Brief overview
- Symptoms: Frequent, painful urination of small amounts of urine, cramp-like pain in the bladder, often unpleasant smelling, cloudy urine (rarely with blood), sometimes fever.
- Causes and risk factors: Mostly bacteria, sometimes other pathogens, often due to carriage of bacteria from the anal region; risk factors: frequent sexual intercourse, urinary drainage obstructions, bladder catheters, diabetes mellitus, immune diseases
- Diagnosis: Medical history, various urine examinations, ultrasound examination (sonography), if necessary further examinations such as urine flow measurement (uroflowmetry) or micturition cystogram (X-ray examination).
- Prevention: Sufficient fluid intake, regular urination, certain contraceptive methods, proper intimate hygiene; in chronic cases, medications or e.g. immune stimulation are an option after medical consultation.
What is cystitis?
Cystitis is typically accompanied by a frequent urge to urinate and pain during urination. In most cases, cystitis is uncomplicated. However, if left untreated, it sometimes leads to pyelonephritis, which is a serious complication that requires urgent medical attention.
After menopause, the risk of bladder infections increases again slightly. Due to the decreasing estrogen level, the mucous membrane in the urethra becomes thinner, which makes it easier for germs to penetrate to the bladder.
Bladder infections occur more often in babies and young children, regardless of gender. One reason is that the immune system is not yet as well developed as in adults. If cystitis occurs particularly frequently, possible malformations of the organs of the urinary tract and genitals are sometimes present, especially in young boys.
Complicated or uncomplicated cystitis?
However, if one of these factors is met, it often promotes the development of cystitis and causes complications. Doctors define this as a complicated form of cystitis.
Special forms of cystitis
In addition to the classic cystitis, there are some other, significantly rarer forms, such as:
- Interstitial cystitis is chronic and has no bacterial or viral cause.
- In emphysematous cystitis, gas formation occurs in the bladder, often affecting diabetics.
Is cystitis contagious?
With proper hygiene, the risk of infection of cystitis is low, but still present.
Direct infection is also possible through sexual intercourse. Here, condoms usually prevent the bacteria from reaching the urethra.
What are the symptoms?
The classic signs of a common (uncomplicated) bladder infection are pain when urinating, which is usually felt as a burning sensation. In addition, a strong and frequent urge to urinate is typical for the inflammation of the bladder. In most cases, only small amounts of urine are discharged during urination.
- Pain during urination
- Difficulty urinating
- Frequent urination
- Increased urination at night (nocturia)
- Pain in the bladder area (suprapubic pain)
- Cramping, painful contraction of the bladder with a strong urge to urinate (tenesmus)
In addition, there are other signs, some of which are indicative of cystitis:
- Cloudy and/or unpleasant smelling urine
- Increased discharge (fluorine) in women, if the infection also extends to the vagina
- Fever, but rare in simple cystitis.
- Uncontrolled leakage of urine: urge to urinate is so sudden and compelling that affected persons can no longer make it to the toilet in time (urge incontinence)
- Urine color brownish or reddish: In rare cases, there is visible discoloration of the urine due to blood (macrohematuria). Blood admixtures not visible to the naked eye, on the other hand, are more common (microhematuria).
What causes cystitis?
By far the most common cause of cystitis is bacteria. In most cases, the pathogens originate in the intestines, enter through the urethra and “climb” up to the bladder. The reverse case, where the inflammation starts at the kidneys and the germs then descend from there via the ureters to the bladder, is very rare.
More rarely, there are also cases of cystitis without bacteria as a trigger. In such cases, fungi such as Candida albicans, parasites and viruses (for example, adeno- or polyoma viruses) are also possible causes of cystitis.
Otherwise, cystitis sometimes also occurs as a side effect of certain drugs, for example cyclophosphamide, which is used for tumor diseases. It is also possible that radiation in the pelvic region can cause cystitis (radiation cystitis).
What exactly happens during cystitis?
When cystitis occurs, the mucous membrane in the urinary bladder is affected.
Blood in the urine may also occur as a result of irritated bladder mucosa, but is one of the rarer signs of the disease.
Risk factors
Certain risk factors increase both the likelihood of developing cystitis and the risk of a complicated course. These include:
- Frequent sexual intercourse (honeymoon cystitis): mechanical friction allows intestinal pathogens from the anal region to enter the urethra more easily.
