Urinary Infections / Cystitis

What is cystitis?

Cystitis is caused by a bacterial infection from a variety of sources. It’s most common in women, but it can affect men and young children. Infections are less common in men because they have longer urethras and bacteria have further to travel to reach the bladder. Four in 10 women will have a bout of cystitis at some point during their lifetime and a third of these women with have recurrent episodes.

Common signs and symptoms

Common symptoms of cystitis include:

  • Pain when you pass urine.
  • A frequent, urgent need to urinate, but only passing small amounts.
  • Cloudy, dark or strong smelling urine.
  • Blood in your urine – this may not always be visible, but can be found by testing the urine.
  • Pain during sex.
  • Pain in your lower abdomen or lower back.
  • Feeling tired or generally unwell.
  • A mild fever.

Overall, the symptoms of cystitis are similar for men and women. If your symptoms don’t get better after two to three days, contact your GP. He or she will be able to rule out any other conditions that could be causing your symptoms.

Complications of cystitis

There is a chance that you could develop a kidney infection called pyelonephritis. This can happen if the infection moves from your bladder into your kidneys. Symptoms of kidney infection often include fever, vomiting, feeling unwell and pain in your lower back. You may also develop chills and shivers. If you have any of these symptoms, contact your GP.

Cystitis causes

Cystitis is caused by a bacterial infection. A bacterium called Escherichia coli (E.coli), which usually lives harmlessly in your bowel, causes over seven out of 10 bouts of cystitis.

Women have shorter urethras than men meaning bacteria have a shorter distance to travel before reaching the bladder. The urethra is also closer to the back passage (anus). This makes it easier for bacteria to get transferred from your bowel into your bladder.

A healthy bladder safeguards against infections by having a protective polyglycan membrane and by regularly emptying urine.

Infections occur when bacteria gain access to the bladder and your normal defense mechanisms are unable to clear the organism. Causes of cystitis include:

  • Incomplete bladder emptying. A bladder that doesn’t empty completely is unable to effectively clear out bacteria.
  • Menopause. In women, natural changes after menopause make it easier for bacteria to enter the bladder.
  • Bowel contamination. Certain hygiene practices can make it easier for bowel organism to enter the bladder. Ways to minimise this are outline below.
  • Intercourse. Bacteria can pass into your bladder when you have sex.
  • Pregnancy. When pregnant, your womb (uterus) puts extra pressure on your bladder. This could prevent your bladder from emptying completely. Retaining small amounts of urine in your bladder could encourage bacteria to grow.
  • Diabetes. If you have diabetes, your urine can contain more sugar than usual. Sugar in your urine encourages bacteria to grow.
  • Contraception. A diaphragm may increase your risk of getting cystitis because it can prevent your bladder from emptying properly. Spermicides can also increase infection risk.
  • Kidney stones. Stones protect bacteria from antibiotics, allowing them to cause recurrent infections.

Treatment of cystitis


Your bladder can clear an infection by itself without the need for antibiotics. There are several things you can do to aid this process while reducing your symptoms and helping you feel better.

  • Taking over-the-counter painkillers, such as paracetamol and ibuprofen.
  • Drink more water to help flush out the infection.
  • Placing a warm hot water bottle on your lower back can help soothe discomfort in this area.
  • Try to rest as much as possible.


If your symptoms continue for longer than two to three days, you may need antibiotics. On average, antibiotics shorten the time you have symptoms by about a day. Trimethoprim and cephazolin are antibiotics that are commonly used to treat cystitis.

If antibiotics don’t work, it’s possible that you may have a different type of cystitis, called interstitial cystitis or painful bladder syndrome. This is a long-term condition in which you have ongoing inflammation in your bladder. This condition isn’t caused by bacteria so can’t be treated with antibiotics.

Minimising development of cystitis

There are several things you can do to help prevent cystitis. Some examples are listed below.

  • Make sure you drink enough fluid (1-2 litres).
  • Cranberry juice, cranberry tablets ( Ellura) may reduce the likelihood of recurrent cystitis. Don’t take cranberry products if you’re taking warfarin.
  • Wear underwear made of natural materials, such as cotton or bamboo. Don’t wear underwear to bed.
  • After using the toilet, wipe from front to back.
  • Always change your tampon after opening your bowels.
  • Wash using pH corrected, unperfumed products (eg. QV, ceptaphil)
  • Do not hold your urine for too long (6 hours).
  • Try to urinate shortly after having sex to help flush away any bacteria.
  • If you are post-menopause, topical oestrogen replacement might help prevent cystitis. This can be a cream or pessary that you insert into your vagina.
  • Spermicidal product for contraception can destroy good bacteria (lactobacilli) increasing risk of pathogenic bacteria.
  • Silicon bases lubrication gels can increase bacterial infection. Change to a plant based product ( Sylk)

Decreasing recurrent cystitis.

If you are getting more than 3 infections a year or more than 2 within 6 months then more preventative measures are required.

Antibiotics have been proven to decrease the rate of recurrent infections. There are 3 ways antibiotics can be used.

  • Continuous prophylaxis. Taking a low dose of antibiotic for very night for 3 months. This has been shown to be effective in reducing recurrent infections. The low dose minimise side effects associated with a full course of antibiotics (Thrush, upset bowel function etc).
  • Pre-emptive antibiotics. Taking antibiotics at high risk events. The most common is post-coital were the antibiotic should be taken within 2 hours.
  • Self-starter. Commencing a course of antibiotics as soon as symptoms start.

Further investigation and treatments

Sometimes further investigation and/or treatment is required. This may include visualisation of the bladder (Cystoscopy) and instillation of agents in the bladder to reduce the risk of infections.


  • Cystitis is a common bacterial infection that causes inflammation in your bladder.
  • Symptoms of cystitis include pain when you pass urine, a frequent, urgent need to urinate, and cloudy or strong smelling urine.
  • The condition usually clears more quickly if you take antibiotics.
  • There are a number of measures that may reduce the rate of infection.
  • Sometimes further investigations are required.