Cystitis in Women

What is cystitis?

Cystitis means inflammation of the bladder. It is usually caused by a bacterial bladder 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 symptoms

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

• Blood in your urine.
• Discomfort in your lower tummy (abdomen) or pelvic area.
• Feeling generally unwell and tired.

You can read more about urinary symptoms in the separate leaflet called Lower Urinary Tract Symptoms in Women (LUTS).

What causes cystitis?

Women are much more likely than men to have cystitis, as the tube that 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.

Cystitis treatment

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.

No treatment

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 and with the help of some home remedies. However, symptoms can sometimes last for a week or so if you do not take antibiotics.

Paracetamol or ibuprofen

These ease pain or discomfort.

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 to prevent cystitis

Simple steps that may help to prevent cystitis include wipe from front to back after going to the toilet, making sure you empty your bladder before and after sex and staying hydrated.

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 antibiotics. Also if blood has been found in your urine you may be asked to provide another sample for testing.

If you develop long-term, 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.