Introduction
Cystitis is inflammation of the bladder. It's usually caused by an infection in the bladder, but can also be caused by irritation or damage (from friction during sex, for example).
Symptoms of cystitis are:
An urgent need to urinate often
Pain or stinging when you urinate
Cystitis usually passes within a few days, or sometimes may need treatment with antibiotics.
Untreated bladder infections can cause kidney infections.
Cystitis in women
Cystitis is more common in women because women have a short urethra (the tube that carries urine from the bladder out of the body). The urethra's opening is also located very close to the anus (bottom), which makes it easy for bacteria from the anus to reach the bladder and cause an infection.
Almost all women will have cystitis at least once in their lifetime. Around one in five women who have had cystitis will get it again (known as recurrent cystitis). Cystitis can occur at any age, but it is more common in:
Pregnant women
Sexually active women
Post-menopausal women (women who have been through menopause)
Cystitis in men
Cystitis is less common in men. It can be more serious in men because it could be caused by:
An underlying bladder or prostate infection, such as prostatitis
An obstruction in the urinary tract, such as a tumour, or an enlarged prostate (the gland located between the penis and the bladder)
Male cystitis is not usually serious if treated quickly, but it can be very painful. Sexually active gay men are more likely to get cystitis than other males.
Outlook
Mild cystitis usually clears up within 4-9 days. You can treat it at home by drinking plenty of water (around 1.2 litres or 6-8 glasses every day) and taking painkillers, such as paracetamol or ibuprofen. More severe cystitis can also cause abdominal pain or fever, and may need treatment with antibiotics.
Seeing Dr. B C Shah
Children and men should always see Dr. B C Shah if they have symptoms of cystitis. Women should always see Dr. B C Shah the first time they have the symptoms of cystitis. They should also return to him if they have the condition ore than three times in one year.
Symptoms of cystitis
Children and adults can get cystitis, and the symptoms can be different.
Symptoms in men and women
Cystitis in men and women can cause:
Pain, burning or stinging when you urinate
Needing to urinate often and urgently but passing only small amounts of urine
Urine that's dark, cloudy or strong smelling
Urine that contains traces of blood (haematuria)
Pain low in your belly (directly above the pubic bone), or in the lower back or abdomen
Feeling unwell, weak or feverish
Symptoms in children
Symptoms of cystitis in children may include:
Weakness
Irritability
Reduced appetite
Vomiting
Pain when urinating
Cystitis is usually treated easily.
Seeing Dr. B C Shah
The usual symptoms of cystitis could also be caused by other conditions, so it's important to see Dr. B C Shah the first time you have any of these symptoms. This means you can be treated correctly for whatever is causing your symptoms.
The symptoms caused by cystitis could also be caused by:
Sexually transmitted infections (STIs), such as gonorrhoea or chlamydia
Being infected with bacterium such as E-coli
Vaginal thrush, also known as candida (a yeast infection)
Inflammation of the urethra (urethritis)
Urethral syndrome (women only)
Inflammation of the prostate gland, also known as prostatitis (men only)
Causes of cystitis
The most common cause of cystitis is a bacterial infection. If bacteria reach the bladder, they can multiply and irritate the bladder lining, causing the symptoms of cystitis.
Cystitis can also result from damage or irritation around the urethra. The urethra is the tube that carries urine from the bladder out of the body. In men, the urethral opening (where urine leaves the body) is at the tip of the penis. In women it's just below the clitoris.
Bacterial infection
This happens when bacteria get into the bladder and multiply. It can happen if you don't empty your bladder properly. Try to empty your bladder fully each time you go to the toilet, to help prevent bacterial infection.
You may not be able to empty your bladder fully if:
You have a blockage somewhere in your urinary system: this could be caused by a tumour or, in men, an enlarged prostate (a gland located between the penis and the bladder)
You are pregnant, as pregnancy puts pressure on the pelvic area and the bladder
Bacterial infection can also happen when bacteria from the anus are transferred to the urethra. This is more common in women than in men, as the urethra is closer to the anus in women than it is in men.
In women, transferring bacteria in this way can happen when you are:
Having sex
Wiping after going to the toilet (you're less likely to transfer bacteria in this way if you wipe from front to back)
Inserting a tampon
Using a diaphragm (a soft dome made of latex or silicone) for contraception
In women who have had, or are going through, the menopause, the lining of the urethra and the bladder become thinner. This is due to a lack of the hormone oestrogen. The thin lining is more likely to become infected or damaged. Women also produce fewer vaginal secretions after the menopause, which means that bacteria are more likely to multiply.