- Prolonged bladder catheter
- Bladder dysfunction: If urine backs up, bacteria find an optimal breeding ground in it to multiply. This may cause recurrent urinary tract infections.
- Diabetes mellitus: Affected individuals are generally more susceptible to infections, and the increased sugar in the urine also serves as a nutrient for bacteria.
- Weakened immune system: caused, for example, by hypothermia (cold, wet clothing) or psychological influences such as stress.
- Mechanical interventions such as cystoscopy and irrigation.
- Pregnancy and puerperium: The urinary tract is dilated due to the change in hormones during pregnancy and in the first weeks after birth. This makes it easier for germs to penetrate and ascend into the urinary tract.
How is cystitis treated?
The goal of treatment for cystitis is primarily to make the bothersome symptoms subside more quickly and to prevent possible complications. Uncomplicated cystitis often heals on its own without the use of antibiotics. In principle, it is advisable to see a doctor if you have symptoms and especially if the cystitis does not go away.
General and drug therapy measures
With the right therapy for cystitis, the doctor is able to speed up the recovery process and keep an eye on possible risk factors. He usually prescribes general therapy measures and, if necessary, medications such as antibiotics.
Furthermore, herbal alternatives can be used especially for frequently recurring bladder infections. These include, for example, preparations with bearberry leaves, nasturtium or horseradish root. In the case of bearberry leaves, it is important not to use them for longer than a week and no more than five times a year. It is best for those affected to talk to their doctor beforehand.
As with almost all bacterial infections, antibiotics are the drug of choice for cystitis caused by bacteria. Doctors usually prescribe them in capsule or tablet form. In more severe cases, when the cystitis leads to inflammation of the kidney pelvis (pyelonephritis), antibiotics are sometimes administered directly into the vein as an infusion.
In principle, doctors try to keep antibiotic therapy as effective and short as possible in order to reduce the risk of so-called resistance to antibiotics developing. Resistances are insensitivities of bacteria to certain active substances.
If a therapy with antibiotics shows no effect, this often has different reasons. Sometimes it is due to application errors when taking the medication, or unrecognized risk factors prevent success. If the cause cannot be eliminated, doctors usually switch to another antibiotic.
Cystitis: Treatment in pregnancy
The treatment of cystitis during pregnancy is also based on antibiotics. However, doctors use preparations that are well tolerated during this particular phase of life. These are primarily active ingredients from the penicillin and cephalosporin groups, as well as fosfomycin-trometamol.
Since cystitis during pregnancy sometimes leads to serious complications, it is important to see a doctor as early as possible. Only in this way it is possible to start with the appropriate treatment and avoid complications. Even when using over-the-counter preparations or home remedies, it is important to consult a doctor in advance during pregnancy.
Cystitis: Home remedies
Preparations containing D-mannose, which are mainly used as a preventive measure for uncomplicated, recurring urinary tract infections in women, are also generally available without prescription from drugstores or pharmacies. In children with frequent bladder infections, doctors recommend the use of mannose only from late childhood and adolescence.
Home remedies have their limits. If the symptoms persist for a long time, do not get better or even get worse, you should always consult a doctor.
Which home remedies also help and which are better to avoid, you will learn here: Cystitis – Home Remedies.
Homeopathy – treat cystitis without antibiotics?
Homeopathic remedies can be used to complement conventional medical treatment of cystitis, but the concept of homeopathy and its specific efficacy are controversial in science and have not been clearly proven by studies.
For more information, click here: Homeopathy for cystitis.
How is cystitis diagnosed?
In a young, otherwise healthy woman, cystitis has a different significance than, for example, in young men, pregnant women or diabetics.
The medical history often also shows whether the cystitis is complicated or uncomplicated.
Urine diagnostics
In other cases, such as in pregnant women, children or young men, further examinations follow the taking of the medical history. Urine diagnostics are particularly important in cases of suspected cystitis. The doctor arranges for the urine to be examined for bacteria and blood, using various methods:
- The microscopic urine examination: Enables a more precise estimation of the bacterial count and identification of cells.
- The urine culture: Here, the pathogens present in the urine are grown on a special nutrient medium in order to then identify them precisely.
