Cystitis

What is cystitis?

Cystitis is inflammation of your bladder. It is commonly caused by a urinary tract or bladder infection that occurs when bacteria enter your bladder.

Cystitis can be categorised as uncomplicated, meaning you are otherwise healthy, or complicated which involves other factors such as an underlying health condition, pregnancy, recent surgery or severe infection. Complicated cystitis may be harder to treat and have a higher risk of complications than uncomplicated cystitis.

Cystitis isn't usually serious, but it can be extremely uncomfortable. Occasionally cystitis can lead to a more serious infection in your kidneys, so it is important to get treatment for cystitis.

Cystitis can be either acute or interstitial.

• Acute cystitis - is a short-term condition where symptoms start suddenly. It is normally caused by infections of the urinary tract
• Interstitial cystitis - also known as bladder pain syndrome is a long-term condition that causes pelvic pain and problems peeing with no detectable infection

Both acute and interstitial cystitis have several possible causes. The type of cystitis depends on the cause.

Types of cystitis include:

• Bacterial cystitis- occurs when bacteria enter your bladder and cause an infection
• Chemical cystitis - occurs due to irritation of your genital area from certain products including perfumed soaps, spermicidal jellies and bubble bath
• Drug-induced cystitis - some medications like chemotherapy can cause cystitis
• Foreign body cystitis - a foreign body such as a long-term catheter (a tube through which you drain urine) can increase your risk of bacterial infection and cause inflammation
• Radiation cystitis - radiation therapy is used to kill cancer cells, but can also damage healthy cells including those in your bladder
• Cystitis associated with other conditions - cystitis is sometimes a symptom of an underlying medical condition such as diabetes, enlarged prostate, HIV or a kidney infection

What causes cystitis?

Cystitis occurs when your bladder becomes inflamed. This is most commonly caused by a urinary tract infection (UTI) where bacteria enter your bladder. Cystitis can be caused by several types of bacteria, but around eight out of ten cases are caused by Escherichia coli (E. coli), a bacteria that normally lives harmlessly in your vagina or bowel.

Other causes of cystitis include:

• Certain drugs
• Radiation therapy
• Bladder surgery
• Long-term catheter use
• Using products that irritate your genital area such as perfumed soaps, shower gels, bubble baths, or spermicidal jelly

Risk factors

Anyone can get cystitis, but the condition is much more common in women as their urethra (the tube from which you pee) is shorter making it easier for bacteria to enter the bladder.

Women may have a higher risk of developing cystitis if they:

• Are sexually active
• Use tampons
• Use personal hygiene products that can cause irritation
• Use diaphragms with spermicide
• Have been through menopause
• Are pregnant

Men may be at a higher risk of developing cystitis if they:

• Have an enlarged prostate

Both men and women may have a higher risk of developing cystitis if they:

• Have a current or recent urinary tract infection (UTI)
• Use a catheter
• Have a medical condition such as diabetes, HIV or kidney stones
• Have spinal injuries
• Are undergoing chemotherapy or radiation therapy
• Have a weakened immune system
• Have a problem that interferes with the flow of your urine

Cystitis symptoms

Cystitis symptoms can vary from person to person and range from mild to severe. Some people with cystitis don't have any symptoms and their condition may be picked up on a routine examination, or a test for another condition.

Symptoms of cystitis may include:

• A strong, persistent urge to pee
• Stinging, burning or pain when peeing
• Passing small amounts of urine
• Cloudy, dark-coloured or strong-smelling urine
• Blood in your urine (haematuria)
• Pain or pressure in your lower abdomen
• Feeling generally unwell
• Low-grade fever
• Pain during sex
• Cramping in your back or abdomen
• Daytime bed-wetting (in children)

Complications of cystitis

Untreated cystitis can lead to a kidney infection (pyelonephritis) which can cause permanent kidney damage.

