Cystitis

Cystitis is a common type of urinary tract infection (UTI) affecting your bladder. It’s usually caused by a bacterial infection. Cystitis is usually treated with a short course of antibiotics, though mild cases can be managed at home.

About cystitis

You usually get cystitis when bacteria enter your bladder through your urethra (the tube that carries urine out of your body). This can happen if bacteria from your back passage (rectum) or vagina spread to the opening of your urethra.

Bacteria can also enter your bladder directly. This may happen during surgery on your bladder or if you have a catheter (a tube that’s put into your urethra to drain urine out of your bladder). The bacteria may also come from your bloodstream.

Women are more likely than men to get cystitis. This is because the urethra in women is closer to the back passage than in men. So bacteria don’t have as far to travel to reach the bladder. In women, the urethra is also shorter. The urethra entrance is also close to the vagina, which is why women may get cystitis after sex. Around half of women will get a urinary tract infection such as cystitis at some point in their lifetime. Older men are more likely to get cystitis than younger men.

Types of cystitis

You may hear different terms used to describe cystitis.

• Your doctor may just call it a UTI (urinary tract infection) rather than cystitis. An uncomplicated UTI is when you don’t have any other underlying health problems increasing your risk of complications. The infection usually clears up easily by itself or with antibiotic treatment. It doesn’t cause too many problems.
• A complicated UTI means you may have other health conditions that can make the infection more dangerous for you. It may be harder to get rid of the infection, or you may be at greater risk of complications.
• A recurrent UTI is when your infection keeps coming back. It usually means you’ve had three or more episodes within six months.

Sometimes you can have symptoms of cystitis without any signs of a bacterial infection. This is called interstitial cystitis, or painful bladder syndrome. Interstitial cystitis is a different condition. It may be caused by a problem with your bladder or immune system, or changes to your nervous system.

Causes of cystitis

Cystitis is caused by a bacterial infection. Around 8 in every 10 cases of cystitis are caused by bacteria called Escherichia coli (E. coli). These bacteria usually live harmlessly in your bowel or vagina.

Certain things can increase your risk of developing cystitis. These include the following.

• Having sex. Bacteria from your vagina or back passage may get into your urethra when you have sex.
• Having a new sexual partner in the last year.
• Conditions that affect the structure of your urinary tract or how it works. This may make it easier for bacteria to enter your bladder.
• Not being able to completely empty your bladder. In men, this is often due to an enlarged prostate.
• Pregnancy. Pregnancy hormones and your growing uterus make it harder to empty your bladder when you’re pregnant. This can make UTIs more likely.
• Taking antibiotics, especially regularly. These medicines can increase the growth of E. coli bacteria in your vagina.
• Having a weakened immune system. Anything that weakens your immune system – including type 1 and type 2 diabetes and HIV – can increase your risk of infection.
• Menopause. Low oestrogen levels can make your urethra wall thinner. This can make you more prone to cystitis.
• Having a catheter. Your risk of cystitis increases the longer you have the catheter. Other procedures or surgery on your urinary tract also increase risk.
• Some types of contraception. Using a diaphragm or spermicide-coated condoms may make you more likely to get cystitis.
• Stones (calculi) in your urinary system – kidney stones or bladder stones. These can trap bacteria, causing an infection.

If you’ve already had cystitis, your risk of getting it again is higher. This is even more likely if you had it as a child.

Symptoms of cystitis

Typical symptoms of cystitis include:

• burning or stinging when you pee
• needing to pee regularly, but only passing a little urine
• needing to pee more often at night
• a strong urge to pee – this can cause incontinence (peeing without meaning to)
• cloudy, dark or strong-smelling urine
• blood in your urine – you may not be able to see the blood, but it can be picked up in urine tests
• pain in your lower tummy

You may get more general symptoms, including:

• tiredness or feeling generally unwell
• a high temperature (fever)
• feeling or being sick
• feeling confused (especially in older people)

Some people may have these general symptoms without the typical symptoms of cystitis. But these symptoms may also be a sign of a kidney infection (pyelonephritis). If you have these symptoms, it’s important to speak to your GP surgery. You should also contact your GP if you have new vaginal discharge or more vaginal discharge than usual. Your symptoms may be caused by a vaginal infection rather than cystitis.

Sometimes, you may not have any symptoms at all with cystitis. You may only find out you have the infection if you have a routine urine test for another reason.

Cystitis in children

Children with cystitis may have symptoms similar to adults. Their symptoms may include:

• pain when they pee
• peeing more often
• wetting the bed
• urine with a bad smell

Younger children and babies may be more likely to:

• have a high temperature
• be sick (vomit)
• be irritable
• not want to eat or feed

Cystitis symptoms can come on very suddenly. They may be so bad that you find it hard to do your usual activities.

Seeking help for cystitis symptoms

Cystitis normally clears up on its own. But your local pharmacist can give you advice on managing your symptoms. If your symptoms aren’t starting to get better after a few days, you should see a GP.

