What's in this article?
- 1 What is cystitis?
- 2 Symptoms of cystitis
- 3 What Causes Chronic Cystitis?
- 4 Types of cystitis
- 5 Risk factors of cystitis
- 6 Who is at risk from cystitis?
- 7 Treatments for cystitis
What is cystitis?
Cystitis usually occurs when the urethra and bladder, which are normally sterile (microbe-free) become infected by bacteria.
Bacteria fasten to the lining of the bladder using thread-like structures (pili); this causes the area to become irritated and inflamed.
Cystitis affects people of both sexes and all ages. It is more common among females than males, because women have shorter urethras.
Approximately 80 percent of all urinary tract infections are caused by Escherichia coli.
These bacteria form part of the healthy intestinal flora. However, virulent types may get into the bladder through the urethra and cause urinary tract infections.
Urinary tract infections account for a large proportion of hospital-acquired infections, especially among patients using urinary catheters.
Symptoms of cystitis
Cystitis can cause problems with peeing and make you feel unwell.
Symptoms of cystitis in adults
Cystitis in adults can cause:
- pain, burning or stinging when you pee
- needing to pee more often and urgently than normal
- feeling like you need to pee again soon after going to the toilet
- urine that’s dark, cloudy or strong-smelling
- pain low down in your tummy
- feeling generally unwell, achy, sick and tired
- blood in your urine
In adults, cystitis doesn’t usually cause a high temperature (fever). If you have a temperature of 38C (100.4F) or above and pain in your lower back or sides, it may be a sign of a kidney infection.
Symptoms of cystitis in children
It can be difficult to tell whether a child has cystitis, because the symptoms can be vague and young children cannot easily communicate how they feel.
Possible symptoms of cystitis in young children may include:
- a high temperature (fever) of 38C (100.4F) or above
- weakness and tiredness
- reduced appetite
Children with cystitis can sometimes also have symptoms usually found in adults, such as pain when peeing, peeing more often than normal and pain in their tummy.
What Causes Chronic Cystitis?
Bladder infections happen when bacteria such as E. coli, which usually live in the bowel, get into the urethra and migrate to the bladder where they multiply and cause an infection. These bacteria are regularly passed with excrement and can be found on the skin around the anus.
When women wipe their bottom from back to front (instead of front to back), they move these bacteria closer to the opening of the urethra. Since the urethra in women is very short, it is easy for bacteria to reach the bladder and start an infection in an environment that is normally “germ-free”. However, this is not the only reason that cystitis occurs.
Other Causes Of Chronic Cystitis & Risk Factors
The natural acidity of the vaginal area normally prevents bacteria from multiplying in this area. However, if this natural defense system is weakened, bacteria can thrive and enter the urethra. A weak immune system can be one of the causes of chronic cystitis, especially if the infection develops and spreads to the kidneys. There are several risk factors which can facilitate recurrent bladder infections:
- Bladder or kidney stones
- Congenital abnormalities in the urinary tract that can cause incomplete emptying of the bladder
- Recent urological operations
It seems that the lower urinary tract (from the bladder to urethra) reacts to oestrogen levels, which may explain why some women get recurrent bladder infections after the menopause – a time during which hormonal changes occur.
Women who have had infectious cystitis (with lab tests confirming the presence of bacteria) at least three times in six months should see their doctor or a urologist to establish the cause and find the best treatment.
Causes Of Severe Cystitis
Sometimes it remains unclear why some women suffer from severe bladder infections. However, severe cystitis can occur when pre-existing conditions worsen or cause the infection. Women who suffer from diabetes, a blockage in the kidney or bladder (e.g. stones, congenital abnormalities) as well as women who have problems emptying their bladder, are more likely to suffer from severe cystitis.
The symptoms of severe cystitis are largely the same as those of a “normal” cystitis, but often more intense. They include: the urge to urinate very frequently, pain during urination, cloudy and smelly urine, pain in the flanks or back. The treatment options are also similar, although it helps to have a urine sample tested to ensure that your doctor can prescribe the most suitable antibiotic.
Types of cystitis
Cystitis can be either acute or interstitial. Acute cystitis is a case of cystitis that occurs suddenly. Interstitial cystitis (IC) is a chronic or long-term case of cystitis that affects multiple layers of bladder tissue. Both acute and interstitial cystitis have a range of possible causes. The cause of cystitis determines the type. The following are types of cystitis:
Bacterial cystitis occurs when bacteria enter your urethra or bladder and cause an infection. This can also result when normally growing bacteria in your body becomes imbalanced. The infection leads to cystitis, or inflammation in your bladder.