Damage or irritation
Cystitis can also be caused by damage or irritation in the area around the urethra in both men and women. This could be the result of:
Damage or bruising caused by vigorous or frequent sex (this is sometimes called honeymoon cystitis)
Wearing tight clothing
Chemical irritants – for example, in perfumed soap or talcum powder
Other bladder or kidney problems, such as a kidney infection or prostatitis
Diabetes (a long-term condition caused by too much glucose in the blood)
Damage caused by a catheter (a tube inserted into the urethra to allow urine to flow into a drainage bag, which is often used after surgery)
Diagnosing cystitis
If you have had cystitis before, you may be able to recognise the symptoms and diagnose the condition yourself.
However, men and children with cystitis symptoms should always see Dr. B C Shah. Men, women and children should see Dr. B C Shah if:
This is the first time you've had cystitis symptoms
There's blood in your urine (haematuria)
You have a high temperature (fever) of 38ºC (100.4ºF)
You're in a lot of pain
You've had cystitis three times in one year
Dr. B C Shah should be able to diagnose cystitis from asking about your symptoms. In some cases, they may also use a dipstick (a chemically treated strip of paper) to test a sample of your urine. The paper will react to certain bacteria by changing colour, showing which kind of infection you have.
Urine culture
Dr. B C Shah may wish to send a sample of your urine to a laboratory for further testing. This sample is called a urine culture. This may be necessary if:
you have recurrent cystitis (more than three times in one year)
it is possible that you may have a kidney infection – cystitis can be a symptom of this
you are on immunosuppressant medication(medication that suppresses your immune system) – these affect your body’s defences so you may be more prone to infection
you have diabetes (a long-term condition caused by too much glucose in the blood) – cystitis can be a complication of diabetes
you may have a sexually transmitted infection(STI) – such as gonorrhoea and chlamydia
it is possible that you have another infection, such as thrush (candida)
The urine culture will confirm which bacteria are causing your cystitis. Alternatively, it may reveal that your cystitis is caused by another condition. Dr. B C Shah can advise you about the most appropriate treatment for you.
Further tests
If you have recurrent cystitis that does not respond to antibiotics, even after a urine culture has been tested,you may need to have some other tests, such as:
An ultrasound scan
An X-ray
A cystoscopy
A cystoscopy is when a tiny fibre-optic camera, called a cystoscope, is used to examine your bladder. The cystoscope is a very thin tube that has a light and a camera at one end. It is inserted into your urethra (the tube that carries urine from your bladder out of your body) and transmits images of the inside of your bladder to a screen.
Any further tests that you need will be explained to you by Dr. B C Shah treating you.
Treating cystitis
Children and men should always see Dr. B C Shah if they have cystitis symptoms. Women should always see Dr. B C Shah the first time they have cystitis symptoms, and also if they have the condition more than three times in one year.
The symptoms of cystitis usually clear up without treatment within 4-9 days. There are some self-help treatments that can ease the discomfort of any symptoms, or Dr. B C Shah may prescribe antibiotics.
Self-help treatments
If you've had cystitis before and you're sure that you have mild cystitis and don't need to see Dr. B C Shah, there are treatments that you can try yourself.
Over-the-counter (OTC) painkillers, such as paracetamol or ibuprofen. These can reduce pain and discomfort. Always read the label and check with your pharmacist first, particularly if you have any other medical condition, you are taking other medicines, or you're pregnant or breastfeeding.
Drinking plenty of water is often recommended as a treatment for cystitis. There's no evidence that this is helpful, although drinking around 1.2 litres (6-8 glasses) of water a day is generally good for your health. Also avoid alcohol.
Don't have sex until your cystitis has cleared up because having sex can make it worse.
Some people find that using urine alkanising agents, such as sodium bicarbonate or potassium citrate, for a short period of time may help to relieve pain when urinating. However, there is currently a lack of clinical evidence for their effectiveness. Check with Dr. B C Shah first if you are taking any other medication.
Drinking cranberry juice is not thought to help relieve pain but may help to prevent outbreaks of recurrent cystitis.
