Cystitis, also known as a urinary tract infection (UTI), is a common condition that can affect anyone, but is particularly prevalent in women. While cystitis is often not serious, if left untreated it can lead to complications. Here we explore the symptoms, causes, and risk factors for cystitis, examine when cystitis may become more serious, and provide an overview of diagnosis and treatment options.
What is cystitis?
Cystitis is inflammation of the bladder, usually caused by a bacterial infection. The main symptom is pain, stinging, or burning when urinating. Other symptoms may include:
- Feeling like you need to urinate more often or urgently
- Pain or discomfort in your lower abdomen or back
- Cloudy, dark, or strange smelling urine
- Feeling unwell or generally under the weather
If the infection spreads to the kidneys, more severe symptoms such as fever, chills, nausea, and vomiting may occur. This is known as pyelonephritis and requires urgent medical treatment.
What causes cystitis?
Most cases of cystitis are caused by a bacterial infection, usually by Escherichia coli (E. coli) from the bowel. The bacteria enter the urethra and travel up to the bladder, binding to the bladder wall and multiplying. This leads to inflammation and irritation of the bladder.
Anything that enables bacteria to reach or adhere to the bladder can increase the risk of cystitis, such as:
- Having a new sexual partner
- Using a diaphragm for contraception
- Holding on too long when you need to urinate
- Not urinating soon after sex
- Menopause, which changes the vagina’s normal bacteria
- Blockages in the urinary tract
Less commonly, cystitis may be caused by other types of bacteria such as Staphylococcus saprophyticus, viruses, fungi, irritants in soaps/cosmetics, underlying health conditions, or radiation treatment.
Who is at risk of cystitis?
Some people are at higher risk of developing cystitis, including:
- Women – due to their shorter urethras making it easier for bacteria to reach the bladder
- Sexually active women – especially with multiple partners or a recent new partner
- Pregnant women – hormonal and physical changes increase risk
- Menopausal women – lower estrogen levels lead to changes in the vagina
- People with urinary tract abnormalities or blockages
- People with weakened immune systems
- People with diabetes or multiple sclerosis
- People with a urinary catheter
However, while women are overall more prone to cystitis, it can affect anyone.
When should I seek medical advice?
In otherwise healthy individuals, mild to moderate symptoms can often be treated at home with remedies and over-the-counter medications. However, you should see your doctor if:
- It is your first suspected UTI
- Symptoms are severe or getting worse
- You have a high fever (over 102°F/39°C)
- You are vomiting and unable to keep fluids down
- There is blood in your urine
- You have pain in your kidneys or lower back
- You have already treated at home but symptoms persist or worsen
- You have frequent UTIs (more than 3 per year)
- You have a weakened immune system
- You are pregnant
Rarely, UTIs that ascend to the kidneys can lead to serious complications if untreated. Seeking prompt medical treatment is advised for people at higher risk of kidney infection, such as those who are very young, elderly, have diabetes or a weakened immune system.
How is cystitis diagnosed?
To diagnose cystitis, a doctor will typically:
- Ask about your symptoms and medical history
- Perform a physical exam of your abdomen
- Take a urine sample for urinalysis and culture
- Possibly take a blood sample to check for signs of infection
Urinalysis involves examining the urine for signs of infection, such as the presence of white blood cells, bacteria, blood or pus. A urine culture allows any bacteria present to multiply so the specific type can be identified.
In complicated cases, imaging tests like an ultrasound, CT scan or cystoscopy may also be undertaken to check for any structural problems in the urinary tract.
What are the treatment options?
Uncomplicated cystitis can often be treated with a short course (usually 3-7 days) of antibiotics. Some common antibiotics used include trimethoprim, nitrofurantoin, amoxicillin and cephalosporins.
For milder symptoms, your doctor may recommend waiting a day or two before starting antibiotics to see if your body can clear the infection on its own.
In more severe cases, you may need intravenous antibiotics or hospitalization. It is important to finish the entire course of antibiotics, even if you feel better, to prevent antibiotic resistance or a repeat infection.
There are also various at-home remedies and over-the-counter medications that can help relieve symptoms, such as:
- Drinking plenty of water
- Applying a warm compress to the lower abdomen or back
- Taking over-the-counter pain medications like acetaminophen or ibuprofen
- Taking phenazopyridine to help relieve urinary discomfort
- Drinking cranberry juice, which may help prevent bacteria adhering to the bladder
See your doctor if home treatments don’t improve symptoms within 2-3 days.
How can recurrent UTIs be prevented?
