.
• If you have a catheter for a long period of time, it’s likely that bacteria will grow and your bladder will become infected.
• Kidney or bladder stones can prevent your bladder from emptying fully, which can encourage bacteria to grow.
• Rarely, reoccurring cystitis can be caused by a tumour in your bladder.

Cystitis is less common among men. If you’re a man, cystitis generally starts with an infection in your urethra that moves into your prostate, then into your bladder. The most common cause of reoccurring cystitis in men is a bacterial infection of the prostate or passing urine less often because your prostate is enlarged.

Diagnosis of cystitis

If you’re a healthy woman, you probably won’t need to see your GP as you can usually treat cystitis at home. However, if your symptoms get worse or don’t improve within two to three days, you should see your GP. If you haven’t had cystitis before and you think you might have it, it’s a good idea to see your GP in case something else is causing your symptoms.

You should always see your GP if you:

• are pregnant
• develop a high fever
• have diabetes
• have a catheter
• have an illness that weakens your immune system (for example, HIV/AIDS)
• have a history of reoccurring bouts of cystitis

Men and children should see their GP as soon as possible for treatment, and not treat their cystitis at home.

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history. Your GP will normally be able to diagnose cystitis based on your symptoms. He or she will test a sample of your urine using a ‘dipstick’ and may send the sample to a laboratory for further tests.

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

Treatment of cystitis

Self-help

You can often treat cystitis at home and won’t need to see your GP. There are several things you can do to reduce your symptoms and feel better.

• Taking over-the-counter painkillers, such as paracetamol and ibuprofen, will help relieve pain. They may also help if you have a fever or a temperature.
• You can buy over-the-counter medicines to treat your cystitis from a pharmacy. These contain potassium or sodium citrate, which work by making your urine less acidic and therefore reduce discomfort. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice. Check with your GP or pharmacist that these medicines can be taken with any other medication you may be taking.
• You can also make your urine less acidic by drinking half a glass of water with one teaspoon of bicarbonate of soda dissolved in it, two to three times a day.
• Increase your intake of fluid to help flush out the infection and dilute your urine.
• Try not to drink too much alcohol, caffeine or acidic drinks, such as orange juice, as these can irritate your bladder.
• Placing a hot water bottle on your lower back can help ease discomfort.
• Try to rest as much as possible.

Medicine

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

Trimethoprim, nitrofurantoin and amoxicillin are antibiotics that are commonly used to treat cystitis. You will usually have to take them for three to seven days. Always ask your GP for advice and read the patient information leaflet that comes with your medicine. Make sure you take the full course of antibiotics prescribed to you to get rid of the infection completely, even if your symptoms clear up sooner.

Some infections can become resistant to antibiotics normally prescribed for cystitis. If your symptoms don’t clear up, your GP may prescribe you a different antibiotic, such as co-amoxiclav.

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.

Sometimes, you may have all the symptoms of bacterial cystitis, but your urine sample doesn’t show that you have an infection. If this is the case, you may have another condition that causes similar symptoms.

Your symptoms may also persist even if you take a course of antibiotics. If this happens, you might have a low grade bacterial infection. You may be prescribed a longer course of antibiotics to help clear the infection. Your GP will be able to give you further advice.

If antibiotics don't work, it's possible that you may have a type of cystitis called interstitial cystitis, also known as painful bladder syndrome or bladder pain syndrome. This is chronic inflammation of your bladder wall and isn’t caused by bacteria, so the condition won’t respond to antibiotics. Your GP will be able to give you further advice if he or she thinks you have interstitial cystitis.

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.
• Limit your intake of alcohol, caffeine (eg, tea and coffee) and fruit juices, as these can irritate your bladder.
• Drink cranberry juice – some research has shown that it can prevent bacteria from sticking to the wall of your urethra.
• Wear clothes made of natural materials, such as cotton or linen – don’t wear thongs.
• Wipe from front to back when using the toilet.
• Wash the area around your anus after a bowel movement.
• Empty your bladder as soon as you feel the urge.
• Wash your genital area before having sexual intercourse and urinate within 15 minutes afterwards to help flush away any bacteria.

Studies have shown that taking daily high doses of cranberry concentrate, usually in the form of tablets, reduces your risk of getting cystitis. Studies using cranberry juice have been less effective, however, there is no reason why you can’t add cranberry juice to your diet to try and help. Try not to buy cranberry juice containing lots of sugar, as sugar can encourage bacteria to grow.

If you’re a woman and have been through the menopause, using an oestrogen replacement treatment might help prevent cystitis. This treatment can come in the form of a cream or a pessary (a small tablet that is inserted into your vagina).

Using spermicidal products for contraception can increase your risk of getting cystitis because it can destroy good bacteria. Talk to your GP or family planning advisor about changing your method of contraception.

Prevention of reoccurring cystitis

If you get cystitis frequently, your GP may prescribe you a low dose antibiotic to keep at home. Your GP will advise you on how often to take them depending on what type of antibiotic you’re prescribed. This could be daily, three times a week or immediately after sexual intercourse. If you get reoccurring cystitis, your GP may refer you to a urologist (a doctor who specialises in identifying and treating conditions that affect the urinary system) for further investigation.

Produced by Alice Rossiter, Bupa Health Information Team, March 2012.

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.