The urine test strip is not sufficient as the sole diagnostic instrument. However, the doctor uses it if it is first necessary to clarify whether bacteria are present in greater numbers in the urine at all. If there are no symptoms of cystitis, although the number of bacteria in the urine is increased (asymptomatic bacteriuria), treatment is not absolutely necessary.
For the urine sample for examination, doctors ask for the so-called “midstream urine”. This means that the urine is to be collected from the already running urine stream. The first or last milliliters therefore go into the toilet.
Imaging examinations
If inflammation of the kidneys or other complicating factors are suspected, ultrasound examination (sonography) is available as a further examination. This makes it possible to determine the amount of residual urine, which allows the physician to draw conclusions about a bladder emptying disorder.
What is the course of cystitis?
The vast majority of cystitis is harmless. A simple cystitis heals either spontaneously or with the right antibiotic therapy after just a few days. Some women experience recurrent cystitis at regular intervals, and the risk increases especially with age.
If you notice the typical symptoms of cystitis, seek advice from a doctor as soon as possible. Even though a common bladder infection is relatively harmless, the risk of complications increases if those affected simply wait. The risk of chronic bladder infections can also be significantly reduced with timely antibiotic therapy.
Possible complications of cystitis
Recurrent cystitis: For people who suffer from cystitis particularly frequently, doctors also refer to chronic or recurrent cystitis. By definition, doctors consider this to be the case when at least two cystitis episodes occur every six months or three per year. In this form, untypical pathogens are also more often the triggers.
In addition to a general, severe feeling of illness, pyelonephritis also presents with the symptoms typical of an infection of the upper genitourinary tract. Specific signs of illness of an inflammation of the bladder are often added. Kidney function, on the other hand, is not affected.
Epididymitis: Just as the pathogens in some cases ascend to the renal pelvis, in men they reach the epididymis via the vas deferens. The result is an inflammation of the epididymis, which is accompanied by swelling and sometimes severe pain. Since the sperm cells mature in the epididymis, infertility may even occur in extreme cases.
Pregnancy complications: Pregnant women are more likely to suffer from bladder infections due to certain hormonal changes. In rare and particularly unfavorable cases, there may be a risk of premature birth, reduced birth weight and a certain form of high blood pressure during pregnancy (preeclampsia).
How to prevent cystitis?
Some people are more prone to getting a bladder infection than others. This depends on various factors. However, there are certain measures that help keep the urinary tract healthy. In addition, there are other preventive options for recurring bladder infections, but some of these require a doctor’s consultation.
What you can do yourself
- Drink plenty: preferably at least two liters of water and unsweetened herbal or fruit tea.
- Visit the toilet regularly: Try not to suppress the urge to urinate. If the urine flushes the urethra more frequently, it is harder for bacteria to rise there. Especially after sexual intercourse, it is important for women to urinate (within ten to fifteen minutes).
- Note the direction of wiping: If you wipe from front to back after going to the toilet, you do not rub the bacteria from the anus into the urethra.
- Keep warm: Especially the feet and the abdomen. Cooling down weakens the immune system, which makes it easy for bacteria to grow.
- Ensure regular but not excessive intimate hygiene: It is best to wash the intimate area only with warm water or a washing lotion with a pH value adapted to the vaginal environment. Soap, intimate sprays or disinfectants sometimes irritate the sensitive mucous membrane.
Prevention of recurrent cystitis
- D-mannose: According to initial studies, D-mannose appears to have a preventive effect similar to antibiotics for recurrent urinary tract infections. Mannose binds to the cell processes (pili) of the bacteria and thus prevents them from attaching to the bladder mucosa.
- Immune stimulation: With the help of the administration of killed pathogens, it is also possible to train the immune system in such a way that fewer bladder infections occur. Immune stimulation is possible both by taking tablets and by administering injections (vaccine).
- Estrogen: Post-menopausal women are helped in some cases by the use of a prescription estrogen ointment to reduce the incidence of urinary tract infections.
According to some studies, the use of prebiotics or certain strains of lactobacilli as well as the intake of cranberry also seem to be able to prevent recurrent bladder infections. However, sufficient scientific evidence is (still) lacking. Data on cranberry products (e.g. juice, capsules, tablets) are inconsistent. For this reason, the currently valid medical guidelines do not make any specific recommendations.
