About half of cases of cystitis are caused by infection. The infection is usually caused by bacteria that are normally present in the anus (back passage). These can get into the urethra when, for example, tampons are inserted, or during sexual intercourse, or when the bottom is wiped from back to front. The bacteria travel up the urethra and multiply in the bladder, causing infection and inflammation.

Women get cystitis more than men because the anus and the opening of the urethra are closer to each other, and a woman’s urethra is shorter than a man's.

Cystitis may also be caused or encouraged to develop by:

• bruising of the urethra during vigorous sex
• poor hygiene on the part of either or both sexual partners
• wearing very tight trousers
• having a catheter fitted
• using a diaphragm as a form of contraception
• the chemicals in some products (such as soaps, bubble bath and vaginal deodorants)
• holding on too long before urinating
• the lower levels of hormones in women after the menopause

Symptoms can vary, but they can include any or all of the following:

• a strong urge to urinate, even when your bladder is empty
• passing frequent small amounts of urine
• stinging or burning when passing urine
• dark or cloudy urine
• strong-smelling urine
• blood in the urine
• dull pain in the lower back or abdomen
• feeling generally unwell or having a fever

You should see a doctor if:

• there is blood in your urine
• you feel no better after 24 hours
• you are or may be pregnant
• you develop a temperature
• you have pain in the lower back or severe abdominal pain
• the cystitis keeps coming back

Children and men who get cystitis should always be seen by a doctor. Cystitis in men can be caused by an enlarged prostate or a congenital problem with the bladder (one you were born with). In children, there is the possibility of an abnormality in the urinary system, and this needs to be checked.

These symptoms can also be due to other infections, such as a sexually-transmitted disease (STD). If you think this might be the case - for example, if you and your sexual partner have symptoms - you should consult a doctor.

To diagnose cystitis, the doctor is likely to ask for a sample of urine, which will be tested to identify any bacteria present. A quick test using a dipstick is now common, but otherwise the doctor may need to send a sample to a laboratory for analysis.

You may be prescribed an antibiotic. If you are, you should always take the full course to get rid of the bacteria completely, even if the symptoms clear up before the antibiotics are finished.

If cystitis is left untreated, you could develop chronic cystitis. This means that the attacks last longer and occur again and again. Women who get repeated attacks may need to have an X-ray or an ultrasound scan to check whether there may be an abnormality in the urinary tract.

If antibiotics do not work at all, it is possible that you have a kind of cystitis called interstitial cystitis (IC). This is a chronic inflammation of the bladder wall that is not caused by infection and does not respond to antibiotics. This condition is yet to be fully understood.

By making some simple changes to your daily routine, you can help prevent cystitis.

• Drink at least one to two litres of water or bland liquid every day
• Pass urine as soon as you need to, rather than trying to hang on
• Women should wipe from front to back after using the toilet
• Make sure you empty your bladder completely by sitting up straight on the toilet
• Avoid perfumed soaps, vaginal deodorants, bubble baths, etc.
• Avoid wearing tight trousers
• Wear cotton, rather than synthetic, underwear
• Avoid or cut down on alcohol, fruit juices, tea and coffee, or spicy food

To help prevent cystitis related to sex:

• Wash your hands and genitals before sex
• Try to urinate immediately after sex
• Use a lubricant to reduce friction and bruising
• Avoid touching the anus

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

The information on this page, and any information on third party websites referred to on this page, is provided as a guide only. It should not be relied upon as a substitute for professional medical advice, nor is it intended to be used for medical diagnosis or treatment. Bupa (Asia) Limited is not liable for any loss or damage you suffer arising out of the use of, or reliance on, the information.

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