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Introduction

Cystitis is inflammation of the bladder, usually caused by a bladder infection.

Bladder infections can be caused by:

  • not emptying your bladder properly – for example, because of pregnancy or an enlarged prostate

  • damage or irritation around the urethra (the tube that carries urine from the bladder out of the body)

  • bacteria being transferred from the anus to the urethra – for example, during sex

Symptoms of cystitis include:

  • an urgent and often need to urinate

  • pain or stinging when you urinate

  • pain in the bladder

 

When to see your GP

The symptoms of cystitis can also be caused by other conditions, so children and men should always see their GP if they have symptoms of cystitis.

Women should see their GP if they experience the symptoms of cystitis for the first time. They should also return to their GP if they have cystitis more than three times in one year.

 

Cystitis in women

Cystitis is more common in women because women have a short urethra. 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

  • women who have been through the 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. Men who have unprotected anal sex are slightly more at risk of cystitis.

 

Treating cystitis

Mild cystitis usually clears up within a few days. You can treat it at home by drinking plenty of water and taking painkillers such as paracetamol or ibuprofen. It can also help if you do not have sex until it's cleared up as sex can make cystitis worse.

More severe cystitis may need treatment with antibiotics.

Untreated bladder infections can cause kidney infections.

 

Symptoms of cystitis 

The symptoms of cystitis can vary between adults and children.

Cystitis in adults can cause:

  • pain, burning or stinging when you urinate

  • needing to urinate often and urgently but only passing small amounts of urine 

  • urine that's dark, cloudy or strong smelling

  • traces of blood in your urine (haematuria)

  • pain low in your belly (directly above the pubic bone), or in the lower back or abdomen

  • feeling unwell, weak or feverish

Symptoms of cystitis in children may include:

  • weakness

  • irritability 

  • reduced appetite

  • vomiting

  • pain when urinating

 

 

Seeing your GP 

The symptoms of cystitis can also be caused by other conditions, so it's important to see your GP the first time you have any of these 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, leading to the symptoms of cystitis.

Cystitis can also result from damage or irritation around the urethra

 

Bacterial infection

This develops 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 – 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.

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 for contraception

In women who have had, or are going through, the menopause, the lining of the urethra and the bladder become thinner because of 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. 

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.

This damage or irritation could be the result of:

  • sex

  • chemical irritants – for example, in perfumed soap or talcum powder

  • other bladder or kidney problems, such as a kidney infection or prostatitis

  • diabetes

  • 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 are a woman who has had cystitis before, you may be able to recognise the symptoms and diagnose the condition without seeing your GP.

However, men and children with cystitis symptoms should always see their GP. 

If you're a woman, you should see your GP if: 

  • you have cystitis symptoms for the first time 

  • 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

  • you're pregnant

  • you have a catheter (a tube inserted into the urethra to allow urine to flow into a drainage bag, which is often used after surgery)

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 sample

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 you have a kidney infection – cystitis can be a symptom of this

  • you are on immunosuppressant medication – this type of medication affects your immune system (the body's defences), so you may be more prone to infection

  • you have diabetes – cystitis can be a complication of diabetes

  • you may have a sexually transmitted infection (STI) – such as gonorrhoea and chlamydia

  • it is possible 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 doesn't respond to antibiotics, even after a urine culture has been tested, you may be referred to a specialist. You may need more tests, such as:

  • an ultrasound scan

  • an X-ray

  • a cystoscopy

A cystoscopy is when a tiny fibreoptic 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.

 

Treating cystitis 

The symptoms of mild cystitis usually clear up without treatment within a few days.

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.

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, can reduce pain and discomfort – always read the information leaflet and check with your pharmacist first, particularly if you have another medical condition, if 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, but drinking plenty of water 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 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.

 

Antibiotics

If your symptoms are severe, your GP may prescribe a short course of antibiotics. This will usually involve taking a tablet two to four times a day for three days.

For more complicated cases of cystitis, such as cystitis with another underlying infection, you may be given antibiotics for 5 to 10 days. Find out more about cystitis complications.

Research suggests that antibiotics can shorten an attack of cystitis by one to two days.

If you have mild cystitis, your GP may prefer not to prescribe antibiotics to avoid antibiotic resistance. This is when the bacteria 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 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 if:

  • cystitis usually occurs after having sex – you may be given a prescription for antibiotics to take within two hours of having sex

  • 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.

 

Preventing cystitis 

It's not always possible to prevent cystitis, but there are some steps you can take that may help.

