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Cystitis

Cystitis

Cystitis is a common condition that affects most women at some point in their lives. It is often, but not always, caused by an infection in the bladder. Symptoms include an urgent and frequent need to go to the toilet, and a pain or stinging sensation when urinating. There are other conditions that cause these symptoms like STDs, so you should see a doctor to check it out. Cystitis can clear up of its own accord but may need treatment with antibiotics.

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 a doctor

Children and men should always see their GP if they have symptoms of cystitis. Women should always see their GP the first time they have the symptoms of cystitis. They should also return to their GP if they have the condition more than three times in one year.

Find out more about:

Anus
The opening at the end of the digestive system where solid waste leaves the body.
Kidneys
Kidneys are a pair of bean-shaped organs located at the back of the abdomen. They remove waste and extra fluid from the blood, and pass them out of the body as urine.
Prostate
A small gland found only in men, located in the pelvis, between the penis and the bladder.
Urethra
The tube that carries urine from the bladder out of the body.

Symptoms

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. Find out more about treating cystitis.

Find out about recognising the signs of serious illness in children.

Seeing a doctor

The usual symptoms of cystitis could also be caused by other conditions, so it's important to see your GP 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: 

Find out more about:

 

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
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.
Urethra
The urethra is a tube that carries urine from the bladder to the outside of the body.
Vomiting
Vomiting is when you bring up the contents of your stomach through your mouth.
 

Causes

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)

Find out more about:

 

Anus
The anus is the opening at the end of the digestive system where solid waste leaves the body.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Catheter
A catheter is a thin, hollow tube usually made of rubber that is placed into the bladder to inject or remove fluid.
Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Prostate
A gland in men located in the pelvis, between the penis and the bladder.
Tumour
A growth of cells.
Urethra
The urethra is a tube that carries urine from the bladder to the outside of the body.

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 their GP. Men, women and children should see their GP 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

Your GP 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

Your GP 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. Your GP 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 be referred to a specialist. You may need to have some other tests, such as:

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 the healthcare professional treating you. 

Find out about:

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Bacterium
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Urine sample
Urinalysis / UA,  or urine culture, is when a urine sample is tested, commonly to check for any signs of infection, or protein or sugar levels.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.

Treating cystitis

Children and men should always see their GP if they have cystitis symptoms. Women should always see their GP 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 your GP 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 your GP, 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 your GP or pharmacist 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.

Find out some useful tips on preventing cystitis.

Antibiotics

If your symptoms are moderate or severe, your GP 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. Find out more about cystitis complications.

Research suggests that antibiotics can shorten an attack of cystitis by 1-2 days.

If your cystitis symptoms are only mild, your GP 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 your GP 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

If you are prescribed antibiotics, your symptoms should start to improve after the first day of taking them. If your symptoms don't improve after your course of antibiotics, go back to see your GP, or call NHS Direct on 0845 4647.

Find out more about:

Antibiotic
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Painkillers
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.