What is cystitis?

Cystitis means inflammation of the bladder. It is usually caused by a urine infection. Typical symptoms are pain when you pass urine, and passing urine frequently. You may also have pain in your lower abdomen, blood in your urine and fever (high temperature). Your urine may also become cloudy and may become smelly.

Most urine infections are due to bacteria (germs) that come from your own bowel. Some bacteria lie around your anus (back passage) after you pass a stool (faeces). These bacteria can sometimes travel to your urethra and into your bladder. Some bacteria thrive in urine and multiply quickly to cause infection.

Note: other causes of cystitis include radiotherapy and certain chemicals. This leaflet will only discuss cystitis caused by an infection.

Who develops cystitis?

Women are eight times more likely to have cystitis than men, as their urethra (the tube from the bladder that passes out urine) is shorter and opens nearer the anus.

Up to 15% of women have cystitis each year and about half of women have at least one bout of cystitis in their life.

Other risk factors for cystitis include having diabetes mellitus, being pregnant and being sexually active.

Can I be sure it is cystitis?

Some conditions cause symptoms that may be mistaken for cystitis. For example, thrush. Also, soaps, deodorants, bubble baths, etc, may irritate your genital area and cause mild pain when you pass urine.

Your doctor or nurse may do a simple dipstick test on a urine sample to check for cystitis. This can detect bacteria in your urine. It is fairly reliable and usually no further test is needed. Occasionally, your urine sample is sent to the laboratory to find out which bacterium is causing the infection.

What is the treatment for cystitis?

Treatment options include the following:

• Antibiotics. A three-day course is a common treatment for most women. Symptoms usually improve within a day or so after starting treatment. On average, taking antibiotics shortens the duration of symptoms by around one day. One option is that your doctor may offer you a delayed prescription for antibiotics. You then need only cash in the prescription if your symptoms worsen, or do not improve, over the next few days.
• Not taking any treatment may be an option (if you are not pregnant or if you have no other illnesses). Your immune system can often clear the infection. Without antibiotics, cystitis, particularly mild cases, often goes away on its own in a few days. However, symptoms can sometimes last for a week or so if you do not take antibiotics.
• Have lots to drink. This is traditional advice to "flush out the bladder". However, there is no proof that this is helpful. Some doctors feel that it does not help and drinking lots may just cause more (painful) toilet trips. Therefore, it is difficult to give confident advice on whether to drink lots, or just to drink normally.
• Paracetamol or ibuprofen. These ease pain or discomfort and can also lower a high temperature.

There is no firm evidence that drinking cranberry juice or taking products that alkalise your urine (such as potassium citrate or bicarbonate) improve the symptoms of cystitis. These sort of products are sometimes sold as a treatment for cystitis.

If your symptoms worsen or you develop a high fever then you should see your doctor. In addition, if your symptoms do not improve by the end of taking the course of antibiotics or if your symptoms recur within two weeks after taking antibiotics then you should see your doctor.

Note: if you are pregnant or have certain other medical conditions, you should always be treated with antibiotics to prevent possible complications.

What is the outlook?

The vast majority of women improve within a few days of developing cystitis. However, if your symptoms do not improve despite taking antibiotics then you may need an alternative antibiotic. Some bacteria causing cystitis can be resistant to some types of antibiotic.

You should see a doctor if you have recurring bouts of cystitis, to discuss ways of preventing it. See separate leaflet called 'Cystitis - Recurrent Infections in Women' for more information.

Further help and information

Cystitis and Overactive Bladder Foundation

Tel: 0121 702 0820 Web: www.cobfoundation.org
The Cystitis and Overactive Bladder Foundation gives support to people with interstitial cystitis, bacterial cystitis and overactive bladder.

References

• Urinary tract infection (lower) - women, Prodigy (October 2009)
• Little P, Turner S, Rumsby K, et al; Dipsticks and diagnostic algorithms in urinary tract infection: development and Health Technol Assess. 2009 Mar;13(19):iii-iv, ix-xi, 1-73. [abstract]
• Colgan R, Williams M; Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011 Oct 1;84(7):771-6. [abstract]
• Guidelines on Urological Infections, European Association of Urology (2011)