Cystitis is an infection of the bladder wall that can lead to ongoing discomfort.
It refers specifically to an inflammation of the bladder wall.
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.
Interstitial cystitis is a more serious, chronic type of cystitis. Find out more about it here.
Here are some key points about cystitis. More detail is in the main article.
- Cystitis is most commonly caused by a bacterial infection.
- In most cases, mild cystitis will resolve itself within a few days.
- If it persists for more than 4 days, it should be discussed with a doctor.
What is cystitis?
Cystitis usually occurs when the urethra and bladder, which are normally sterile, or microbe-free, become infected with bacteria.
Bacteria fasten to the lining of the bladder and cause 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.
Most of these bacteria form part of the healthy intestinal flora, but once they enter the sterile space in the urethra and bladder, they can cause a UTI.
UTIs are the most common hospital-acquired infections in the United States (U.S.), especially among patients using urinary catheters.
The following are common signs and symptoms of cystitis:
- traces of blood in the urine
- dark, cloudy, or strong-smelling urine
- pain just above the pubic bone, in the lower back, or in the abdomen
- burning sensation when urinating
- urinating frequently or feeling the need to urinate frequently
Elderly individuals may feel weak and feverish but have none of the other symptoms mentioned above. They may also present with altered mental status.
There is a frequent need to urinate, but only small amounts of urine are passed each time.
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, or inflammation of the urethra
- Bladder pain syndrome
- Prostatitis, or inflammation of the prostate gland
- Benign prostatic hyperplasia, in men
- Lower urinary tract syndrome
- Candida, or thrush
The prolonged use of a catheter can lead to cystitis.
There are many possible causes of cystitis. Most are infectious, and the majority of these cases stem from an ascending infection. The bacteria enter from the external genitourinary structures.
Risk factors include:
- Tampon use: When inserting a tampon, there is a slight risk of bacteria entering via the urethra.
- Inserting, changing, or prolonged use of a urinary catheter: There is a chance the catheter will carry bacteria along the urinary tract.
- Diaphragm for birth control: There is a higher incidence of cystitis among women who use the diaphragm with spermicides, compared with sexually active women who do not use one.
- Full bladder: If the bladder is not emptied completely, it creates an environment for bacteria to multiply. This is fairly common among pregnant women or men whose prostates are enlarged.
- Sexual activity: Sexually active women have a higher risk of bacteria entering via the urethra.
- Blockage in part of the urinary system that prevents the flow of urine.
- Other bladder or kidney problems.
- Frequent or vigorous sex: This increases the chances of physical damage, which in turn increases the likelihood of cystitis. This is sometimes called honeymoon cystitis.
- Falling estrogen levels: During menopause, estrogen levels drop, and the lining of a woman's urethra gets thinner. The thinner the lining becomes, the higher the chances are of infection and damage. After menopause, the risk is higher.
- Gender: A woman's urethra opening is nearer the anus than a man's, so there is a higher risk of bacteria from the intestines entering the urethra.
- Mucus reduction: During menopause, women produce less mucus in the vaginal area. This mucus normally acts as a protective layer against bacteria.
- Radiotherapy: Damage to the bladder can cause late radiation cystitis.
Women on hormone replacement therapy (HRT) have a lower risk of developing cystitis compared with menopausal women not on HRT. However, HRT has its own set of risks, so it is not routinely used for the treatment of infectious cystitis in post-menopausal women.
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. Urine dipstick results come back quickly while the patient is still in the office.
A 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 doctor will prescribe an oral antibiotic.
Most doctors will also offer to test for 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 of the bladder, using a fiber-optic camera.
Cystitis can be treated with antibiotics.
Most cases of mild cystitis will resolve itself within a few days. Any cystitis that lasts more than 4 days should be discussed with a doctor.
Doctors may prescribe a 3 day or 7 to 10 day course of antibiotics, depending on the patient. This should start to ease symptoms within a day.
If symptoms do not improve after taking the antibiotics, the patient should return to the doctor.
Antibiotics commonly used for bacterial cystitis are nitrofurantoin, trimethoprim-sulfamethoxazole, amoxicillin, cephalosporins, ciprofloxacin, and levofloxacin.
In older people and those with weakened immune systems, due, for example, to diabetes, have a higher risk of the infection spreading to the kidney and other complications.
Vulnerable people and pregnant women should be treated promptly.
The following home remedies and measures may help:
- Painkillers, such as acetaminophen (Tylenol) or ibuprofen may relieve discomfort.
- Water and other fluids help flush the bacteria through the system.
- Alcohol should be avoided.
- Cranberries contain an active ingredient that prevents bacteria from sticking to the bladder wall, but cranberry juice or capsules may not contain enough active ingredient to prevent symptoms.
- Refraining from sex reduces the chance of bacteria entering the urethra.
Cystitis is often not preventable, but the following measures may help:
- Practicing good hygiene after sex
- Using neutral, unperfumed soaps around the genitals
- Emptying the bladder completely when urinating
- Not postponing urination
- Avoiding tight underwear and tight pants
- Wearing cotton underwear
- Wiping from front to back
- Using a lubricant during sex
Catheter users should ask a doctor or nurse how to avoid damage when changing the catheter.
Most women are expected to have at least one incident of cystitis during their lives, and many will have more than one.
All men and children should see a doctor if they have cystitis.
When men get cystitis, it can be more serious than for women.
Male cystitis is more likely to result from another underlying condition, such as a prostate infection, cancer, an obstruction, or an enlarged prostate.
Men who have sex with men are more likely to have cystitis than other men.
In most cases of male cystitis, early treatment solves the problem effectively, but untreated male bladder infections can lead to kidney or prostate infections or damage.