Cystitis

Symptoms of cystitis include:

• pain when you pass urine
• a frequent, urgent need to go to the toilet, but you only pass small amounts or no urine
• cloudy, dark or strong smelling urine
• blood in your urine – you might not always be able to see this but it can be detected in tests
• pain in your lower abdomen (tummy) or lower back
• feeling tired or generally unwell
• a fever
• feeling confused (particularly in older people)

The pain from cystitis can be quite mild. Or in some people, it can be so bad that it can affect your daily activities and stop you sleeping.

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

Symptoms in children

As well as the above symptoms, some children may get a fever, have little appetite and have bouts of vomiting too.

If you think your child might have cystitis, contact your GP for advice. It’s important to seek medical help as soon as possible because these symptoms may be caused by other, more serious conditions.

Cystitis is caused by a bacterial infection. A bacterium called Escherichia coli (E.coli), which usually lives harmlessly in your bowel, causes over eight out of 10 bouts of cystitis.

There are lots of ways that bacteria can get into your urinary tract and cause infection, which include the following:

• Sex. When you’re having sex, bacteria can pass into your bladder. Your urethra and bladder can also be bruised during sex, which can cause similar symptoms to cystitis.
• Poor hygiene. Women have shorter urethras than men so bacteria have a shorter distance to travel before reaching their bladder compared with men. Their urethra is also closer to their back passage (anus), which makes it easier for bacteria to get transferred from your anus into your urethra.
• Pregnancy. If you’re pregnant, your womb (uterus) may put extra pressure on your bladder. This could prevent your bladder from emptying completely. Holding small amounts of urine in your bladder could encourage bacteria to grow.
• Diabetes. If you have diabetes, your urine can contain more sugar than usual. This can encourage bacteria to grow in your bladder and urethra.
• Menopause. After you go through the menopause, the types of bacteria that usually live harmlessly in your vagina may change, increasing your risk of getting cystitis.
• Having a catheter (a tube that’s put into your urethra to drain urine out of your bladder). Bacteria could get into your bladder if you have a catheter. Your bladder and urethra could also be injured when your catheter is inserted, which could increase your risk of getting a bacterial infection.
• Contraception. Using a diaphragm or spermicide-coated condoms may increase your risk of getting cystitis. Diaphragms can prevent your bladder from emptying properly, which can encourage bacteria to grow.
• Kidney stones or bladder stones. These can prevent your bladder from emptying fully, which can encourage bacteria to grow.
• An enlarged prostate. In men, a common cause of cystitis is passing urine less often because your prostate is enlarged.
• Abnormalities of the urinary tract. You can be born with certain conditions that affect the structure of your urinary tract and this can increase your risk of getting cystitis.

Self-help

Cystitis usually clears up by itself, without any treatment. There are several things you can do during this time to ease your symptoms.

• Take over-the-counter painkillers, such as paracetamol and ibuprofen, to help ease your pain.
• Drink more fluids, such as water, to help flush out the infection. Make your urine less acidic by drinking a glass of water with a teaspoon of bicarbonate of soda dissolved in it.
• Put a warm hot water bottle on your lower back to help soothe any discomfort.
• Avoid having sex and drinking alcohol while the attack lasts
• Try to rest as much as possible.
• Cranberry juice or capsules are believed by many to help fight cystitis. It is yet Its yet to be completely proven, but research is underway to investigate this.

Medicines

If your symptoms last longer than a few days, contact your GP. They may prescribe you antibiotics to help get rid of the infection.

Antibiotics such as trimethoprim and nitrofurantoin are often used to treat cystitis. You take these as tablets. Your symptoms will usually start to get better within a few days of starting antibiotics and will clear up within eight days. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

If antibiotics don't work, it's possible that you may have a different type of cystitis, called interstitial cystitis. This is a long-term condition where you have ongoing inflammation in your bladder. It isn’t caused by bacteria so can’t be treated with antibiotics. Your GP may refer you to a urologist (a doctor who specialises in the urinary system) for more tests.

Complications of cystitis include the following.

• A kidney infection called pyelonephritis. If the infection moves from your bladder into your kidneys, this can happen.
• Prostatitis. If the infection travels to your prostate gland, you can get prostatitis. This can make you more likely to keep getting bouts of cystitis in the future.

Cystitis and pregnancy

If you get cystitis when you’re pregnant, it can lead to you giving birth early. You’ll be screened for cystitis at your early antenatal appointments to prevent this and will be treated quickly if you get an infection.

There are lots of things you can do to help prevent cystitis, which include the tips below.

• Drink at least one to two litres (three of four pints) of water or bland liquid every day
• Drink cranberry juice or take tablets that contain a cranberry extract. Some research has shown that cranberry products could help to prevent bacteria from growing and prevent cystitis coming back, although the research isn’t conclusive.
• Wear underwear that’s made of natural materials, such as cotton or linen – don’t wear thongs.
• After you go to the toilet, wipe from front to back.
• Avoid perfumed soaps, vaginal deodorants, bubble baths, etc.
• After a bowel movement, wash the area around your bottom.
• Go to the toilet as soon as you feel you need to go, don’t put it off.
• Wash your genital area before you have sex and try to urinate immediately after sex.
• Go to the toilet shortly after you have sex if you can, to help flush away any bacteria.
• If you have been through the menopause, use an oestrogen replacement treatment as it might help to prevent cystitis.
• If it suits your circumstances, use a non-barrier method of contraceptive (such as the contraceptive pill) that doesn’t require spermicide. Talk to your GP or family planning adviser about changing your method of contraception if necessary.

