Cystitis (Bladder Inflammation)

What causes cystitis

Bacterial cystitis

Most cystitis is caused by bacteria from the bowel, mainly E. coli, which travel up the urethra into the bladder. Women are much more prone because the urethra is short (about 4 cm) and close to the anus.

Risk factors:

• sexual activity, especially with a new partner
• spermicides and diaphragms
• menopause, as falling estrogen changes the vaginal and urethral tissues
• pregnancy
• not emptying the bladder fully, from prolapse, an enlarged prostate or nerve problems
• urinary catheters
• diabetes
• kidney stones or other blockages
• a previous UTI

Non-infectious cystitis

• Interstitial cystitis (bladder pain syndrome): chronic bladder pain and frequency with no infection.
• Radiation cystitis: after radiotherapy to the pelvis.
• Drug-induced cystitis: from some chemotherapy drugs (cyclophosphamide) and ketamine misuse.
• Chemical irritation: from bubble baths, scented soaps or spermicides.
• Catheter-related irritation.

Symptoms

• burning or stinging when passing urine (painful urination)
• needing to pee often and urgently, but passing only small amounts
• pain or pressure low in the belly (suprapubic pain)
• cloudy, dark or strong-smelling urine
• blood in the urine
• feeling generally unwell or tired

Older adults may have less typical symptoms, such as new confusion, falls or incontinence. Young children may have fever, irritability, poor feeding, tummy pain or new bedwetting.

Cystitis vs UTI vs kidney infection

"UTI" is the umbrella term for infection anywhere in the urinary tract. Cystitis is the bladder form. See urinary tract infection for the broader picture.

Diagnosis

• Symptoms: In a healthy, non-pregnant woman with typical symptoms, the diagnosis can often be made without tests, sometimes by phone or telehealth.
• Urine dipstick: checks for white blood cells (leukocytes) and nitrites.
• Urine culture: identifies the bacterium and the best antibiotic. Recommended for men, pregnant women, children, recurrent or complicated infections, and when treatment fails.
• Further tests: ultrasound, cystoscopy or kidney imaging for men, recurrent infections, blood in the urine or suspected blockage.
• STI testing: chlamydia and gonorrhea can cause similar symptoms (urethritis).

Treatment

Antibiotics

Uncomplicated cystitis in women is usually treated with a short course: nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or a single dose of fosfomycin, depending on local resistance patterns and allergies. Symptoms usually start improving within 1 to 2 days. Men, pregnant women and complicated cases need longer courses chosen with culture results. Finish the full course as prescribed.

Some women with mild symptoms may choose to wait 48 hours with pain relief and fluids, with a backup prescription if symptoms do not improve. Discuss this with your clinician.

Symptom relief

• Pain relief: ibuprofen or acetaminophen (paracetamol), following the label dose.
• Drink fluids regularly to keep urine pale.
• Heat: a warm pad on the lower belly.
• Phenazopyridine (over the counter in the US) numbs the bladder for up to 2 days. It turns urine orange and does not treat infection.
• Avoid irritants such as coffee, alcohol and fizzy drinks until symptoms settle.

Recurrent cystitis

Recurrent cystitis means 2 or more infections in 6 months, or 3 or more in a year. Options to reduce recurrences:

• Vaginal estrogen after menopause, which significantly reduces infections
• Increasing water intake in women who drink little, shown to reduce recurrences
• Cranberry products: may modestly reduce recurrences in some women
• Methenamine hippurate: a non-antibiotic preventive medicine
• Low-dose preventive antibiotics, daily or after sex, for selected women
• Patient-started treatment: a prescription to start at the first symptoms after a urine sample

Cystitis in men

Cystitis is less common in men and is considered complicated. It often relates to an enlarged prostate, prostatitis, kidney stones or a structural problem. Men need a urine culture, usually a 7-day antibiotic course, and sometimes further tests.

Prevention

• Drink enough fluids so you pass pale urine regularly.
• Pass urine when you need to and after sex.
• Wipe from front to back.
• Avoid spermicides and scented products in the genital area.
• Treat constipation.
• After menopause, ask about vaginal estrogen.

Frequently asked questions

What are the symptoms of cystitis?

The main symptoms are burning or stinging when you pee, needing to pee often and urgently, passing small amounts, pain low in the belly, and cloudy, smelly or bloody urine. Fever and back pain suggest the infection has spread to the kidneys.

Is cystitis the same as a UTI?

Cystitis is the most common type of UTI. A UTI is an infection anywhere in the urinary tract, while cystitis specifically means the bladder is inflamed, usually by infection. Kidney infection is a more serious UTI.

Can cystitis go away without antibiotics?

Mild cystitis in otherwise healthy women sometimes clears on its own within about a week. Antibiotics shorten symptoms and reduce the chance of spread to the kidneys. Pregnant women, men, children and anyone with fever or back pain should be treated.

How long does cystitis last?

With antibiotics, symptoms usually improve within 1 to 2 days and clear within 3 to 5 days. Without antibiotics, mild cystitis may last up to a week. See a doctor if symptoms are not improving after 48 hours of treatment.

What causes cystitis after sex?

Sex can push bacteria from around the vagina and anus toward the urethra and into the bladder. Peeing soon after sex, avoiding spermicides and, for frequent episodes, a single preventive antibiotic dose after sex can help.

Why do I keep getting cystitis?

Recurrent cystitis is linked to sexual activity, spermicides, menopause, incomplete bladder emptying, diabetes and genetics. A doctor will check for underlying causes and can offer prevention such as vaginal estrogen, methenamine or preventive antibiotics.