It is important to treat a bladder infection. If the infection spreads you your kidneys it can become a serious health issue.
Certain medications can cause your bladder to become inflamed. Medicines pass through your body, and eventually exit through your urinary system. Some medications can irritate your bladder as they exit your body.
For example, the chemotherapy drugs cyclophosphamide and ifosfamide can cause cystitis.
Radiation therapy is used to kill cancer cells and shrink tumors, but it can also damage healthy cells and tissues. Radiation treatment in the pelvic area can cause your bladder to become inflamed.
Foreign body cystitis
Ongoing use of a catheter, a tube used to facilitate the release of urine from the bladder, can increase your risk of bacterial infection, and damage tissues in the urinary tract. Both bacteria and damaged tissues can cause inflammation.
Certain hygiene products can irritate your bladder. Products that may cause cystitis include:
- spermicidal jellies
- use of a diaphragm with spermicide
- feminine hygiene sprays
- chemicals from a bubble bath
Cystitis associated with other conditions
Sometimes cystitis occurs as a symptom of other medical conditions, such as:
- kidney stones
- enlarged prostate
- spinal injuries
Risk factors of cystitis
Some people are more likely than others to develop bladder infections or recurrent urinary tract infections. Women are one such group. A key reason is physical anatomy. Women have a shorter urethra, which cuts down on the distance bacteria must travel to reach the bladder.
Women at greatest risk of UTIs include those who:
- Are sexually active. Sexual intercourse can result in bacteria being pushed into the urethra.
- Use certain types of birth control. Women who use diaphragms are at increased risk of a UTI. Diaphragms that contain spermicidal agents further increase your risk.
- Are pregnant. Hormonal changes during pregnancy may increase the risk of a bladder infection.
- Have experienced menopause. Altered hormone levels in postmenopausal women are often associated with UTIs.
Other risk factors in both men and women include:
- Interference with the flow of urine. This can occur in conditions such as a stone in the bladder or, in men, an enlarged prostate.
- Changes in the immune system. This can happen with certain conditions, such as diabetes, HIV infection and cancer treatment. A depressed immune system increases the risk of bacterial and, in some cases, viral bladder infections.
- Prolonged use of bladder catheters. These tubes may be needed in people with chronic illnesses or in older adults. Prolonged use can result in increased vulnerability to bacterial infections as well as bladder tissue damage.
In men without any predisposing health issues, cystitis is rare.
Who is at risk from cystitis?
Infection from intestinal bacteria is by far the most frequent cause of cystitis, especially in women, who have a very short urethra (the tube through which the urine passes from the bladder to the outside).
Normally, urine is sterile (there are no micro-organisms such as bacteria present).
Between 20 to 40 per cent of women will get cystitis in their lifetime.
However, it’s possible to have bacteria in the bladder without having any symptoms (especially in the elderly).
There can be several reasons for the bacteria settling in the bladder.
Inadequate emptying resulting in stagnation of urine may lead to infection. This may be caused by some drugs (for example, antidepressants), immobility, abnormal bladder control and constipation.
Treatments for cystitis
In the vast majority of cases, mild cystitis will resolve itself within a few days. Any cystitis that lasts more than 4 days should be discussed with a doctor.
Sometimes, a short 3-day course of antibiotics is given, though some doctors will treat for 7-10 days depending on the patient.
Most patients will experience the beneficial effects of an antibiotic within the first day of treatment.
If symptoms do not improve after taking the antibiotics, the patient should return to the doctor.
The following antibiotics are commonly used for cystitis: Nitrofurantoin, trimethoprim-sulfamethoxazole, amoxicillin, cephalosporins, ciprofloxacin, and levofloxacin.
Elderly people, and those with weakened immune systems, such as people with diabetes, have a higher risk of the infection spreading to the kidney, as well as other complications. Vulnerable people should be treated promptly.
The following home remedies and measures may help:
- Painkillers, such as acetaminophen (Tylenol) or ibuprofen may help with the discomfort. Pregnant individuals should discuss this with their doctor or pharmacist.
- Drinking plenty of fluids helps flush the bacteria through the system.
- Avoid alcohol.
- There is an active ingredient in cranberries that prevents bacteria from sticking to the bladder wall; however, cranberry juice or capsules may not contain enough of this active ingredient to be beneficial in preventing symptoms. Research is conflicting. Nevertheless, cranberry juice is a common method used by people to prevent urinary tract infections.
- Refrain from sex while infected.