Most pharmacies in the UK can test you for cystitis and prescribe antibiotics if you have a bacterial infection. You may be able to talk to your pharmacist about cystitis treatment rather than seeing a GP if the pharmacy offers the Pharmacy First service. The pharmacist may prescribe a three-day course of nitrofurantoin (an antibiotic) for cystitis. If a pharmacist prescribes antibiotics but the medicine isn’t working after 48 hours, it’s important to go back to the pharmacy or see your GP.

It’s important that you see a GP straight away if you:

• can see blood in your urine
• are male and you have any UTI symptoms
• think your baby or child may have cystitis
• are pregnant and think you may have cystitis
• keep getting infections, despite trying self-help measures
• have other long-term illnesses that affect your immune system, such as diabetes
• are feeling very unwell with a temperature or shivers, pain in your sides, or vomiting
• have unusual or increasing vaginal discharge

Diagnosis of cystitis

Your GP will ask about:

• your symptoms
• your medical history
• whether you could be pregnant and if you use contraception
• which treatments you have already tried, including antibiotics from a pharmacy

They may also ask to examine you.

Your GP will often be able to diagnose cystitis from your symptoms without doing any tests. They may ask for a sample of your urine to check for signs of a bacterial infection. Sometimes, they may send the sample to a laboratory for further tests.

Most people won’t need any further tests. But sometimes your GP may recommend further tests to check for any underlying problems, especially if your cystitis keeps coming back. Tests may include:

• an ultrasound scan of your kidneys and bladder – this uses soundwaves to create an image of the inside of your body
• a cystoscopy – this is a test to look inside your bladder and urinary tract using a thin tube inserted into your urethra

If you have symptoms of cystitis but you don’t have signs of a bacterial infection, you may have interstitial cystitis. Interstitial cystitis is difficult to diagnose and treat, so your GP may refer you to a specialist for further investigation.

Self-help measures for cystitis

Mild symptoms may clear up after a few days without any specific treatment for cystitis. In the meantime, you can try the following to ease your symptoms.

• Take over-the-counter painkillers such as paracetamol and ibuprofen to help with any pain.
• Drink enough fluids to keep hydrated.
• Don’t drink too much strong tea or coffee (containing caffeine), alcohol, or acidic drinks (such as fruit juices and fizzy drinks).

You can buy cystitis remedies over the counter from a pharmacy. These aim to make your urine less acidic and reduce the burning or discomfort when you pee. But there’s no evidence that these cystitis sachets work. If you decide to try them, check with your pharmacist or GP first. You may not be able to use them if you’re pregnant, on a low-salt diet, or have heart, liver, or kidney problems.

There’s no evidence that cranberry drinks or products help to relieve cystitis symptoms.

Complications of cystitis

Cystitis is usually mild and doesn’t cause any further problems. But in some people, it can be harder to get rid of or more likely to cause complications. Certain things can make you more likely to develop complicated cystitis.

These include:

• being pregnant
• being older
• getting cystitis from a catheter
• having conditions that affect the structure or your urinary tract or how it works
• having conditions affecting your immune system, such as diabetes

The most common complication is when bacteria from your bladder travel up to your kidneys. This causes a kidney infection (pyelonephritis). Symptoms can include pain in your side and back and a high temperature (fever). You may feel sick (or be sick) too. Pyelonephritis can be treated with antibiotics. If it isn’t treated, it may damage your kidneys.

If you’re pregnant, untreated pyelonephritis can cause you to give birth early. You’ll be screened for cystitis at your early antenatal appointments. This means if you have it, it can be treated quickly with antibiotics and reduce your risk of pyelonephritis.

Men are more likely than women to develop complications from cystitis. Cystitis in men may lead to an infection of their prostate gland (prostatitis). This can cause pain, especially at the bottom of the penis and around the anus (back passage). Men may have difficulty passing urine. Prostatitis is treated with antibiotics.

Prevention of cystitis

If you keep getting cystitis, there are some things you can try to reduce the risk of it coming back. This includes the following.

• Drink enough fluids to keep hydrated.
• Eat a healthy, balanced diet to help your immune system work well.
• Wear underwear that’s made from natural materials, such as cotton or linen.
• Wipe from front to back after doing a poo.
• Always pee as soon as you feel you need to go – don’t put it off.
• Go for a pee as soon as you can after sex.
• If you’ve been through the menopause, consider using oestrogen replacement vaginal creams and gels.
• Try not to use spermicide-coated condoms or diaphragms.

Talk to your GP or practice nurse about the most appropriate contraception for you if you keep getting cystitis. Some people find that cranberry drinks or products help to prevent cystitis if they’re prone to the infections.

There’s some evidence that cranberry products can help prevent attacks in some people who get regular cystitis. Some people find that taking a substance called D-mannose helps with cystitis prevention. But there’s not a lot of evidence for D-mannose. If you’re pregnant, check with a pharmacist or your GP before taking these products.

Antibiotics to prevent cystitis

If you’ve tried the measures above and they aren’t helping, your GP may suggest taking antibiotics to prevent cystitis. This may be:

• a single dose to take when you’re exposed to something that usually triggers cystitis for you (such as having sex)
• a daily antibiotic

You’ll usually be prescribed trimethoprim or nitrofurantoin if you’re taking antibiotics to prevent cystitis. There are potential side-effects and risks to taking antibiotics regularly or long-term. Your doctor will discuss these with you.