Cystitis (urinary tract infection)

People with cystitis usually have to make frequent trips to the bathroom and feel a stinging and burning sensation when urinating. Those affected often find the symptoms very unpleasant but cystitis can be effectively treated.
Uncomplicated cystitis usually clears up without any problems. Antibiotics are effective as treatment, but they aren't always needed.

There's not as yet any way to reliably prevent cystitis, and much of the common advice on preventing it hasn't yet been scientifically tested.

A strong and frequent urge to urinate is typical of cystitis. Symptoms also include a stinging or burning sensation when passing urine.

Many women find that it's particularly painful when their bladder is almost or completely empty. The urge to urinate often comes very suddenly and the person affected quickly needs 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 also has blood in it.

Sometimes urine tests detect bacteria in the urine although the person doesn't have any noticeable symptoms. Doctors call this asymptomatic bacteriuria. It is usually harmless.

Uncomplicated cystitis is normally caused by bacteria that get into the urethra, enter the bladder and then grow there – the mucous membrane of the urinary bladder is inflamed.

Sexual intercourse 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 to some extent.

Pregnant women are more likely to get cystitis. Other high-risk groups include people who have: 

• a urinary catheter,
• a urological disease,
• anatomical changes in their urinary tract,
• diabetes mellitus,
• multiple sclerosis.

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

Women are much more likely to get cystitis than men 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.

The cystitis is referred to as “uncomplicated” 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.

Uncomplicated cystitis 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.

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. 

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

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

Doctors can assess whether a patient has uncomplicated or complicated cystitis based on their medical history and symptoms. Also a urine sample can be examined at the doctor’s office using a test strip. If the symptoms lead to a clear diagnosis, further urine tests are usually not necessary.

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

Often, a visit to the General Practitioner is sufficient, but people affected can also turn to a gynecologist or urologist.

For many women affected, cystitis is unpleasant but a one-time or rare issue. For others, it's a recurrent problem. Antibiotics usually help to relieve acute cystitis quite fast and shorten the duration of the disease. But there’s not always a 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. Affected persons can talk to their doctor about whether it makes sense to use antibiotics. If someone has complicated cystitis, though, it will definitely have to be treated with antibiotics. 

With mild to moderate symptoms, painkillers like paracetamol or ibuprofen can present an alternative. 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.

More detailed information, for example on the treatment of cystitis, can be found at gesundheitsinformation.de.