For people who experience frequent UTIs (more than 2-3 per year), there are various prevention strategies that may help reduce recurrence:
- Stay hydrated – drink plenty of fluids daily
- Urinate as soon as possible after intercourse
- Wipe from front to back after using the toilet
- Avoid irritants like deodorant sprays or douches in the genital area
- Wear cotton underwear and loose fitting clothes
- Consume cranberry products like juice or supplements
- Take a daily low-dose antibiotic
- Use topical vaginal estrogen therapy after menopause
- Take probiotic supplements to promote healthy bacteria
For postmenopausal women, topical vaginal estrogen therapy can help prevent UTIs by restoring thinning tissue and correcting changes in vaginal bacteria.
When does cystitis require emergency medical care?
Occasionally cystitis may lead to complications that require emergency medical care. Seek immediate medical help if you have symptoms like:
- Very high fever (over 103°F/39.4°C)
- Chills and shaking
- Difficulty passing urine
- Vomiting that prevents keeping liquids down
- Back/flank pain
- Confusion, drowsiness or agitation
These may indicate the infection has reached the kidneys (pyelonephritis) or spread to the bloodstream (urosepsis), which can be life-threatening. Urosepsis requires hospitalization for intravenous antibiotics and fluid support.
When should children receive medical attention for a UTI?
UTIs are uncommon in young children, but can be more serious when they occur. Infants and children with a suspected UTI should receive prompt medical care. Seek emergency advice if your child has:
- A high fever
- Vomiting
- Poor eating/drinking
- Drowsiness
- Abdominal pain
- Frequent urination
- Cloudy, bloody or foul-smelling urine
- Crying when urinating
- Wetting issues after potty training established
Young children have a higher risk of kidney damage from UTIs so quick treatment is important. Babies under 3 months with a UTI should be hospitalized and treated with intravenous antibiotics.
What complications can occur with cystitis?
In most healthy adults, cystitis resolves promptly with proper treatment and has no long-term consequences. However, potential complications can sometimes arise, especially if UTIs are frequent or left untreated.
Possible complications include:
- Recurrent UTIs – Defined as 3 or more UTIs within 12 months. May require further testing and prevention strategies.
- Kidney infection (pyelonephritis) – The infection travels to one or both kidneys, causing fever, nausea, vomiting and severe back pain. Can lead to permanent kidney damage and sepsis if not treated quickly.
- Urosepsis – A life-threatening systemic infection spreading through the bloodstream from the infected urine. Requires emergency hospital treatment.
- Pregnancy complications – UTIs during pregnancy can increase risk of low birth weight or preterm delivery if untreated.
- Bladder or kidney stones – Recurrent UTIs may be associated with stone formation.
- Incontinence – Frequent UTIs may cause urinary retention problems.
Rarely, scarring from repeated infections can lead to end-stage renal failure requiring dialysis. Following doctor’s orders for testing, treatment and prevention is key to avoid complications.
When should men seek medical attention for UTIs?
While less common in men, cystitis can become serious if left untreated. Men should seek prompt medical care if they have symptoms like:
- Burning during urination
- Increased urgency and frequency of urination
- Discomfort or pain in the rectum, testicles or lower back
- Cloudy, bloody or strange smelling urine
- Fever, chills, nausea or vomiting
Men are more prone to complications from UTIs like kidney infections. Other potential causes of urinary symptoms in men include prostatitis and sexually transmitted infections like chlamydia or gonorrhea.
When to seek follow up care
You should follow up with your doctor if:
- Symptoms do not fully resolve within a few days of finishing treatment
- You experience more than 2 recurrent UTIs within 6 months
- You have structural abnormalities in your urinary tract
- Your UTI occurred during pregnancy
- You have a weakened immune system or chronic illness
- Kidney infection or urosepsis occurred
Your doctor can check if further testing is needed to look for any underlying causes for recurrent infections. They may also prescribe longer courses of antibiotics or low-dose daily preventative antibiotics if UTIs keep returning.
Conclusion
Cystitis is typically a benign and rapidly resolving condition when treated properly. However, recurrent infections, ascending kidney infections or life-threatening urosepsis can occasionally occur. Seeking prompt medical attention whenever symptoms persist or worsen is key, especially in at-risk groups like young children, the elderly, those with diabetes or weakened immune systems, and pregnant women.
With appropriate diagnosis and treatment guided by a doctor, cystitis generally resolves fully without permanent effects. Paying attention to prevention strategies can also help avoid recurrent discomfort from this common but treatable infection.