Cystitis is inflammation of the bladder. It's usually caused by an infection in the bladder.
Bladder infections can be caused by:
- not emptying your bladder properly - for example, due to pregnancy or an enlarged prostate
- damage or irritation around the urethra (tube through which urine passes out of the body)
- bacteria being transferred from the anus to the urethra (for example, during sex)
Symptoms of cystitis include:
- an urgent and often need to urinate
- pain or stinging when you urinate
- pain in the bladder
Cystitis usually passes within a few days, or sometimes may need treatment with antibiotics.
Untreated bladder infections can cause kidney infections.
Seeing a doctor
Symptoms of cystitis can be caused by other conditions. Children and men should always see their GP if they have symptoms of cystitis. Women should always see their GP the first time they have the symptoms of cystitis. They should also return to their GP if they have the condition more than three times in one year.
Cystitis in women
Cystitis is more common in women because women have a short urethra (the tube that carries urine from the bladder out of the body). The urethra's opening is also located very close to the anus (bottom), which 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 (known as recurrent cystitis). Cystitis can occur at any age, but it is more common in:
- pregnant women
- sexually active women
- post-menopausal women (women who have been through menopause)
Cystitis in men
Cystitis is less common in men. It can be more serious in men 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. Men who have unprotected anal sex are slightly more at risk of cystitis.
Some people experience almost constant symptoms of cystitis, or recurring episodes, which do not respond to treatment with antibiotics. This is known as interstitial cystitis. See the complications section for further information.
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Children and adults can get cystitis, and the symptoms can be different.
Symptoms in Adults
Cystitis in adults can cause:
- pain, burning or stinging when you urinate
- needing to urinate often and urgently but passing only small amounts of urine
- urine that's dark, cloudy or strong smelling
- urine that contains traces of blood (haematuria)
- pain low in your belly (directly above the pubic bone), or in the lower back or abdomen
- feeling unwell, weak or feverish
Symptoms in children
Symptoms of cystitis in children may include:
- reduced appetite
- pain when urinating
Cystitis is usually treated easily. Find out more about treating cystitis.
Seeing a doctor
The symptoms of cystitis could also be caused by other conditions, so it's important to see your GP the first time you have any of these symptoms.
The symptoms caused by cystitis could also be caused by:
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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.
Cystitis can also result from damage or irritation around the urethra.
This happens when bacteria get into the bladder and multiply. It can happen if you don't empty your bladder properly. Try to empty your bladder fully each time you go to the toilet, to help prevent bacterial infection.
You may not be able to empty your bladder fully if:
- 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)
- you are pregnant, as pregnancy puts pressure on the pelvic area and the bladder
Bacterial infection can also happen when bacteria from the anus are transferred to the urethra. This is more common in women than in men, as the urethra is closer to the anus in women than it is in men.
In women, transferring bacteria in this way can happen when you are:
- having sex
- wiping after going to the toilet (you're less likely to transfer bacteria in this way if you wipe from front to back)
- inserting a tampon
- using a diaphragm (a soft dome made of latex or silicone) for contraception
In women who have had, or are going through, the menopause, the lining of the urethra and the bladder become thinner. This is due to a lack of the hormone oestrogen. The thin lining is more likely to become infected or damaged. Women also produce fewer vaginal secretions after the menopause, which means that bacteria are more likely to multiply.
Damage or irritation
Cystitis can also be caused by damage or irritation in the area around the urethra in both men and women.
The urethra is the tube that carries urine from the bladder out of the body. In men, the urethral opening (where urine leaves the body) is at the tip of the penis. In women it's just below the clitoris.
This could be the result of:
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- 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)
- damage caused by a catheter (a tube inserted into the urethra to allow urine to flow into a drainage bag, which is often used after surgery)
If you are a woman who has had cystitis before, you may be able to recognise the symptoms and diagnose the condition without seeing your GP.
However, men and children with cystitis symptoms should always see their GP.