Prevention of reoccurring cystitis

If you get cystitis a lot, your GP may prescribe you a low-dose antibiotic to keep at home. You can take this if your cystitis comes back again.

Your GP will let you know how often to take your medicine depending on what type of antibiotic you’re prescribed. You may be prescribed trimethoprim, which you can take daily. Another medicine used to treat re-occurring cystitis is called nitrofurantoin. You take this immediately after you have sex.

If you get reoccurring cystitis, it’s important to see your GP. They will probably refer you to a urologist (a doctor who specialises in the urinary system). They may offer you some further tests.

1. Is cystitis a sexually transmitted infection?

No, cystitis isn’t a sexually transmitted infection (STI) but having sex can increase your risk of getting it.

Cystitis is usually caused by a bacterial infection. Escherichia coli (E. coli), a bacterium that usually lives harmlessly in your bowel. This causes over eight out of 10 bouts of cystitis.

Bacteria can get into your bladder when you have sex, but there are things you can do to reduce your risk of this:

• Go to the toilet urine after you have sex (within 15 minutes) to help flush away any bacteria.
• Wash your genital area (and hands) before you have sex.
• If you use a diaphragm for contraception, make sure it’s fitted correctly. If it isn’t, it could put extra pressure on your bladder and prevent your bladder from emptying properly. If you retain small amounts of urine in your bladder, it can encourage bacteria to grow.
• Use an alternative contraceptive method to spermicide-coated condoms if possible as these may increase your risk of getting cystitis. But make sure you protect yourself from STIs – ask your GP or family planning adviser for advice.

If you keep getting cystitis after having sex, see your GP. They may prescribe you antibiotics that you can keep at home and take immediately after you have sex. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

2. Are there any changes I can make to my diet to help prevent cystitis?

Yes, you can make some changes to your diet that might help to relieve your symptoms of cystitis and prevent it coming back.

Cystitis is a bacterial infection that affects your bladder. It’s important to keep your immune system healthy, so you’re able to fight off infections. Making some changes to your diet could help to boost your immune system and lower your risk of getting cystitis.

• Eat plenty of fresh fruit and vegetables.
• Drink enough fluids to help flush out any bacteria.
• Don’t drink too much caffeine (such as in tea and coffee) and alcohol, as they may irritate your bladder.
• Drink cranberry juice or take cranberry extract tablets as it may reduce the likelihood of recurrent cystitis. Some research has shown that cranberry products may help to prevent bacteria from growing but the research isn’t conclusive.

You may find that certain food or drink triggers cystitis. If this is the case, try to cut it out of your diet or have less of it. Have a chat with your GP or dietitian if you’re thinking about making any changes to your diet.

 3. Can interstitial cystitis be treated?

Yes, there are lots of treatments for interstitial cystitis, but there isn’t a specific one that works for everyone. This means you may have to try several different treatments before you find one that works for you.

Interstitial cystitis (also known as painful bladder syndrome) is different from bacterial cystitis. It’s a long-term condition in which there is ongoing inflammation in your bladder. Symptoms include:

• passing urine frequently
• an urgent need to pass urine − this can be followed by pain, pressure or spasms in your bladder
• pain in your lower abdomen (tummy) or vagina, especially when your bladder is full
• pain when you have sex

As the symptoms are similar to cystitis it can be difficult to tell the difference. But interstitial cystitis isn’t caused by bacteria so can’t be treated with antibiotics. Other treatments that might help include the following:

• Over-the-counter anti-inflammatory medicines, such as aspirin or ibuprofen, may help to ease pain. Your GP may prescribe you other, stronger anti-inflammatory medicines if your pain is severe.
• Antispasmodic medicines may help to control your symptoms of bladder spasm. They can reduce your need to go to the toilet so much.
• Antidepressant medicines, such as amitriptyline, can help to reduce the amount of pain you may feel.

Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist or GP for advice.

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 Further information

• The Cystitis and Overactive Bladder Foundation www.cobfoundation.org

Sources

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• Acute cystitis. Epidemiology. BMJ Best Practice. www.bestpractice.bmj.com, published 24 September 2014
• Fitzgerald A, Mori R, Lakhanpaul M, et al. Antibiotics for treating lower urinary tract infection in children. Cochrane Database of Systematic Reviews, 2012, Issue 8. doi: 10.1002/14651858.CD006857.pub2
• Urinary tract infection (lower) – women. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2015
• Urinary tract infection. Oxford Handbook of General Practice (Online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014
• Bacterial cystitis. The Cystitis and Overactive Bladder Foundation. www.cobfoundation.org, accessed 20 November 2015
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• Self help. The Cystitis and Overactive Bladder Foundation. www.cobfoundation.org, accessed 20 November 2015
• Interstitial cystitis. PatientPlus. www.patient.info/patientplus, reviewed 28 May 2014
• Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network. www.sign.ac.uk, published July 2012
• Preventative measures. The Cystitis and Overactive Bladder Foundation. www.cobfoundation.org, accessed 20 November 2015
• Urinary tract infection in adults. PatientPlus. www.patient.info/patientplus, reviewed 22 April 2013
• BC diet and nutrition. The Cystitis and Overactive Bladder Foundation. www.cobfoundation.org, accessed 20 November 2015