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Bladder infection

 

Cystitis means 'inflammation of the bladder'. It causes:

  • an urgent and frequent need to urinate
  • pain or stinging when passing urine

Cystitis is usually the result of an infection in the bladder, but it can also be caused by irritation or damage. Cystitis caused by a bladder infection is sometimes known as 'bacterial cystitis'.

Untreated bladder infections can cause kidney infections.

Cystitis in females

Cystitis is more common in women because women have a short urethra (the tube that passes from the bladder out of the body), and its opening is located very close to the anus. This makes it easy for bacteria from the anus to reach the bladder and cause an infection. 

Almost all women will have cystitis at least once in their lifetime. Around one in five women who have had cystitis will get it again (recurrent cystitis). Cystitis can occur at any age, but it is more common in:

  • pregnant women
  • sexually active women
  • post-menopausal women (after the menopause)

Cystitis in males

Cystitis is less common in men, but potentially more serious. This is because it could be caused by:

  • an underlying bladder or prostate infection, such as prostatitis
  • an obstruction in the urinary tract, such as a tumour, or an enlarged prostate (the gland located between the penis and the bladder)

Male cystitis is not usually serious if treated quickly, but it can be very painful. Sexually active gay men are more likely to get cystitis than other males.

Outlook

Mild cystitis usually clears up within 5- 7 days. It may clear up by drinking plenty of water (around 1-2 litres or 6-8 glasses every day) and taking painkillers, such as paracetamol and ibuprofen. More severe cystitis with back  back  pain,  fever or blood in the urine  will  need treatment with antibiotics.

Patients should see their GP if they have cystitis. All patients should have a urine sample sent to the hospital for culture and antibiotic sensitivity testing. The result should be obtained from from your GP within 3 days and the antibiotic changed if the bacteria is resistent to the initial antibiotic prescribed.  

Anus
The opening at the end of the digestive system where solid waste leaves the body.
Kidneys
Kidneys are a pair of bean-shaped organs located at the back of the abdomen. They remove waste and extra fluid from the blood, and pass them out of the body as urine.
Prostate
A small gland found only in men, located in the pelvis, between the penis and the bladder.
Urethra
The tube that carries urine from the bladder out of the body.

Symptoms of cystitis, in both men and women, include:

  • pain, burning or stinging sensations when passing urine 
  • needing to urinate frequently and urgently but only passing small amounts of urine 
  • urine that is dark, cloudy or strong smelling
  • urine that contains traces of blood (haematuria)
  • pain directly above the pubic bone, or in the lower back or abdomen
  • feeling unwell, weak or feverish

Cystitis can also affect children. Their symptoms may include:

  • weakness
  • irritability 
  • reduced appetite
  • vomiting
  • pain when passing urine

The symptoms described above could be caused by conditions other than cystitis. This is why it is important to see your GP the first time you have symptoms such as these. The symptoms could be confused with:

Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Urethra
The urethra is a tube that carries urine from the bladder to the outside of the body.
Vomiting
Vomiting is when you bring up the contents of your stomach through your mouth.
 

The most common cause of cystitis is a bacterial infection. If bacteria reach the bladder, they can multiply and irritate the bladder lining, causing the symptoms of cystitis.

A bacterial infection can be caused by not emptying the bladder fully. You may not be able to empty your bladder fully if:

  • you are pregnant, as there is pressure on the pelvic area
  • you have a blockage somewhere in your urinary system. This could be caused by a tumour or, in men, an enlarged prostate (a gland located between the penis and the bladder). 

Cystitis in females

In women, the opening of the urethra (the tube that passes from the bladder out of the body) is very close to the opening of the anus. There is often bacteria around the anus, which can be transferred to the urethra. From there, the bacteria can enter the bladder and cause irritation.

In women, cystitis is often caused by transferring bacteria in this way. This can happen when you are:

  • inserting a tampon
  • having sex
  • wiping back to front when you go to the toilet (instead of front to back)
  • using a diaphragm (a soft dome made of latex or silicone) for contraception

In menopausal women, the lining of the urethra and the bladder become thinned due to a lack of the hormone oestrogen. The thin lining is more likely to become infected and damaged. Women also produce less mucus around the vagina after the menopause. Without the mucus, bacteria are more likely to multiply.