If you're a woman, you should see your GP if:
- this is the first time you've had cystitis symptoms
- there's blood in your urine (haematuria)
- you have a high temperature (fever) of 38ºC (100.4ºF)
- you're in a lot of pain
- you've had cystitis three times in one year
- you are pregnant
- you have a catheter (a tube inserted into the urethra to allow urine to flow into a drainage bag, which is often used after surgery)
Your GP should be able to diagnose cystitis from asking about your symptoms. In some cases, they may also use a dipstick (a chemically treated strip of paper) to test a sample of your urine. The paper will react to certain bacteria by changing colour, showing which kind of infection you have.
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 – cystitis can be a complication of diabetes
- you 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.
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:
A cystoscopy is when a tiny fibre-optic camera, called a cystoscope, is used to examine your bladder. The cystoscope is a very thin tube that has a light and a camera at one end. It is inserted into your urethra (the tube that carries urine from your bladder out of your body) and transmits images of the inside of your bladder to a screen.
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The symptoms of mild cystitis usually clear up without treatment within a few days.
Children and men should always see their GP if they have cystitis symptoms. Women should always see their GP the first time they have cystitis symptoms, and also if they have the condition more than three times in one year.
There are some self-help treatments that can ease the discomfort of any symptoms, or your GP may prescribe antibiotics.
If you've had cystitis before and you're sure that you have mild cystitis and don't need to see your GP, there are treatments that you can try yourself.
- Over-the-counter (OTC) painkillers, such as paracetamol or ibuprofen. These can reduce pain and discomfort. Always read the label and check with your pharmacist first, particularly if you have any other medical condition, you are taking other medicines, or you're pregnant or breastfeeding.
- Drinking plenty of water is often recommended as a treatment for cystitis. There's no evidence that this is helpful, although drinking plenty of water a day is generally good for your health. Also avoid alcohol.
- Don't have sex until your cystitis has cleared up because having sex can make it worse.
Some people find that using urine alkanising agents, such as sodium bicarbonate or potassium citrate, for a short period of time may help to relieve pain when urinating. However, there is currently a lack of clinical evidence for their effectiveness. Check with your GP or pharmacist first if you are taking any other medication.
Drinking cranberry juice is not thought to help relieve pain but may help to prevent outbreaks of recurrent cystitis
Find out some useful tips on preventing cystitis.
If your symptoms are severe, your GP may prescribe a short course of antibiotics. This will usually involve taking a tablet 2-4 times a day, for three days.
For a more complicated case of cystitis, such as cystitis with another underlying infection, you may be given antibiotics for 5-10 days. Find out more about cystitis complications.
Research suggests that antibiotics can shorten an attack of 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 the antibiotics. Over time, this means that the treatment becomes less effective.
If you keep getting cystitis (known as having recurring cystitis) your doctor may prescribe 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 taking them. If your symptoms don't improve after your course of antibiotics, go back to see your GP, or call NHS Direct Wales on 0845 4647.
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Interstitial cystitis causes recurring discomfort in the bladder and pelvic area. The symptoms vary between individuals, but some people can experience intense pain.
The pelvic pain may increase with a full bladder or when urinating.
Like regular cystitis, interstitial cystitis can cause an urgent and frequent need to urinate. However, the condition doesn't respond to treatment with antibiotics as it is not caused by a bacterial infection.
Around 400,000 people in the UK have interstitial cystitis. More than 90% of these cases are in women. It's often diagnosed at around the age of 40.
What causes interstitial cystitis?
It's not clear what causes interstitial cystitis, but researchers are investigating whether the condition is inherited. It also may be associated with other conditions, such as irritable bowel syndrome and fibromyalgia, as many women with interstitial cystitis also have these conditions.
Another theory is that one of the protective layers of the bladder wall may "leak" in people with interstitial cystitis, allowing chemicals in the urine to irritate the bladder.
