Introduction

Many women know all too well the symptoms of cystitis – an inflammation of the bladder, also often referred to as a urinary tract infection (UTI). The symptoms include frequent trips to the bathroom and a stinging and burning sensation when peeing (urinating). Although these are often very unpleasant, there are effective treatments.

Uncomplicated cystitis usually clears up without any problems. Antibiotics are effective, but they aren't always needed.

Unfortunately, there's no sure-fire way to reliably prevent cystitis, and much of the common advice on preventing it hasn't been scientifically tested.

Symptoms

Cystitis makes you pee more often, which can be painful or cause a burning sensation. So you not only have to go to the toilet more often; going to the toilet can be very unpleasant too.

Many women find that it's particularly painful when their bladder is almost or completely empty. The urge to pee often comes very suddenly and they quickly need to get to a bathroom – but often only a small amount of urine comes out. Some women have difficulties holding back urine, which can be very distressing. The urine may be cloudy in color and have an unusual smell, and sometimes has blood in it.

The pain might spread across your entire abdomen (belly) or into your back. Severe cystitis can make you feel generally ill, weak and irritable, and affect your sleep.

Sometimes urine tests detect bacteria although the person doesn't have any noticeable symptoms. That is called “asymptomatic bacteriuria.” It is usually harmless.

Causes

Uncomplicated cystitis is an inflammation of the mucous membranes lining the bladder. It's normally caused by bacteria outside the body that get into the urethra (the tube that leads to the bladder), enter the bladder and then grow there.

Risk factors

Having sex increases the risk of getting cystitis because it increases the likelihood of bacteria entering the urethra. Sperm-killing creams and gels (spermicides) and contraceptive diaphragms can also increase the risk somewhat.

Pregnant women are more likely to get cystitis. Other high-risk groups include people who have a urinary catheter or anatomical changes in their urinary tract, as well as people who have diabetes, multiple sclerosis or a urological disease.

Women who have already had cystitis are also more likely to get it again. It's more common after menopause.

Prevalence

Women are much more likely to get cystitis than men are because their urethra is shorter, which makes it easier for bacteria to enter the bladder. About 10 out of 100 women have cystitis at least once a year. Half of those women have it again within one year.

Effects

If the symptoms stay in the lower urinary tract (the bladder and the urethra) and there are no risk factors for severe cystitis or complications, then the cystitis is referred to as "uncomplicated." This is easy to treat and usually goes away without too much trouble.

The cystitis is "complicated" if there's a greater risk of it leading to other medical problems (complications).  People who have a higher risk of complications include men and people with a weakened immune system or damaged kidneys. Changes or anatomical abnormalities in the urinary tract also increase the likelihood of complications. If there's a higher risk of the inflammation spreading to the kidneys, it is considered to be a complicated case of cystitis too. If the bacteria travel up the ureters (the tubes that lead from the bladder to the kidneys) and into the kidneys, they can cause an inflammation of the renal pelvis. This is called pyelonephritis.

You should urgently seek a doctor or go to a hospital if you have cystitis and the following symptoms develop:

• Pain near the kidneys (flank pain)
• Fever
• Nausea and vomiting

These symptoms may be a sign of pyelonephritis, which can be dangerous and should be treated quickly to avoid long-term damage. Pyelonephritis is very rare, though.

Diagnosis

Your doctor can assess whether you have uncomplicated cystitis based on your medical history and symptoms. You can also give a urine sample at the doctor's office, where they can examine it using a test strip. If your symptoms lead to a clear diagnosis, you usually won't need to do any other urine tests.

Ultrasound can be used to examine your kidneys and bladder. This examination is typically only done if you have complicated cystitis or if it keeps coming back. X-rays and an examination known as a cystoscopy are also done in very rare cases, for instance if you have severe cystitis that keeps coming back. A cystoscopy is a procedure that involves inserting a tube with a small camera at the end of it (an endoscope) into the urethra and guiding it through to the bladder. The doctor can look at the images produced by the camera to see whether there is anything abnormal on the wall of the bladder.

Often, just a visit to your family doctor is enough. But you can also go to see a gynecologist or urologist.

Prevention

Sometimes cystitis comes "out of the blue" and there is no clear cause. Women who get cystitis a lot can try to observe whether any factors in their everyday life increase the risk of recurrence. If those factors can't be avoided and they still have recurrent cystitis, they can take medication to prevent cystitis.

Although this medication can effectively prevent cystitis, it needs to be used regularly. And it has side effects too.

Treatment

For many women, cystitis is a one-time unpleasant issue. For others, it's a recurrent bigger problem. Antibiotics usually help to relieve acute cystitis quite fast and shorten the duration of the disease. But you don't always need to take antibiotics. Uncomplicated cystitis clears up in 30 to 50 out of 100 women within one week even if they don't use antibiotics – and not using antibiotics generally isn't expected to result in complications. If someone has complicated cystitis, though, it will definitely have to be treated with antibiotics. You can talk to your doctor about whether it makes sense for you to use antibiotics.

If you have mild to moderate symptoms, you can use painkillers like acetaminophen (paracetamol) or ibuprofen instead. They can relieve the pain until the body has fought off the bacteria itself. There are also some household remedies that are believed to help – such as drinking a lot of fluids and applying heat.

Further information

When people are ill or need medical advice, they usually go to their family doctor first. Read about how to find the right doctor, how to prepare for the appointment and what to remember.

Sources

• Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM). Brennen beim Wasserlassen. S3-Leitlinie und Anwenderversion der S3-Leitlinie Harnwegsinfektionen. AWMF-Registernr.: 053-001. July 2018. (DEGAM guidline no. 1).
• Deutsche Gesellschaft für Urologie (DGU). Interdisziplinäre S3 Leitlinie: Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. Update 2017. AWMF-Registernr.: 043-044. April 2017.
• Falagas ME, Kotsantis IK, Vouloumanou EK, Rafailidis PI. Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J Infect 2009; 58(2): 91-102. [PubMed: 19195714]
• Malterud K, Baerheim A. Peeing barbed wire. Symptom experiences in women with lower urinary tract infection. Scand J Prim Health Care 1999; 17(1): 49-53. [PubMed: 10229994]
• Zalmanovici Trestioreanu A, Green H, Paul M, Yaphe J, Leibovici L. Antimicrobial agents for treating uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 2010; (10): CD007182. [PubMed: 20927755]

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  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. We do not offer individual consultations.

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