Cystitis – Causes, Symptoms and Treatment

What is Cystitis?

Cystitis is an inflammation of the urinary bladder, most commonly caused by a bacterial infection. It is one of the most frequent types of urinary tract infection (UTI) and primarily affects women due to their shorter urethra. Men can also develop cystitis, although this is less common.

Causes

The most common cause of cystitis is the bacterium Escherichia coli (E. coli), which normally lives in the intestine and can enter the bladder through the urethra. Other possible pathogens include:

• Staphylococci
• Klebsiella species
• Proteus mirabilis
• Rarely: fungi or viruses

Contributing risk factors include:

• Insufficient fluid intake
• Poor genital hygiene
• Sexual activity
• Hormonal changes (e.g., during pregnancy or menopause)
• Urinary tract abnormalities or urinary retention
• Weakened immune system
• Diabetes mellitus

Symptoms

The typical signs and symptoms of cystitis include:

• Pain or burning sensation during urination (dysuria)
• Frequent urge to urinate, even when little urine is produced (pollakiuria)
• Cloudy, foul-smelling, or blood-tinged urine
• Pressure or pain in the lower abdomen
• Occasionally a mild fever

If fever exceeds 38.5 °C, chills, or flank pain occur, the infection may have spread to the kidneys (pyelonephritis), requiring immediate medical attention.

Diagnosis

Diagnosis is typically established through:

• Urinalysis: Detection of bacteria, white blood cells, and possibly blood in the urine
• Urine culture: Identification of the causative organism and antibiotic sensitivity testing
• For recurrent infections: ultrasound of the urinary tract or further urological evaluation

Treatment

Antibiotics

Uncomplicated cystitis is usually treated with antibiotics. Commonly used agents include fosfomycin, nitrofurantoin, and trimethoprim. Treatment duration ranges from 1 to 7 days depending on the medication. Antibiotic selection should ideally be guided by sensitivity testing to prevent antibiotic resistance.

General Measures

• Drink plenty of fluids (at least 1.5–2 litres per day) to flush bacteria from the bladder
• Apply warmth (e.g., a heating pad to the lower abdomen) to relieve discomfort
• Pain relievers such as ibuprofen or paracetamol for significant pain

Herbal and Complementary Remedies

Certain herbal preparations (e.g., bearberry leaf extracts, cranberry products) are traditionally used as supportive measures. However, scientific evidence for their effectiveness is limited. They may help relieve mild symptoms but do not replace antibiotic therapy when a bacterial infection is confirmed.

Prevention

• Stay well hydrated
• Wipe from front to back after using the toilet
• Urinate before and after sexual intercourse
• Avoid tight-fitting synthetic underwear
• Avoid getting cold in the pelvic region
• For recurrent infections: consult a doctor regarding long-term preventive strategies

References

1. European Association of Urology (EAU) – Guidelines on Urological Infections, 2023.
2. Hooton, T.M. – Uncomplicated Urinary Tract Infection. New England Journal of Medicine, 366(11), 1028–1037, 2012.
3. World Health Organization (WHO) – Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report, 2022. Available at: www.who.int