Cystitis - BMJ Best Practice

Patient information from the BMJ Group
Cystitis
If you get a burning pain when you pass urine, you might have cystitis. Cystitis
can clear up on its own in a few days, but you might need treatment. If you get a
lot of infections, your doctor may recommend treatments to prevent them.
We've looked at the best and most up-to-date research to produce this information.
You can use it to talk to your doctor and decide which treatments are right for you.
What happens?
Cystitis happens when germs (bacteria) grow in your bladder. This causes inflammation.
Both men and women can get cystitis. But cystitis is rare in men. This information is
about cystitis in women and what to do about frequent infections.
Normally, urine contains no bacteria. But sometimes bacteria from around your back
passage can spread to your urethra (the tube that carries urine from your bladder to
outside your body). From here, the bacteria can travel to your bladder and cause an
infection.
You’re more likely to get cystitis after sex. Other things that increase your chances of
getting cystitis include:
•
Using a vaginal spermicide cream or gel
•
Having diabetes
•
Having a tube to drain urine from your bladder (this is called a catheter)
•
Being elderly
•
Reaching the menopause
•
Being pregnant.
Some women get cystitis again and again. If it happens more than three times a year,
doctors call this recurrent cystitis.
What are the symptoms?
The main symptoms of cystitis are a burning pain when you pass urine and feeling the
need to pass urine often. Your urine might be a cloudy colour and smell bad. It might
contain blood. You might also have pain in your tummy area. If your symptoms are very
bad, or get worse, you should see your doctor.
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Cystitis
Your doctor or nurse can test your urine for infection, to check whether you have cystitis.
You may need further urine tests if your doctor wants to know which bacteria are causing
your infection.
Sometimes cystitis can spread to your kidneys. This can be more serious. You should
see a doctor straight away if you have signs of a kidney infection. These include a high
temperature, pain in your side, nausea, and vomiting.
What treatments work?
Cystitis often goes away on its own in about three days. But you may need to take
antibiotics for a few days. There are things you can do to help avoid another attack. If
you get frequent infections, there are medicines that may help.
What to do during an attack
Some doctors recommend that you should start drinking more fluids (such as water), to
try to ‘flush out’ the bacteria. But there’s no research to show if this will help. It may be
best to avoid acidic drinks like fruit juice, and drinks that may irritate your bladder, like
coffee.
You can buy potassium citrate or sodium citrate powder, to make into drinks, at a
pharmacy. They make your urine less acidic, which can reduce the burning feeling when
you pass urine. But they won’t kill the bacteria causing your infection.
You can take paracetamol to relieve your pain. Holding a hot water bottle over your
abdomen may be comforting.
Your doctor may prescribe a three-day course of antibiotic tablets to treat your cystitis.
You’ll probably take trimethoprim (brand name Monotrim), nitrofurantoin (Furadantin),
cefalexin (Ceporex), or amoxicillin.
Which antibiotic your doctor prescribes will depend on whether bacteria where you live
have become resistant to certain antibiotics.
Things you can do yourself to prevent more attacks
We don't really know if drinking cranberry juice or taking capsules of concentrated
cranberry extract may help to prevent bladder infections.
One study found that you may be half as likely to get bladder infection in a year if you
regularly take cranberry capsules. But there’s not enough research to be sure how much
juice or how many capsules you need to take.
It's unclear from the research whether drinking cranberry juice can help. Studies have
found different results.
Some women find cranberry products increase acid in your throat (acid reflux), and make
you pass stools more often.
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Cystitis
Many women say that passing urine straight after sex stops them getting cystitis. There’s
no research to say whether this works. But it might be worth trying, especially if you
notice that you get cystitis after you've had sex.
Medicines to prevent cystitis
Because antibiotics kill bacteria, doctors have looked at whether taking antibiotics can
prevent cystitis. There are three things your doctor may suggest if you keep getting
antibiotics.
You could take a low dose of antibiotics for six months to 12 months. There’s good
research to show that this can cut the number of infections you get while you’re taking
the antibiotics.
Your doctor might prescribe trimethoprim (Monotrim), nitrofurantoin (Furadantin), or
cefalexin (Ceporex). Your doctor will tell you how often to take your antibiotics. It might
be each day, every other day, once a week, or once a month.
If you’re pregnant and keep getting cystitis, your GP might refer you to a specialist. Some
antibiotics aren’t safe to take if you’re pregnant. More research is needed to find out how
long you need to take antibiotics to prevent cystitis, and which antibiotics work best.
You might have side effects, but these will probably be mild. Studies show that 4 in 10
women get side effects if they take a low dose of antibiotics for a long time. The most
common problems are stomach upset, skin rash, and a yeast infection in the vagina
(thrush).
Alternatively, you could take a single antibiotic tablet within two hours of having sex.
There’s some good research to show this works as well as taking a low dose of antibiotics
for several months. Your doctor might prescribe a single dose of nitrofurantoin or
ciprofloxacin (Ciproxin) to take whenever you have sex.
Or you could try treating yourself with a single antibiotic tablet, as soon as you get
symptoms. Your doctor might give you a supply to keep at home so you can do this. But
there’s not enough research to show if this works.
If you've been through the menopause, an oestrogen cream that you put in your vagina
might help to prevent cystitis. You can also get oestrogen pills you put in your vagina,
or vaginal rings that release oestrogen slowly over time. This treatment is a kind of
hormone replacement therapy (HRT), so it's a good idea to talk to your doctor to get a
full idea of the possible benefits and side effects.
What will happen to me?
Cystitis can clear up by itself in about three days without any treatment. But if it doesn't,
taking antibiotics for a few days will probably work. There’s not enough research to say
what will happen if you don’t get treatment for cystitis. Some research shows most women
get better without any treatment.
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Cystitis
If you have more than two infections a year for a few years in a row, you’ll probably keep
getting infections unless you have treatment.
This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content. These
leaflets are reviewed annually.
© BMJ Publishing Group Limited 2015. All rights reserved.
Last published: Sep 16, 2015
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