Let’s face it – Cystitis

Cystitis can be uncomfortable and disruptive to your day-to-day. So why isn’t it spoken about as much as it should be? We lift the lid on this common condition and encourage you to reach out to your GP and speak up in your appointments should you be unsure or concerned about anything. The more they know, the more they can help.

What is cystitis?

Cystitis is a specific type of UTI that involves inflammation of the bladder, often caused by a bacterial infection. It can affect anyone but occurs most often in women due to the urethra (the tube that carries urine out of the body) being shorter. This allows bacteria, including those from poo such as E. coli, to travel more easily from outside the body to the bladder, leading to infection.

What else causes cystitis in women?

Cystitis can also be caused by non-infectious factors such as irritants (soaps, hygiene products), certain medicines, pelvic radiotherapy¹ and underlying medical conditions.

How do I know if I have cystitis or a UTI?

Most UTIs affect the bladder, so you’ll likely be experiencing burning when urinating, having trouble urinating, as well as pelvic pain above the pubic bone². While each UTI type shares common symptoms, the location of the infection can cause some different symptoms as well (not all UTIs are bladder infections)².

Cystitis symptoms: What to look out for

Mild cases of cystitis may clear up on their own, and you might not notice any symptoms. However, when it’s caused by a more serious infection, symptoms can include:

• Bloody or cloudy-looking urine.
• Strong-smelling urine.
• Burning or pain when urinating.
• A strong urge to urinate, even after you’ve urinated.
• Cramping or pressure in the lower middle back or abdomen.
• Low fever. A sign your body is trying to fight off infection.
• Pain during sex.
• Feeling pressure or bladder fullness.

If a bladder infection spreads to your kidneys, it can become a serious health issue. If left untreated, kidney infections due to UTIs can cause infections in the bloodstream, which can be life-threatening.

The NHS³ recommends seeing your GP if:

• You think you have cystitis, and your symptoms have not gone away within 3 days.
• Your symptoms have not gone away after treatment with antibiotics.
• You have severe cystitis symptoms, such as severe pain in your lower tummy.
• You get cystitis symptoms frequently.
• You have symptoms of cystitis and you're pregnant or you're a man.
• Your child has symptoms of cystitis.

Cystitis diagnosis

As well as urinalysis (testing your urine for an infection and other health conditions) and a urine culture check (understanding what type of bacteria or fungi it is to prescribe the most appropriate course of antibiotics), your doctor may want to offer an imaging test. Not usually needed for cystitis, it can be helpful in some cases. For example, an X-ray or ultrasound may help your doctor find other potential causes of bladder inflammation, such as a tumour or anatomy problem.

Cystitis treatment

If you have cystitis, your GP may:

• Offer self-care advice and recommend taking a painkiller.
• Do a urine test, although this is not always needed.
• Prescribe a 3-day course of antibiotics.
• Prescribe antibiotics but suggest you wait for 48 hours before taking them in case your symptoms go away on their own³.

If you keep getting cystitis, your GP may prescribe:

• A single-dose antibiotic to take within 2 hours of having sex, if you've noticed sex triggers cystitis.
• A low-dose antibiotic to take for up to 6 months.
• A vaginal oestrogen cream, if you have gone through the menopause³.

In some women, antibiotics don’t work, or urine tests are unable to pick up an infection, even though you have cystitis symptoms. This may mean you have a long-term (chronic) bladder infection that’s not picked up by current urine tests. Ask your GP for a referral to a specialist for further tests and treatment. Long-term infections are linked to an increased risk of bladder cancer in people aged 60 and over³.

Treatment you can try yourself to ease symptoms

If you have mild symptoms of cystitis, it can help to:

• Take paracetamol up to 4 times a day to reduce pain³.
• Drink plenty of water.
• Hold a hot water bottle over your lower tummy.
• Avoid having sex.
• Avoid drinks that may irritate your bladder, like fruit juices, coffee, and alcohol.
• Urinate frequently.

Always check with your doctor before trying any treatments to ensure it’s safe and appropriate for your individual needs.

How to prevent cystitis

• Wipe from front to back.
• Urinate as soon as possible after sex.
• Drink plenty of fluids, especially water – so that you urinate regularly during the day and don’t feel thirsty / your urine is a pale yellow.
• Have a shower rather than a bath – this prevents exposing your genitals to cleaning products for too long.
• Wash the skin outside your vagina (vulva) with water before and after sex.
• Change soiled nappies or incontinence pads promptly.
• Keep your genital area clean and dry.

