Cystitis: bladder infection

by | Pharmacy Care, Women's Health

Cystitis means inflammation of the bladder and is usually due to an infection. Cystitis is the most common type of urinary tract infection (UTI) and is very common, especially among women.

Cystitis is usually a mild illness that can be easily treated with antibiotics. There are steps you can take to help prevent cystitis if you have had problems with bladder infections in the past.

What are the symptoms of cystitis?

Common symptoms of cystitis in adults include:

  • passing urine frequently;
  • a persistent feeling of urgency (an urgent need to pass urine);
  • a burning sensation or pain when passing urine;
  • passing urine that smells different from normal, looks cloudy or has blood in it;
  • discomfort or pain low down in the abdomen;
  • fevers; and
  • feeling generally unwell.

In older adults or young children the symptoms may not be so obvious. A generalised illness with a fever, tummy-ache or vomiting may be the only symptoms of a urinary tract infection in children.

In older adults, a period of agitation or worsening confusion may be caused by cystitis.

What causes a bladder infection?

Bladder infections are usually caused by bacteria which have made their way into the body via the urethra (the tube that drains urine from the bladder to the outside of the body). The bacteria can multiply very rapidly in urine and move up from the urethra to the bladder.

Less commonly, bacteria can enter the bladder from the kidneys (where urine is made) or via the bloodstream.

The bacterium most commonly involved in bladder infections is Escherichia coli, which is found in your bowel and sometimes around your anus, but other bacteria or infectious agents can also cause cystitis.

Risk factors for bladder infections

There are several factors that can increase your risk of getting a bladder infection.

Cystitis is more common in women than in men. This is because women have a much shorter urethra, making it easier for bacteria to enter the bladder. Also, in women the opening of the urethra is close to the vagina and anus, where bacteria can be found.

For women, being pregnant, using a diaphragm for contraception, having a new sexual partner and wiping from back to front after using the toilet can further increase the risk of developing a bladder infection. Also, women who have been through menopause have an increased risk of getting cystitis.

Any condition that makes it more difficult for the bladder to empty properly, such as an enlarged prostate in men or a stone in the urinary tract, can also result in cystitis.

Having diabetes or a problem with your immune system can also make you more prone to urinary tract infections (UTIs).

Occasionally, children get cystitis. In some cases this is caused by an anatomical abnormality which forces urine back up the ureters, disrupting the flow of urine through the urinary system. Any child who has symptoms of cystitis should see a doctor.

Diagnosing cystitis

Your doctor will ask about your symptoms and perform a physical examination to check for signs of a urinary tract infection. If your doctor suspects you have cystitis, they will request a urine sample.

Your doctor will test the urine sample in their office with a dipstick, looking for markers of cystitis. If cystitis is likely, treatment with antibiotics can be started. The urine sample may also be sent to a microbiology laboratory for further testing to confirm the diagnosis and to find out what kind of bacteria are causing the infection (to check that the most appropriate antibiotic has been prescribed).

In some circumstances, further testing (including imaging tests of the bladder and urinary tract) may be recommended.

Giving a urine sample

Urine samples used to test for a bladder infection require a mid-stream sample of urine – see instructions below.

  • Wash the end of the penis or the vaginal area with warm water (alternatively, you may be asked to wipe the area with a disinfectant). Women should wash from front to back.
  • To give a ‘mid-stream’ sample – pass a small amount of urine into the toilet, pause, then pass a small amount into the test pot (about 4 teaspoons), pause, then pass the rest into the toilet.

Do not touch the inside of the test pot as it is sterile.

Treatment for cystitis (bladder infection)

Antibiotics are needed to treat bacterial cystitis. It’s important to take the entire course of antibiotics as prescribed by your doctor, even if your symptoms improve within a couple of days.

If you are having recurrent bouts of cystitis, you may need to take a longer course of antibiotics, or your doctor may refer you to a urologist (specialist in problems with the urinary tract).

Self care for cystitis

The following self-care tips can help make you feel more comfortable when you have cystitis.

  • Drink plenty of fluids (particularly water). Drinking as much liquid as possible will increase the production of urine and help wash the bacteria out of the bladder.
  • Reduce the amount of tea, coffee and alcohol you drink, as these can irritate the bladder.
  • Try taking a urinary alkaliniser, such as Citralite, Citravescent or Ural, which are available over the counter from pharmacies. These medicines reduce the acidity of the urine, making it difficult for the bacteria to survive and also helping to reduce the pain and burning of cystitis. These medicines should not be used long term, or by people who have kidney or heart disease.
  • Apply a warm pack (such as a hot water bottle or wheat bag) to your tummy or your back for relief of pain or discomfort.

If your symptoms do not ease within 2 days, or start to worsen, see your doctor. See your doctor straight away if you experience high fevers, chills or back pain, as these symptoms suggest a possible kidney infection.

Preventing bladder infections

If you have had several bouts of cystitis, it’s worth following these simple steps to help reduce the risk of developing further bladder infections.

  • Urinate frequently (as soon as you feel the need to pass urine). Make sure you empty your bladder completely when you go.
  • Drink plenty of fluids (particularly water) every day.
  • Women should wipe from front to back after passing urine, reducing the chance that bacteria around the anus are wiped over the entrance to the urethra.
  • Shower in preference to using a bath if cystitis is a recurring problem. Hand-held shower attachments or bidets make washing the area much easier. Shower or wash at least daily.
  • Pass urine after having sex. This allows any bacteria introduced to the urethra to be flushed out before they can begin to multiply.

Drinking cranberry juice has been previously recommended to reduce the risk of cystitis. However, current evidence for the effectiveness of cranberry juice or cranberry products (e.g. tablets and capsules) in preventing urinary tract infections is lacking. Cranberry products should be avoided if you are taking warfarin (a blood-thinning medicine).

When to see the doctor about cystitis

See your doctor if bladder infection symptoms last longer than a day or you experience fever, back pain, or blood in the urine (this is because the infection may have spread to the kidney).

See your doctor as soon as symptoms appear if you are pregnant (pregnant women are more at risk of kidney infection).

Your doctor may recommend further tests or referral to a specialist doctor if:

  • you have repeated urinary tract infections; or
  • the cystitis occurs in a man or child.

In these cases, tests may be recommended find out if your ureters (tubes that carry urine from the kidneys to the bladder) and bladder are normal, and that your kidneys have not been damaged by the repeated infections.

Interstitial cystitis

Ongoing symptoms of bladder pain or discomfort and a frequent or urgent need to urinate may be the result of a condition known as interstitial cystitis (also called painful bladder syndrome or bladder pain syndrome). This condition is not well understood and there is currently no cure – antibiotics are not helpful for interstitial cystitis as it does not seem to be caused by a bacterial infection. However, there are some treatments and self-help measures that can help improve the symptoms. Talk to your doctor if you have ongoing or recurring bladder symptoms.