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Cystitis

Cystitis is an infection of the bladder that is most common in women. Around one in six women get cystitis each year. Children and men can also get cystitis.

  • About cystitis
  • Symptoms
  • Causes
  • Diagnosis
  • Treatment
  • Prevention
  • Further information
  • Sources
  • Related topics

About cystitis

Cystitis is the inflammation of the bladder due to an infection or irritation. Anyone can get cystitis, but it's most common in women. Cystitis can be painful, particularly when you pass urine, but it usually clears up within a few days.

Urine is produced by each of your two kidneys and drains into your bladder through tubes called ureters. When you pass urine, the bladder contracts, squeezing urine out of your body through a tube called the urethra.

Usually cystitis only affects the bladder and is known as a lower urinary tract infection (UTI). If the infection goes higher, to the ureters or kidneys, this can be a more serious illness known as an upper urinary tract infection. This factsheet is about lower urinary tract infections.

Symptoms

Symptoms of cystitis can include:

  • a stinging or burning sensation when you pass urine
  • the need to urinate more often than you usually do
  • feeling the need to urinate urgently, even if you pass very little or no urine
  • urine that is cloudy or dark coloured, and may have a strong smell
  • blood in your urine
  • pain or tenderness in your lower back or lower abdomen
  • a general feeling of being unwell

These symptoms can also be due to a sexually transmitted infection (STI) such as chlamydia (see Related topics). If you think you may have an STI, visit your GP or a genito-urinary medicine (GUM) clinic for confidential diagnosis and treatment.

Causes

Cystitis is often caused by bacteria that get into your urethra from surrounding skin and travel up towards your bladder, causing infection and irritation. The majority of infections are caused by bacteria that normally live harmlessly in your bowel. The infections are usually caused by a bacterium called Escherichia coli (or E. coli for short).

Women get cystitis more than men partly because, in women, the urethra is nearer the opening of the back passage (the anus) where bacteria from your bowel can collect. This makes it easier for bacteria to get transferred from the surrounding skin into the urethra. The urethra is also much shorter in women than in men, so there is less distance for the infection to travel to the bladder.

There are a number of ways that bacteria can get into your bladder. You are more likely to get cystitis if you:

  • are sexually active - the risk seems to go up with the frequency you have intercourse
  • use spermicide-coated condoms or a diaphragm with spermicide as a method of contraception
  • have passed the menopause - this causes changes to the lining of your vagina and urethra that may make you more likely to get bacteria in your urine
  • have a urinary catheter - this can introduce bacteria directly into your bladder
  • have diabetes - your urine may contain more sugar and so encourage bacteria to grow
  • have a condition that prevents you from emptying your bladder - for example if you have bladder or kidney stones, have an enlarged prostate or are pregnant

Bathing and hygiene products, such as talcum powder or perfumed soap, may also irritate your urethra or bladder.

Diagnosis

If you are generally in good health, you may not need to see your GP, as cystitis often clears up by itself with home treatments. However you should visit your GP if:

  • symptoms don't improve after a two to three days
  • you have blood in your urine
  • you are or may be pregnant
  • you are over 65
  • symptoms are accompanied by a high temperature, nausea or vomiting
  • you have pain in your lower back or severe abdominal pain
  • the cystitis keeps coming back
  • you have other problems with your urinary system such as kidney stones or difficulty emptying your bladder
  • you have diabetes

Children and men who get cystitis should always see a doctor. Cystitis in men can be caused by an enlarged prostate, which will need to be checked. In young children it's important to rule out any abnormality of the urinary system so as to prevent kidney problems later.

To diagnose cystitis, your GP will ask you for a sample of urine. He or she may test your urine with a "dipstick" or may send the sample to a laboratory for more detailed tests.

Treatment

Self-help

You can often treat cystitis yourself by doing the following things.

To reduce discomfort, take the painkiller that you would take for a headache.

Make your urine less acidic by drinking a glass of water with half a teaspoon of bicarbonate of soda dissolved in it. Products that contain sodium bicarbonate or potassium citrate have the same effect and are available from your pharmacist. Always ask your doctor or pharmacist for advice and read the patient information that comes with your medicine.

Some doctors recommend that you drink lots of water to help flush out the infection.

Medicines

Your GP may prescribe antibiotics and will let you know how many days you need to take them for. Usually you will need to take them for three to six days. You should always take the full course of antibiotics to get rid of the bacteria completely, even if the symptoms clear up before you finish the course.

If your symptoms don't clear up, you may wish to go back to see your GP as some infections can be resistant to the antibiotics normally used.

If antibiotics don't work at all, it's possible that you have a kind of cystitis called interstitial cystitis. This is a chronic inflammation of the bladder wall that is not caused by infection and does not respond to antibiotics. Your GP will be able to give you more information.

Prevention

There is evidence that drinking cranberry juice or taking cranberry extract capsules has some effect in preventing cystitis from coming back. Although there is good evidence that cranberry products can help to prevent cystitis in women, it's not clear if it works as a treatment. Ask your GP or pharmacist for advice before taking cranberry capsules or drinks, particularly if you are taking the blood-thinning medicine, warfarin.

If you get three or more attacks a year, your GP may give you a course of antibiotics to keep at home so you can use them as soon as you know you are getting a bout of cystitis. Alternatively, women who get repeated attacks may need to take a low dose of antibiotics for six to 12 months. If you get cystitis after sexual intercourse, your GP may advise you to take a single dose of antibiotics immediately after you have had intercourse to prevent an attack.

Using spermicide-covered condoms and spermicidal products with a diaphragm for contraception can increase the risk of cystitis. If you use these, it may be worth discussing alternative methods of contraception with your GP or family planning adviser.

For women who have had the menopause, creams containing oestrogen can be applied to the vagina and may reduce the risk of cystitis.

Although lacking in scientific evidence, some women also find that the following measures help prevent cystitis, these include:

  • urinating after sexual intercourse
  • increasing your fluid intake
  • wearing loose clothing
  • wiping front to back, not back to front after going to the toilet
  • urinating as soon as you feel the need to, instead of "holding on"

Further information

The Cystitis and Overactive Bladder Foundation

Sources

  • Car J. Urinary tract infections in women: diagnosis and management in primary care. BMJ 2006; 332:94
  • Bacterial cystitis. The Cystitis and Overactive Bladder Foundation. www.cobfoundation.org, accessed 5 July 2007
  • Prevention of bacterial cystitis. Cystitis and overactive bladder foundation. www.cobfoundation.org, accessed 5 July 2007
  • Urinary tract infection - women. Clinical knowledge summaries, July 2006. http://cks.library.nhs.uk
  • Urinary tract infection (lower) - children. Clinical Knowledge Summaries, July 2006. http://cks.library.nhs.uk
  • Urinary tract infection (lower) - men. Clinical Knowledge Summaries, July 2006. http://cks.library.nhs.uk
  • Recurrent cystitis in non-pregnant women. BMJ Clinical Evidence. www.clinicalevidence.com, accessed 5 July 2007
  • Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. 2nd edition. Oxford: Oxford University Press, 2002
  • Hooton TM, Scholes D, Hughes JP, Winter C, Roberts PL, Stapleton AE, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med 1996;335: 468-74
  • Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network. July 2006. SIGN 88
  • Vogel T, Verreault R, Gourdeau M, Morin M, Grenier-Gosselin L, Rochette L. Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double blind randomized controlled trial. Can Med Assoc J 2004;170: 469-473
  • British National Formulary. BMJ Publishing Grou2006. 52

Related topics

Sexually transmitted infections