Can cranberry juice prevent cystitis returning?

If you keep getting cystitis, there’s some evidence you may find it helpful to take:

• D-mannose: A sugar you can buy as a powder or tablets to take every day.
• Cranberry products: Available as juice, tablets or capsules to take every day³.

Be aware that D-mannose and cranberry products can contain a lot of sugar. If you're taking warfarin, you should avoid cranberry products³.

However, there’s no evidence they help ease symptoms or treat cystitis if the infection has already started.

Cystitis and UTIs: What’s the difference?

Cystitis is a specific type of UTI – an inflammation that occurs only in the bladder, which can result from infectious or non-infectious causes.

‘Urinary tract infection’ is a broad term that refers to infections occurring anywhere in the urinary tract, which includes the kidneys, ureters (tubes which transport urine from the kidney to the bladder), bladder, and urethra.

Did you know? A pharmacist can help with cystitis and UTIs.

You can speak to a pharmacist about treatments. They can:

• Offer advice on things that can help you get better.
• Suggest the best painkiller to take.
• Provide the same UTI treatment as a GP, if it's suitable for you. Some pharmacies offer a cystitis management service. They may be able to give antibiotics if they're needed³.
• Tell you if you need to see a GP about your symptoms⁴.

Find a pharmacy here.

Important: Potential complications

If left untreated, cystitis / a UTI can spread through your urinary tract to your kidneys (pyelonephritis) and cause sepsis, which is a life-threatening response to infection.

How do I know if my cystitis or UTI has developed into a kidney infection?

You may notice a change or worsening in symptoms such as:

• Pain location: While cystitis typically causes pain and discomfort in the lower abdomen, a kidney infection often results in pain in the back, sides, or groin.
• Fever and chills: Developing a high fever, chills, or sweating can be a sign of a kidney infection.
• Nausea and vomiting: Feeling nauseated or experiencing vomiting can indicate the infection has spread to the kidneys.
• Severe pain: The pain associated with kidney infections is often more severe and persistent than that of cystitis.
• Fatigue: Increased tiredness or feeling unusually weak.
• Changes in urine: While cystitis can lead to painful urination, a kidney infection may cause your urine to become cloudy, have a strong odour, or contain blood.

If you suspect that your cystitis / UTI has developed into a kidney infection, it's important to seek urgent medical attention promptly for proper diagnosis and treatment.

What is urosepsis?

Urosepsis is a serious condition where a UTI spreads to the bloodstream, causing widespread inflammation. It requires immediate medical treatment and can be fatal if not treated properly⁵.

Common signs of urosepsis:

• High fever or low body temperature.
• Rapid heart rate.
• Rapid breathing or difficulty breathing.
• Confusion or altered mental state.
• Extreme pain or discomfort, often in the lower back or abdomen.
• Decreased urine output.
• Weakness or fatigue.
• Chills or shivering.
• Clammy or sweaty skin.
• A general feeling of being unwell⁶.

If you suspect urosepsis, it's crucial to seek emergency medical attention immediately, as it can rapidly become life-threatening.

Please note: While the basic treatment for cystitis and UTIs typically involves antibiotics for both men and women, the approach can differ slightly for men due to anatomical differences and potential underlying causes. Men may require a longer course of antibiotics compared to women, and healthcare providers often investigate further to rule out complications such as prostate issues or urinary tract obstructions.

Read more: Urinary tract infections in men.

Also, the treatment of cystitis and UTIs in children can differ from that in adults, primarily in terms of antibiotic selection and dosage. If you’re concerned about anything, contact a medical professional as soon as possible for assessment and treatment.

It's important for anyone experiencing symptoms of cystitis or a UTI to consult a healthcare professional for an accurate diagnosis and appropriate treatment plan tailored to their specific needs. Cystitis and urinary tract infections (UTIs) can lead to various complications if not properly treated. If you’re showing signs of a kidney infection or urosepsis, seek urgent medical attention immediately.

Discover more information on other important women’s health topics here.

References

1. Radiation cystitis – Macmillan Cancer Support
2. Bladder infection vs. UTI: How to tell which one you have – Healthline
3. Cystitis – NHS
4. Urinary tract infections – NHS
5. What is urosepsis? – WebMD
6. Urinary tract infections – The Urology Foundation