Other causes

Cystitis can also be caused by damage or irritation in the area around the urethra in both men and women. This could be the result of:

  • damage caused when changing a catheter (a tube inserted into the urethra to allow urine to flow into a drainage bag, which is often used after surgery)
  • damage or bruising caused by vigorous or frequent sex, sometimes called honeymoon cystitis
  • wearing tight clothing
  • chemical irritants - for example, in perfumed soap or talcum powder
  • other bladder or kidney problems, such as a kidney infection or prostatitis
  • diabetes (a long-term condition caused by too much glucose in the blood).
Anus
The anus is the opening at the end of the digestive system where solid waste leaves the body.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Catheter
A catheter is a thin, hollow tube usually made of rubber that is placed into the bladder to inject or remove fluid.
Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Prostate
A gland in men located in the pelvis, between the penis and the bladder.
Tumour
A growth of cells.
Urethra
The urethra is a tube that carries urine from the bladder to the outside of the body.

If you have had cystitis before, you may be able to recognise the symptoms and diagnose the condition yourself. However, men and children with cystitis should always see their GP. Also see your GP if:

  • this is the first time you have had cystitis
  • there is blood in your urine (haematuria)
  • you have a high temperature (fever) of 38ºC (100.4ºF)
  • you are in a lot of pain
  • you have had cystitis three times in one year

Your GP should be able to diagnose cystitis from asking about your symptoms. In some cases, they may also use a dipstick to test your urine. This is when a chemically treated strip of paper is dipped into a sample of your urine. The paper will react to the presence of certain bacteria and reveal which kind of infection you have.

Urine culture

In some cases, your GP may wish to send a sample of your urine to a laboratory for further testing. This sample is called a urine culture. This may be necessary if:

  • you have recurrent cystitis (more than three times in one year)
  • it is possible that you may have a kidney infection - cystitis can be a symptom of this
  • you are on immunosuppressant medication (medication that suppresses your immune system) - these affect your body's defences so you may be more prone to infection
  • you have diabetes (a long-term condition caused by too much glucose in the blood) - cystitis can be a complication of diabetes
  • you may have a sexually transmitted infection(STI) - such as gonorrhoea and chlamydia
  • it is possible that you have another infection, such as thrush (candida)

The urine culture will confirm which bacteria are causing your cystitis. Alternatively, it may reveal that your cystitis is caused by another condition. Your GP can advise you about the most appropriate treatment for you. 

Further tests

If you have recurrent cystitis that does not respond to antibiotics, even after a urine culture has been tested, you may be referred to a specialist. You may need to have some other tests, such as:

  • an ultrasound scan
  • an X-ray
  • a cystoscopy
  • flow test and post void bladder scan to outrule obstruction of the bladder

A cystoscopy is when a fibre-optic camera, called a cystoscope, is used to examine your bladder. The cystoscope is a thin, fibre-optic tube that has a light source and a camera at one end. It is inserted into your urethra (the tube that passes from your bladder out of your body) so that images of the inside of your bladder can be transmitted to a screen.

Any further tests that you need will be explained to you by the healthcare professional treating you. 

Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Bacterium
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Ultrasound
Ultrasound scans are a way of producing pictures of inside the body using sound waves.
Urine sample
Urinalysis / UA,  or urine culture, is when a urine sample is tested, commonly to check for any signs of infection, or protein or sugar levels.
X-ray
An X-ray is a painless way of producing pictures of inside the body using radiation.

All patients should see their GP if they have cystitis.  They should also return to see their GP if they have the condition more than three times in one year.

The symptoms of cystitis usually clear up without treatment within a week. There are some self-help treatments that can ease the discomfort of any symptoms, or your GP may prescribe antibiotics.

Self-help treatments

If this is the first time that you have had cystitis, see your GP. If you are sure that you have mild cystitis and do not need to see your GP, there are treatments that you can try yourself.

  • Over-the-counter (OTC) painkillers, such as paracetamol or can be taken to reduce discomfort. Always read the label and check ibuprofenwith your pharmacist first, particularly if you have any other medical condition, you are taking other medicines, or you are pregnant or breastfeeding.
  • Drinking plenty of water is often recommended as a treatment for cystitis. There is no evidence that this is helpful, although drinking around 1.2 litres (6-8 glasses) of water a day is generally good for your health. Also avoid alcohol.
  • Do not have sex until your cystitis has cleared up because it can make it worse.

The following treatments are no longer recommended because there is not enough evidence that these are effective at treating the symptoms of cystitis:

  • urine alkanising agents, such as sodium bicarbonate or potassium citrate
  • drinking cranberry juice - although it may help to prevent outbreaks of recurrent cystitis.

There are some more useful tips for avoiding cystitis in the prevention section.

Antibiotics

If your symptoms are moderate or severe, your GP may prescribe a short course of antibiotics. This will usually be in the form of a tablet to be swallowed 2-4 times a day, for three to five days.

For a more complicated case of cystitis, such as cystitis with another underlying infection, you may be given antibiotics for 5-10 days.

Research suggests that antibiotics can shorten the duration of the cystitis by 1-2 days.