Signs of a kidney infection include:

• Fever
• Back, side or groin pain
• Nausea and vomiting
• Pain or burning when peeing
• Peeing frequently
• Needing to pee urgently
• Pus or blood in your urine

Seek immediate medical attention if you have symptoms of a kidney infection. In rare cases, untreated cystitis can lead to sepsis - a life-threatening condition that needs immediate treatment.

When to see a specialist for cystitis

If your cystitis is mild, it may clear up on its own, but in some cases, you may need a prescription medication to treat your cystitis.

Always get treatment if your cystitis doesn't get better within a few days. Untreated cystitis can lead to serious complications.

Make an appointment with a consultant if:

• You have had symptoms of cystitis for more than three days
• Your symptoms are severe
• Your cystitis has not cleared up after treatment with antibiotics
• You get cystitis frequently
• You are pregnant and have symptoms of cystitis
• You are male and have symptoms of cystitis
• Your child has symptoms of cystitis

How is cystitis diagnosed?

Your consultant can usually diagnose cystitis by asking about your symptoms. They may also test your urine to check for a bacterial infection.

If your cystitis is severe or keeps coming back, your consultant may refer you for further tests such as:

• An ultrasound scan – allows your consultant to examine your bladder using images created by high-frequency soundwaves and look for other causes of your symptoms
• A cystoscopy – a procedure where a thin tube with a camera and a light is inserted into your bladder to examine your bladder and take a sample of tissue (biopsy) if needed

Treatment for cystitis

Self-care for cystitis

If your cystitis is mild, it may go away without treatment. Some home remedies that can help to ease symptoms of cystitis include:

• Take an over-the-counter painkiller like paracetamol to relieve any pain or discomfort
• Apply a hot water bottle over your lower abdomen to relieve pain
• Drink plenty of fluids (water is best)
• Avoid drinks that may irritate your bladder, like alcohol, coffee and fruit juices
• Pee frequently to help flush out the infection
• Avoid having sex while you have symptoms of cystitis

Medication

Treatment for acute cystitis is with antibiotics. This is normally a three-day course. Your consultant may prescribe a course of antibiotics for you to take straight away, or they may tell you to wait 48 hours before taking them to see if your cystitis clears up on its own.

If your cystitis keeps coming back, your consultant may prescribe:

• A low-dose antibiotic to take for up to six months
• A single-dose antibiotic to take within two hours of having sex (if sex triggers your cystitis)
• A vaginal oestrogen cream, if your cystitis is related to the menopause

Can cystitis be prevented?

Cystitis can't always be prevented, but there are some things you can do that may lower your risk of getting cystitis including: 

• Drink plenty of water every day
• Empty your bladder as soon as you need to
• Wipe yourself from front to back after peeing to avoid spreading bacteria from your anus to your urethra
• Wear cotton underwear and avoid tight trousers, jeans and nylon tights
• Avoid products that could cause irritation such as perfumed soaps, talcum powder or deodorant around your genital area
• Don't use bubble bath
• Wash your genital area before sex (and encourage your partner to do the same)
• Pee straight away after sex
• Treat any vaginal infections straight away as the bacteria can increase your risk of getting cystitis

Does cranberry juice help with cystitis?

Cranberries contain compounds called proanthocyanidins (PACs) that may help prevent harmful bacteria from attaching to the walls of your urinary tract and leading to infection.

Drinking cranberry juice or taking supplements containing PACs may help prevent or treat cystitis, though more research is needed. Though cranberry juice or supplements may be helpful for some people, they should never be used in place of a medical diagnosis and treatment from your consultant. Cranberry juice can also change the way some antibiotics work, so let your consultant know if you are taking cranberry juice or using any supplements to treat your cystitis.

Getting help for recurring cystitis

Cystitis is a common condition, especially in women. It causes inflammation of the bladder and is usually caused by a bacterial infection. Mild cystitis may clear up without treatment, but in some cases, you may need to take antibiotics to treat your cystitis.

Untreated cystitis can lead to serious complications such as a kidney infection, so if your symptoms are severe, keep coming back, or have lasted longer than three days, make an appointment with a consultant.