People who have interstitial cystitis often have small areas of scarring, stiffness or bleeding on the wall of their bladder. Around 5-10% of people with interstitial cystitis have patches of inflammation and broken skin in the bladder, which leads to more severe symptoms. These are known as Hunner's ulcers.
Read more information about interstitial cystitis on The Cystitis and Overactive Bladder Foundation website.
It may be possible to reduce the symptoms of interstitial cystitis by making some lifestyle changes.
Avoid clothes and belts that are tight fitting, especially if they put pressure on your waist or tummy.
There is some evidence that smoking can make the symptoms of interstitial cystitis worse.
Smoking is also a potential cause of bladder cancer, so it is recommended that you quit if you smoke.
Read more information about getting to help quit smoking.
Stress is thought to contribute to a flare-up of symptoms. It may help to try stress relieving techniques such as deep breathing and muscle relaxation.
Read more information about stress.
Regular exercise may help to reduce stress and improve your physical and mental health.
Simple stretching exercises may also help to reduce symptoms.
Read more about the benefits of exercise.
There is currently no scientific evidence that changes to your diet will benefit interstitial cystitis, although some people believe eliminating certain food or drinks can improve symptoms.
Speak to your doctor before making any changes to your diet, as it is important to maintain a healthy, balanced diet.
There is no single treatment that is effective for every person with interstitial cystitis. As the symptoms can vary between individuals, you may need to try several treatments to find one that works for you.
It is important to discuss the options with your doctor first to help decide which treatments may benefit you.
Treatment can include:
- physiotherapy – this can help relieve any pelvic pain caused by muscles or surrounding tissue
- painkillers – such as aspirin and ibuprofen
- certain antidepressants – these may reduce pain and improve other symptoms
- certain antihistamines – these may reduce the frequency of needing to urinate and improve other symptoms
- bladder distension (where the bladder is filled with water to increase its volume) – this may help to temporarily relieve symptoms within a week or two after the procedure
- bladder instillation (where the bladder is filled with a solution that includes medication to reduce inflammation of the bladder walls) – this may help to temporarily relieve symptoms within three to four weeks after the procedure
- transcutaneous electrical nerve stimulation – where mild electric pulses are used to block or reduce pain signals going to the spinal cord and brain
If other treatments haven't worked, surgery may be an option. However, surgery is rarely used to treat interstitial cystitis.
Surgical options may include:
- treating Hunner's ulcers with electricity or lasers (fulguration)
- removing Hunner's ulcers (resection)
- making the bladder larger using part of the small intestine (augmentation) – this usually includes removing any inflamed areas of the bladder
- in very rare cases, bladder removal
Surgery is rarely used and the potential risks and benefits should be discussed with a surgeon before making a decision.
Painful bladder syndrome (PBS)
Some GPs may use the term "painful bladder syndrome" (PBS) to describe a condition that causes pain but doesn't meet the criteria to be diagnosed as interstitial cystitis.
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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
It's not always possible to prevent cystitis, but you can take some steps to help avoid the condition:
- don't use perfumed bubble bath, soap, or talcum powder around your genitals - use plain, unperfumed varieties
- 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
- don't wait to go if you need to urinate: delaying it can place extra stress on your bladder and could make it more vulnerable to infection
- wear underwear made from cotton rather than synthetic material such as nylon
- avoid wearing tight jeans and trousers
- always wipe from the front of your genital area to the 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
Although cranberry products are not effective at treating cystitis, there has been contrary evidence about their role in preventing recurrent attacks.
However the latest review published in 2013 suggested cranberry juice could not be recommended for preventing urinary tract infections.
Cystitis and sex
Try these tips if your cystitis is triggered by having sex:
- if you're a woman and you use a diaphragm for contraception, you may wish to change to another method of contraception
- after having sex, empty your bladder as soon as possible to get rid of unwanted bacteria
People who have 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.
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Last Updated: 26/08/2014 15:30:23