What is cystitis?
The word cystitis is derived from the Greek words 'cyst ', meaning bladder, and 'itis ', meaning inflammation. Inflammation of the bladder may or may not be caused by an infection. In over 60 per cent of cases, cystitis is caused by a bacterial infection - this is known as bacterial cystitis. In the remainder of cases some other factor is responsible for the inflammation - this type of cystitis is known as interstitial cystitis. Cystitis is suffered mainly by women but can also affect men.
What are the symptoms of cystitis?
The symptoms of cystitis vary in form and severity. If they are not recognised and treated quickly, they will become more severe. Pain when passing urine is one of the first signs of cystitis. It may start as a twinge at the end of passing urine but if not treated promptly will progress to pain often described as feeling like broken glass is being passed. Urgency to pass urine and a need to pass urine more frequently than usual are also common symptoms. In severe bacterial cystitis, bleeding may occur - this can happen quickly in women who have had previous attacks. Backache and fever may also start when bleeding has occurred - this may mean that the infection is also affecting the kidneys. The early signs of cystitis may become familiar to frequent sufferers.
What causes cystitis?
Bacterial cystitis is commonly caused by infection of the bladder with a type of bacteria called Escherichia coli (E. coli). These bacteria occur naturally in the gut and do not usually cause a problem until they get into the urinary system. In 99 per cent of cases, bacterial cystitis is the result of self-infection and is not "caught" or passed on from another person.
Faecal bacteria are easily passed into the urethra and bladder, often by incorrect wiping of the perineum or perineal area (the area around the vagina and the rectum) when going to the toilet. Wiping should always be from front to back. Some women may be more prone to bacteria entering the urinary system because of poor hygiene, episiotomy scars (resulting from an incision into the perineum and vagina during childbirth), diarrhoea, in-dwelling catheters or sexual intercourse.
Chlamydia is a sexually transmitted infection caused by the bacteria Chlamydia trachomatis, usually present in the cervix as well as in the urethra. It is another cause of cystitis and, if present, will require treatment of both sexual partners.
Interstitial (non-bacterial) cystitis can be caused by a number of things, including:
- Dehydration - this can be caused by insufficient intake of fluids or by the effect of some foods or drink. Alcohol, tea, coffee and fizzy drinks can all stimulate the kidneys and cause dehydration by increasing urinary output.
- Certain foods can irritate the bladder in sensitive people.
- Occasionally, thrush (a fungal infection) can cause cystitis; the situation may be made worse by the consumption of sugary foods.
- Sexual intercourse may cause irritation and bruising - these factors are personal to each individual and may need to be addressed. Washing the perineum within six hours before intercourse and passing urine after sex helps to prevent cystitis. Repeated episodes of cystitis can occur, especially when regular intercourse is initiated (often referred to as 'honeymoon cystitis') - this situation often resolves over time.
- Chemicals in the form of deodorised soaps, bubble baths and washing powders can also cause irritation.
- Underwear made of man-made fibres can prevent air reaching the perineal area and may cause cystitis or thrush.
Are any tests necessary?
A urine test to diagnose whether the cystitis is caused by an infection may be necessary before treatment can be started. A mid-stream specimen of urine (MSU) will be sent off to a laboratory and the result will indicate which bacteria are causing the infection and which antibiotics will be effective at treating it. If other symptoms such as soreness or swelling of the perineum are present along with the cystitis, a sexually transmitted disease may be the cause. If this is the case you may need to visit a genito-urinary (GU) or special clinic for additional tests to look for the presence of a causative factor such as chlamydia.
In some cases, referral to a urologist for further tests may be necessary.
What treatment is available?
A bladder infection may cause the urine to become acidic causing a burning sensation when urine is passed. For this reason, simple alkalinising agents such as potassium citrate or sodium citrate, which make the urine more alkaline (less acidic), are often effective at relieving the symptoms. Potassium citrate can be purchased over the counter or obtained on prescription. It is available as effervescent tablets (Effercitrate®) or as powder in sachets to be mixed with water. Several products for cystitis are available to buy from pharmacies.
Various antibiotics may be prescribed. Some are specifically for urinary tract infections and include quinolones such as ciprofloxacin (eg, Ciproxin®) and nalidixic acid. Other antibiotics that may be prescribed for cystitis include nitrofurantoin (eg, Macrobid®), methenamine (eg, Hiprex®), pivmecillinam (Selexid®) and trimethoprim.
Preparations containing sodium hyaluronate (Cystistat®, Hyacyst®, iAluRil®) relieve the symptoms of cystitis by replenishing the bladder's natural protective layer. They are administered directly into the bladder by a healthcare professional.
- Always wipe the anus from behind and wipe from front to back, never the other way around. Teach little girls to wipe correctly from an early age.
- Clean the perineum before sexual intercourse, afterwards is too late.
- Pass urine after intercourse.
- Avoid wearing man-made underwear, cotton allows air through. Do not wear underwear in bed at night as the perineum needs air.
- Ensure that fluid intake is sufficient to avoid dehydration.
- Do not use perfumed, coloured soaps on the perineum.
Fact sheet provided by MIMS
Date last reviewed: May 2008