Cystitis is a fairly common lower urinary tract infection, it refers to an inflammation of the bladder, specifically, the wall of the bladder.
Although cystitis is not normally a serious condition, it can be uncomfortable and lead to complications if left untreated.
In this article, we will cover the causes of cystitis, how it is diagnosed and treated, including home remedies, and how it can be prevented.
Fast facts on cystitis
Here are some key points about cystitis. More detail and supporting information is in the main article.
- Cystitis is most commonly caused by a bacterial infection
- In the vast majority of cases, mild cystitis will resolve itself within a few days
- If cystitis persists for more than 4 days, it should be discussed with a doctor
What is cystitis?
Cystitis is an infection of the bladder wall.
Cystitis usually occurs when the urethra and bladder, which are normally sterile (microbe-free) become infected by bacteria.
Bacteria fasten to the lining of the bladder using thread-like structures (pili); this causes the area to become irritated and inflamed.
Cystitis affects people of both sexes and all ages. It is more common among females than males, because women have shorter urethras.
These bacteria form part of the healthy intestinal flora. However, virulent types may get into the bladder through the urethra and cause urinary tract infections.
Urinary tract infections account for a large proportion of hospital-acquired infections, especially among patients using urinary catheters.
Causes of cystitis
There are many possible causes of cystitis, but most cases have an infectious cause; among the infectious cases, the majority are the result of an ascending infection - bacteria enters from the external genitourinary structures.
Risk factors include:
- When inserting a tampon, there is a slight risk of bacteria entering via the urethra.
- When a urinary catheter is inserted or changed, there is a chance it will carry bacteria along the urinary tract.
- There is a higher incidence of cystitis among women who use the diaphragm for contraception, compared to sexually active women who don't.
- If the bladder is not emptied completely, it creates an environment for bacteria to multiply. This is fairly common among pregnant women and men whose prostates are enlarged.
- Sexually active women have a higher risk of bacteria entering via the urethra.
- Part of the urinary system may be blocked.
- Other bladder or kidney problems.
- Frequent and/or vigorous sex increases the chances of physical damage or bruising, which in turn increases the likelihood of cystitis. This is sometimes called honeymoon cystitis.
- During menopause, women produce less mucus in the vaginal area. This mucus normally stops bacteria from multiplying. Women on HRT (hormone replacement therapy) have a lower risk of developing cystitis compared with menopausal women not on HRT.
- During menopause, the lining of a woman's urethra gets thinner as her levels of estrogen drop. The thinner the lining becomes, the higher the chances are of infection and damage.
- A woman's urethra opening is much nearer the anus than a man's. Consequently, there is a higher risk of bacteria from the intestines entering the urethra.
Diagnosis of cystitis
A doctor will ask the patient some questions, carry out an examination, and do a urine test. The urine test will either be sent to a laboratory, or the doctor may use a dipstick.
A "clean catch" (urine culture) or catheterized urine specimen may be performed to determine the type of bacteria in the urine. After finding out which specific bacterium is causing the infection, the patient will be prescribed an oral antibiotic.
Most doctors will also offer to find out whether the patient might have a sexually transmitted infection (STI). STIs often have similar symptoms to cystitis.
Patients who get cystitis regularly may need further tests. This could include an ultrasound scan, an X-ray, or a cystoscopy (a fiber optic camera examination) of the bladder.
Treatments for cystitis
Cranberry juice is commonly consumed to prevent bladder infections.
In the vast majority of cases, mild cystitis will resolve itself within a few days. Any cystitis that lasts more than 4 days should be discussed with a doctor.
Sometimes, a short 3-day course of antibiotics is given, though some doctors will treat for 7-10 days depending on the patient.
Most patients will experience the beneficial effects of an antibiotic within the first day of treatment.
If symptoms do not improve after taking the antibiotics, the patient should return to the doctor.
The following antibiotics are commonly used for cystitis: Nitrofurantoin, trimethoprim-sulfamethoxazole, amoxicillin, cephalosporins, ciprofloxacin, and levofloxacin.
Elderly people, and those with weakened immune systems, such as people with diabetes, have a higher risk of the infection spreading to the kidney, as well as other complications. Vulnerable people should be treated promptly.
The following home remedies and measures may help:
- Painkillers, such as acetaminophen (Tylenol) or ibuprofen may help with the discomfort. Pregnant individuals should discuss this with their doctor or pharmacist.
- Drinking plenty of fluids helps flush the bacteria through the system.
- Avoid alcohol.
- There is an active ingredient in cranberries that prevents bacteria from sticking to the bladder wall; however, cranberry juice or capsules may not contain enough of this active ingredient to be beneficial in preventing symptoms. Research is conflicting. Nevertheless, cranberry juice is a common method used by people to prevent urinary tract infections.
- Refrain from sex while infected.
Symptoms of cystitis
The following are common signs and symptoms of cystitis:
- Urine may have traces of blood
- Urine is dark and/or cloudy
- Urine has a strong smell
- Pain just above the pubic bone
- Pain in the lower back
- Pain in the abdomen
- Only small amount of urine is passed each time
- Frequent need to urinate
- Burning sensation when urinating
- Older women may feel weak and feverish but have none of the other symptoms mentioned above
When children have cystitis, they may have any of the symptoms listed above, plus vomiting and general weakness
Some other illnesses or conditions have similar symptoms to cystitis, these include:
- Urethritis (inflammation of the urethra)
- Bladder pain syndrome
- Some bacterial infections
- Prostatitis (inflammation of the prostate gland)
- Benign prostatic hyperplasia (only in men)
- Lower urinary tract syndrome
- Candida (thrush)
Many cases of cystitis are not preventable. However, the following measures may help:
- Practice good hygiene after sex - use neutral soaps around the genitals, not perfumed ones
- When urinating, empty the bladder completely
- Do not postpone urination
- Avoid tight underwear and tight pants
- Wear cotton underwear
- Wipe from front to back
- When having sex, use a lubricant
- For catheter users, ask a doctor or nurse how to avoid damage when changing it
Experts say that the majority of women will have at least one incidence of cystitis during their lives; and, a sizable number will have more than one incidence. Doctors say a woman should see doctor when she gets cystitis for the first time, as should any woman who has cystitis three or more times within a 12-month period.
Doctors recommend that all men and children should see their doctor if they have cystitis.
When men get cystitis, it is potentially more serious than it is for women. Male cystitis is more likely to be caused by another underlying condition, such as a prostate infection, cancer, an obstruction, or an enlarged prostate.
In most cases of male cystitis, early treatment is effective, and the problem is solved. However, untreated male bladder infections can lead to kidney or prostate infections and/or damage. Men who have sex with men are more likely to have cystitis than other men.