Antibiotics
If your symptoms are moderate or severe, Dr. B C Shah may prescribe a short course of antibiotics. This will usually involve taking a tablet 2-4 times a day, for three days.
For a more complicated case of cystitis, such as cystitis with another underlying infection, you may be given antibiotics for 5-10 days.
If your cystitis symptoms are only mild, Dr. B C Shah may prefer not to prescribe antibiotics to avoid ‘antibiotic resistance’. This is when the bacteria that cause cystitis adapt and learn to survive the antibiotics. Over time, this means that the treatment becomes less effective.
Recurring cystitis
If you keep getting cystitis (known as having recurring cystitis) your doctor may prescribe stand-by antibiotics or continuous antibiotics. A stand-by antibiotic is a prescription for you to take the next time you have cystitis, without needing to visit Dr. B C Shah again.
Continuous antibiotics are antibiotics that you take for several months to prevent further episodes of cystitis. These may be prescribed for two reasons:
If your cystitis usually occurs after having sex, you may be given a prescription for antibiotics to take within two hours of having sex
If your cystitis is not related to having sex, you may be given a low-dose antibiotic to take for a trial period of six months
Complications
Most cases of cystitis clear up on their own or with antibiotics. However, untreated bladder infections can cause kidney infections, which can be serious.
Although cystitis usually clears up on its own or with antibiotics, some people experience almost constant symptoms or recurring episodes. If no cause can be found, and the cystitis doesn't respond to antibiotics, you may have interstitial cystitis.
Interstitial cystitis
Interstitial cystitis causes recurring discomfort in the bladder and pelvic area. Like cystitis, it can cause an urgent and frequent need to urinate. Other symptoms, and the level of pain it causes, can vary from person to person.
Some people may find it more painful when their bladder is full, or more painful when they urinate. Women may find the condition more painful during their period.
How is it treated?
Treatment can include:
Medications, including painkillers and antidepressants
Bladder distension – when the bladder is filled with water to increase its volume
Bladder instillation – the bladder is filled with a solution that includes medication to reduce inflammation of the bladder walls
Surgery, if other treatments haven't worked
If you're diagnosed with interstitial cystitis, Dr. B C Shah will explain the condition and the treatment options in more detail.
Dr. B C Shah may use the term 'painful bladder syndrome' (PBS) to describe a condition that causes pain but doesn't meet the criteria to be diagnosed as interstitial cystitis.
Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Painkillers
Painkillers (analgesics) are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.
Preventing cystitis
It's not always possible to prevent cystitis, but you can take some steps to help avoid the condition:
Don't use perfumed bubble bath, soap, or talcum powder around your genitals – use plain, unperfumed varieties
Have a shower, rather than a bath, to avoid exposing your genitals to the chemicals in your cleaning products for too long
Always empty your bladder fully when you go to the toilet
Don't wait to go if you need to urinate: delaying it can place extra stress on your bladder and could make it more vulnerable to infection
Wear underwear made from cotton rather than synthetic material such as nylon
Avoid wearing tight jeans and trousers
Always wipe from the front of your genital area to the back, not back to front, when you go to the toilet
Some people find certain types of food and drink make their cystitis worse: for example, coffee, fruit juice or spicy foods. If there is anything that triggers your cystitis, you may wish to avoid it
Cranberry products
Although cranberry products are not effective at treating cystitis, they may help to prevent recurrent attacks. High-strength capsules, which contain 200mg of cranberry extract, are available in shops .
Cranberry capsules may be a more effective treatment than drinking cranberry juice, as you need to drink a lot of juice for it to benefit you, and not everyone likes the taste. Cranberry capsules are not recommended if you are taking warfarin (blood-thinning medication).
Cystitis and sex
Try these tips if your cystitis is triggered by having sex:
Wash your genital area and your hands before and after sex
Use a lubricant during sex to avoid damaging your genital area through friction (use a water-based lubricant if you're using latex condoms, as oil-based lubricant can make latex condoms less effective)
If you're a woman and you use a diaphragm for contraception, you may wish to change to another method of contraception
After having sex, empty your bladder as soon as possible to get rid of unwanted bacteria
There is currently no evidence that oestrogen products, used to treat women after the menopause, can prevent cystitis.
People who have catheters need special advice about how to change them without damaging the area. Ask the healthcare professional who is treating you to show you how to do this.