For example:

  • don't use perfumed bubble bath, soap, or talcum powder around your genitals – use plain, unperfumed varieties

  • have a shower, rather than a bath – this avoids 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, such as 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, there has been contrary evidence about their role in preventing recurrent attacks.

However the latest review published in 2013 suggested cranberry juice could not be recommended for preventing urinary tract infections.

 

Cystitis and sex

Try these tips if your cystitis is triggered by having sex:

  • 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

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.

 

Interstitial cystitis 

Interstitial cystitis causes recurring discomfort in the bladder and pelvic area. The symptoms vary between individuals, but some people can experience intense pain.

The pelvic pain may increase with a full bladder, when urinating, during periods or while having sex.

Like regular cystitis, interstitial cystitis can cause an urgent and frequent need to urinate. However, the condition doesn't respond to treatment with antibiotics as it is not caused by a bacterial infection.

Around 400,000 people in the UK have interstitial cystitis. More than 90% of these cases are in women. It's often diagnosed at around the age of 40.

Interstitial cystitis can have a significant effect on a person's lifestyle and daily habits. Many people find the pain affects relationships or work and the frequent need to urinate can be tiring or embarrassing. For some people, this can lead to further problems such as depression or avoiding leaving the house.

 

What causes interstitial cystitis?

It's not clear what causes interstitial cystitis, but researchers are investigating whether the condition is inherited. It also may be associated with other conditions, such as irritable bowel syndrome and fibromyalgia, as many women with interstitial cystitis also have these conditions.

Another theory is that one of the protective layers of the bladder wall may "leak" in people with interstitial cystitis, allowing chemicals in the urine to irritate the bladder.

People who have interstitial cystitis often have small areas of scarring, stiffness or bleeding on the wall of their bladder. Around 5-10% of people with interstitial cystitis have patches of inflammation and broken skin in the bladder, which leads to more severe symptoms. These are known as Hunner's ulcers.

 

Lifestyle changes

It may be possible to reduce the symptoms of interstitial cystitis by making some lifestyle changes.

Clothing

Avoid clothes and belts that are tight fitting, especially if they put pressure on your waist or tummy.

Smoking

There is some evidence that smoking can make the symptoms of interstitial cystitis worse.

Smoking is also a potential cause of bladder cancer, so it is recommended that you quit if you smoke.

Stress

Stress is thought to contribute to a flare-up of symptoms in some people. It may help to try stress relieving techniques such as deep breathing and muscle relaxation.

Exercise

Regular exercise may help to reduce stress and improve your physical and mental health.

Some simple stretching exercises may also help to reduce symptoms.

Diet

There is currently no scientific evidence that changes to your diet will benefit interstitial cystitis, although some people believe eliminating certain food or drinks can improve symptoms.

Speak to your doctor before making any changes to your diet, as it is important to maintain a healthy, balanced diet.

 

Treating interstitial cystitis

There is no single treatment that is effective for every person with interstitial cystitis. As the symptoms can vary between individuals, you may need to try several treatments to find one that works for you.

It is important to discuss the options with your doctor first to help decide which treatments may benefit you.

Treatment can include:

  • physiotherapy – this can help relieve any pelvic pain caused by muscles or surrounding tissue

  • painkillers, such as aspirin and ibuprofen - however some people find these actually make their symptoms worse

  • certain antidepressants – these may reduce pain and improve other symptoms

  • certain antihistamines – these may reduce the frequency of needing to urinate and improve other symptoms

  • bladder distension (where the bladder is filled with water to increase its volume) – this may help to temporarily relieve symptoms within a week or two after the procedure

  • bladder instillation (where the bladder is filled with a solution that includes medication to reduce inflammation of the bladder walls) – this may help to temporarily relieve symptoms within three to four weeks after the procedure

  • transcutaneous electrical nerve stimulation – where mild electric pulses are used to block or reduce pain signals going to the spinal cord and brain

 

Surgery

If other treatments haven't worked, surgery may be an option. However, surgery is rarely used to treat interstitial cystitis.

Surgical options may include:

  • treating Hunner's ulcers with electricity or lasers (fulguration)

  • removing Hunner's ulcers (resection)

  • making the bladder larger using part of the small intestine (augmentation) – this usually includes removing any inflamed areas of the bladder

  • in very rare cases, bladder removal

Surgery is rarely used and the potential risks and benefits should be discussed with a surgeon before making a decision.

 

Painful bladder syndrome (PBS)

Some GPs 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.