If your cystitis symptoms are only mild, your GP may prefer not to prescribe antibiotics to avoid 'antibiotic resistance'. This is when the bacteria that cause cystitis adapt and learn to survive despite the use of antibiotics. Over time, this means that the treatment becomes less effective.

Recurring cystitis

If you have recurring episodes of cystitis, you may be prescribed stand-by antibiotics or continuous antibiotics. A stand-by antibiotic is a prescription for you to take the next time you have cystitis, without needing to visit your GP again.

Continuous antibiotics are antibiotics that you take for several months to prevent further episodes of cystitis. These may be prescribed for two reasons:

  • if your cystitis usually occurs after having sex, you may be given a prescription for antibiotics to take within two hours of having sex
  • if your cystitis is not related to having sex, you may be given a low-dose antibiotic to take for a trial period of six months.

If you are prescribed antibiotics, your symptoms should start to improve after the first day of treatment. If your symptoms do not improve after your course of antibiotics, go back to see your GP.

Antibiotic
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. For example amoxicillin, streptomycin and erythromycin.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Painkillers
Analgesics are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.

While most cases of cystitis clear up on their own or with antibiotics, some people may experience almost constant symptoms or recurring episodes. If no cause can be found, and the cystitis does not respond to antibiotics, you may have interstitial cystitis. 

Some GPs may also use the term 'painful bladder syndrome' (PBS) to describe a condition that causes pain but does not meet the criteria to be diagnosed as interstitial cystitis.

Interstitial cystitis

Interstitial cystitis is a condition that causes recurring discomfort in the bladder and pelvic region. Like cystitis, it can cause an urgent and frequent need to urinate. Other symptoms, and the level of pain caused by interstitial cystitis, can vary from person to person.

Some people may find it more painful when their bladder is full, or more painful when they pass water. Women may find the condition more painful during their period.

How common is it?

Over 90 per cent of the people with interstitial cystitis are women. On average it is diagnosed at around 40 years of age.

What causes it?

It is not clear what causes interstitial cystitis. Researchers are currently investigating whether the condition is inherited, or if it is part of a more general condition that causes inflammation and, in some people, affects the bladder.

How is it treated?

Treatment can include:

  • medications, including painkillers and antidepressants
  • bladder distension - when the bladder is filled with water to increase its volume
  • bladder instillation - the bladder is filled with a solution that includes medication to reduce inflammation of the bladder walls
  • surgery, if other treatments have not worked 

If you are diagnosed with interstitial cystitis, your GP or the healthcare professional will explain the condition and the treatment options in more detail.

Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
Painkillers
Painkillers (analgesics) are medicines that relieve pain. For example paracetamol, aspirin and ibuprofen.

It is not always possible to prevent cystitis, but there are some steps that you can take to avoid the condition.

  • Do not use perfumed bubble bath, soap, or talcum powder around your genitals.
  • Have a shower, rather than a bath, to avoid exposing your genitals to the chemicals in your cleaning products for too long.
  • Always empty your bladder fully when you go to the toilet.
  • Do not wait to go if you need to urinate. Delaying it can place extra stress on your bladder and could make it more susceptible to infections.
  • Wear cotton underwear and avoid wearing tight jeans and trousers.
  • Always wipe from front to back, not back to front, when you go to the toilet.
  • Some people find certain types of food and drink make their cystitis worse. For example, coffee, fruit juice or spicy foods. If there is anything that triggers your cystitis, you may wish to avoid it.

Cranberry products

Although cranberry products are not effective at treating cystitis, they may help to prevent recurrent attacks. High-strength capsules, which contain 200mg of cranberry extract, are available in shops .

Cranberry capsules may be a more effective treatment than drinking cranberry juice, as you need to drink a lot of juice for it to benefit you, and not everyone likes the taste. Cranberry capsules are not recommended if you are taking warfarin (blood-thinning medication).

Cystitis and sex

Below are some prevention tips that you may find useful if your cystitis is triggered by having sex:

  • Wash your genital area and your hands before and after sex.
  • Use a lubricant when having sex to avoid damaging your genital area.
  • If you use a diaphragm for contraception, you may wish to change to another method of contraception.
  • After having sex, make sure that you empty your bladder as soon as possible to get rid of any germs.

There is currently no evidence that oestrogen products, used to treat women after the menopause, can prevent cystitis.

People who wear catheters need special advice about how to change them without damaging the area. Ask the healthcare professional who is treating you to show you how to do this.

Bladder
The bladder is a small organ near the pelvis that holds urine until it is ready to be passed from the body.
Catheter
A catheter is a tube inserted into the urethra to allow urine to flow into a drainage bag.
Urethra
The tube that carries urine from your bladder out of your body.

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.