A urine infection in the bladder (cystitis) is common in women. A short course of medicines called antibiotics is the usual treatment.
Cystitis means inflammation of the bladder. It is usually caused by an infection in the urine which responds well to a short course of medicines called antibiotics. Occasionally it may improve without the need for antibiotics. Cystitis clears quickly without complications in most people.
Cystitis can cause various symptoms. The main ones are:
- Needing to pass urine urgently:
- The urgent feeling to pass urine can be very severe but may not disappear after having passed urine. This is called strangury.
- Needing to pass urine frequently:
- Often only small amounts may be passed.
- Burning or stinging feeling when you urinate:
- Women sometimes describe this as feeling like they are 'peeing broken glass'.
Other symptoms may be:
- Blood in the urine.
- Discomfort in your lower tummy (abdomen).
- Feeling generally unwell and tired.
What is cystitis?
Cystitis is an inflammation of the bladder. A urine infection is the most common cause. As well as the typical symptoms described above, your urine may also become cloudy and may become smelly. (Without the typical symptoms of cystitis, cloudy or smelly urine isn't usually abnormal.)
Most urine infections are due to germs (bacteria) that come from your own bowel. Some bacteria live in and around your back passage (anus) without causing any harm. However these bacteria can sometimes get into the tube that you pass urine out of (called the urethra). The urethra leads up to the bladder, so the bacteria can sometimes get as far as the bladder. Once in the bladder some bacteria thrive in urine and multiply quickly to cause infection.
Note: painful bladder syndrome (also called interstitial cystitis) causes similar symptoms but is not caused by infection. You can read more about it in the separate leaflet called Painful Bladder Syndrome (Interstitial Cystitis). Other causes of cystitis include radiotherapy and certain chemicals. This leaflet will only discuss cystitis caused by an infection.
Women are much more likely than men to have cystitis, as the tube that passes out urine from a woman's bladder (the urethra) is shorter and opens much nearer to the back passage (anus).
About half of women have at least one bout of cystitis in their lives. One in three women will have had cystitis by the age of 24. About 4 out of 100 pregnant women develop cystitis.
Apart from being female, other things that make cystitis more likely include:
- Being pregnant.
- Being sexually active.
- Using spermicide with contraception.
- Having had the menopause. The changes in the tissues of the vagina and urethra after menopause make it harder for them to defend against infection.
- Having diabetes mellitus.
- Having a catheter in your bladder.
- Having abnormalities in your kidneys, bladder or urinary system.
- Having an immune system which is not working well (for example, due to AIDS or medication which suppresses the immune system).
Can I be sure it is cystitis?
Some conditions cause symptoms that may be mistaken for cystitis - for example, vaginal thrush or genital herpes. Also soaps, deodorants, bubble baths, etc, may irritate your genital area and cause mild pain when you pass urine.
Your doctor or nurse may do a simple dipstick test on a urine sample to check for cystitis. This can detect changes in the urine that may indicate an infection. It is fairly reliable and usually no further test is needed. If the infection does not improve with treatment, or improves but then returns quickly, you will be asked to do a midstream specimen of urine (MSU). This is then sent to the laboratory to confirm the diagnosis and to find out which germ (bacterium) is causing the infection.
Treatment options include the following:
- Antibiotic medication. A three-day course of an antibiotic (either trimethoprim or nitrofurantoin) is a common treatment for most women. Symptoms usually improve within a day or so after starting treatment. Sometimes you may be offered a delayed prescription for antibiotics if your symptoms are mild. You then need only pick up the prescription if your symptoms worsen, or do not improve, over the following few days.
- Not taking any treatment may be an option if symptoms are very mild (and if you are not pregnant or if you have no other illnesses). Your immune system can often clear the infection. Without antibiotics, cystitis (particularly mild cases) may go away on its own in a few days. However, symptoms can sometimes last for a week or so if you do not take antibiotics.
- Paracetamol or ibuprofen. These ease pain or discomfort.
Being told to have lots to drink is traditional advice to 'flush out the bladder'. However, there is no proof that this is helpful. Some doctors feel that it does not help and drinking lots may just cause more (painful) toilet trips. Therefore, it is difficult to give confident advice on whether to drink lots, or just to drink normally.
There is no good evidence that drinking cranberry juice either treats or prevents cystitis. Nor is there any strong evidence that taking products that reduce the acidity of your urine (such as potassium citrate or bicarbonate) improve the symptoms of cystitis. These sorts of products are sometimes sold as a treatment for cystitis.
If your symptoms worsen or you develop a fever or pain in your loin you should see your doctor. You should also see your doctor if your symptoms do not improve by the end of taking the course of antibiotics or if they come back within two weeks of the course finishing.
Note: if you are pregnant or have certain other medical conditions, you should always be treated with antibiotics to prevent possible complications.
How can I prevent cystitis?
Simple steps that may help to prevent cystitis include wiping your bottom from front to back after going to the toilet, passing urine after sex and making sure you don't get dehydrated.
What is the outlook (prognosis)?
The vast majority of women improve within a few days of developing cystitis. However, if your symptoms still do not improve after you have been taking antibiotics then you may need an alternative antibiotic. Some germs (bacteria) causing cystitis can be resistant to some types of antibiotic. Also if blood has been found in your urine you may be asked to provide another sample for testing.
If you develop recurrent bouts of cystitis you should see your doctor. You can learn more about recurrent cystitis and how to prevent it in the separate leaflet called Recurrent Cystitis in Women.
Further reading and references
; NICE CKS, July 2015 (UK access only)
; Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 2011 Oct5(5):316-22. doi: 10.5489/cuaj.11214.
; Urinary alkalisation for symptomatic uncomplicated urinary tract infection in women. Cochrane Database Syst Rev. 2016 Apr 194:CD010745. doi: 10.1002/14651858.CD010745.pub2.
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