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Published by Bupa's Health Information Team, April 2010. This factsheet is for people who have cystitis, or who would like information about it. Cystitis is an infection of the bladder. It's most common in women.

About cystitis Symptoms of cystitis Causes of cystitis Diagnosis of cystitis Treatment of cystitis Prevention of cystitis Questions and answers Related topics Further information Sources

About cystitis
Urine is produced by each of your two kidneys. It drains into your bladder through tubes called ureters. When you pass urine, your bladder contracts, squeezing urine out of your body through a tube called the urethra.

The position of the bladder and surrounding structures Cystitis is inflammation of your bladder due to an infection or irritation. Usually cystitis only affects your bladder and is known as a lower urinary tract infection (UTI). If the infection goes higher, to your ureters or kidneys, this can be a more serious illness known as an upper urinary tract infection. Around one in three women will have at least one bout of cystitis before they are 24. Children and men can also get cystitis, but it's not as common.

Symptoms of cystitis
Symptoms of cystitis include: a stinging or burning sensation when you pass urine the need to pass urine more often feeling you want to urinate urgently, even if you pass very little or no urine cloudy or dark coloured urine blood in your urine pain or tenderness in your lower back or lower abdomen (tummy) feeling generally unwell Cystitis can be painful, particularly when you pass urine, but it usually clears up within four to nine days.These symptoms can also be due to a sexually transmitted infection (STI) such as chlamydia. If you think you may have an STI, visit your GP or a sexual health clinic.

Causes of cystitis
Cystitis is often caused by bacteria that get into your urethra from surrounding skin and travel up towards your bladder, causing infection and irritation. Most infections are caused by bacteria that normally live harmlessly in your bowel, usually a type of bacteria called Escherichia coli (or E. coli for short). Women get cystitis more than men partly because, in women, the urethra is nearer the opening of the back passage (anus) where bacteria from your bowel can collect. This makes it easier for bacteria to get transferred from the surrounding skin into the urethra. The urethra is also much shorter in women than men, so there is less distance for the infection to travel to the bladder. You're more likely to get cystitis if you: are sexually active - the risk increases the more often you have sex use spermicide-coated condoms or a diaphragm with spermicide have been through the menopause - causing changes to the lining of your vagina and urethra, making you more likely to have bacteria in your urine have a urinary catheter - introducing bacteria directly into your bladder have diabetes - your urine may contain more sugar, encouraging bacteria to grow have a condition that prevents you from emptying your bladder such as bladder or kidney stones, an enlarged prostate or if you're pregnant use irritants such as certain soaps, which may irritate your urethra or bladder

Diagnosis of cystitis
If you're a woman and in good health, you may not need to see your GP, as cystitis often clears up by itself with home treatments. However you should contact your GP if: your symptoms don't improve after two to three days you have blood in your urine you're pregnant or may be pregnant you're over 65 you have a high temperature, feel sick or are vomiting you have pain in your lower back or severe abdominal pain

the cystitis keeps coming back you have other problems with your urinary system such as kidney stones or difficulty emptying your bladder you have diabetes

Children and men who get cystitis should always see a doctor. Cystitis in men can be caused by an enlarged prostate, which needs to be checked. In young children it's important to rule out any abnormalities of the urinary system to prevent kidney problems later on. Your GP will ask about your symptoms and also for a sample of your urine. He or she may test your urine with a 'dipstick' or send the sample to a laboratory for more detailed tests.

Treatment of cystitis
You can often treat cystitis yourself by doing the following. Take an over-the-counter painkiller, such as paracetamol. Always read the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice. Make your urine less acidic by drinking a glass of water with half a teaspoon of bicarbonate of soda dissolved in it. Products that contain sodium bicarbonate or potassium citrate have the same effect and are available from your pharmacist. Always read the patient information that comes with your medicine and ask your pharmacist for advice if you have any questions. Make sure you drink enough fluids to help flush out the infection.

Your GP may prescribe antibiotics, which you will need to take for three to six days. You should always take the full course of antibiotics to get rid of the bacteria completely, even if your symptoms clear up before you finish the course. Always ask your doctor or pharmacist for advice and read the patient information leaflet that comes with your medicine. If your symptoms don't clear up, contact your GP as some infections can be resistant to the antibiotics normally used. If antibiotics don't work, it's possible that you have a type of cystitis called interstitial cystitis. This is chronic (long-lasting) inflammation of your bladder wall that isn't caused by infection. Your GP will be able to give you more information.

Prevention of cystitis
There's good evidence to show that drinking cranberry juice or taking capsules containing 200mg of cranberry extract is effective in preventing cystitis from coming back. However, it's not clear if this works as a treatment. Ask your GP or pharmacist for advice before taking cranberry capsules or drinks, particularly if you're taking the blood-thinning medicine warfarin. Avoid cranberry juice containing lots of sugar, as sugar can encourage bacteria to grow.

If you get cystitis three or more times a year, your GP may give you a course of antibiotics to keep at home so you can start taking them as soon as you know you're getting a bout of cystitis. Alternatively, if you get repeated attacks, you may need to take a low dose of antibiotics for six to 12 months. If you get cystitis after having sex, your GP may advise you to take a single dose of antibiotics immediately after you have had sex to prevent an attack. If you use spermicidal products for contraception, which can increase your risk of getting cystitis, ask your GP or family planning adviser about alternative methods. For women who have been through the menopause, creams containing oestrogen can be applied to the vagina and may reduce the risk of cystitis. Although lacking in scientific evidence, the following may help to prevent cystitis: passing urine after having sex increasing your fluid intake wearing loose clothing wiping front to back, not back to front after going to the toilet passing urine as soon as you feel the need to, instead of 'holding on' Some people find that certain triggers, such as tea or coffee, can make cystitis worse. If you notice any such triggers, try to avoid them Sources

Prevalence of urinary tract infection. Clinical Knowledge Summaries., accessed 25 November 2009 Definition of cystitis. Clinical Knowledge Summaries., accessed 25 November 2009 Symptoms and signs of cystitis. Clinical Knowledge Summaries., accessed 25 November 2009 Management of suspected bacterial urinary tract infection in adults. Scottish Intercollegiate Guidelines Network (SIGN), 2006. Causes of cystitis. Clinical Knowledge Summaries., accessed 25 November 2009 Bacterial cystitis. The Cystitis and Overactive Bladder Foundation., accessed 25 November 2009 Car J. Urinary tract infections in women: diagnosis and management in primary care. BMJ 2006; 332:94-97. doi:10.1136/bmj.332.7533.94 Urinary tract infection (lower): men. Clinical Knowledge Summaries., accessed 25 November 2009 Urinary tract infection in children - diagnosis, treatment and long-term management. The National Institute for Health and Clinical Excellence (NICE), 2007. Diagnosis of cystitis. Clinical Knowledge Summaries., accessed 25 November 2009 Urinary tract infection (lower): women - management. Clinical Knowledge Summaries., accessed 25 November 2009 Alkalinization of urine. British National Formulary 58. September 2009. Simon C, Everitt H, Kendrick T. Oxford handbook of general practice. 2nd ed. Oxford: Oxford University Press, 2006:692-93 Interstitial cystitis/painful bladder syndrome. The Cystitis and Overactive Bladder Foundation., accessed 25 November 2009 Medications for Bacterial Cystitis. The Cystitis and Overactive Bladder Foundation., accessed 25 November 2009 Prevention of Bacterial Cystitis. The Cystitis and Overactive Bladder Foundation., accessed 25 November 2009

This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: April 2010