What causes cystitis?

Cystitis is an inflammation of the bladder which can lead to pain and discomfort when urinating. It is very common amongst women - half of women will suffer from cystitis at least once in their lives - and it is usually very easy to treat, either with over-the-counter painkillers or prescription antibiotics. However, knowing both the symptoms and causes of cystitis, you may be able to avoid it.

The symptoms of cystitis

Most commonly, cystitis presents with:

• pain, stinging or burning when you urinate
• the need to urinate often
• passing small amounts of dark, strong-smelling urine
• traces of blood in your urine
• pain in your belly or in your lower back
• feeling unwell or feverish

These cystitis symptoms usually indicate that you have cystitis, however they can also be caused by other medical conditions, including sexually transmitted infections. They could also point to vaginal thrush (in women) or prostatitis (in men).

Cystitis causes

Cystitis is usually caused by a bacterial infection in the bladder which irritates the bladder lining. It can also be caused by damage to or irritation of the urethra.

Bacterial infection

There is usually no obvious reason why the urinary tract gets infected, although some women find that they develop cystitis after sex.

Urine infections can happen as a result of bacteria being transferred from the anus to the urethra. This is far more common in women than in men, as the female urethra is shorter and closer to the anus.

In women, bacteria can be spread by wiping from back to front after going to the toilet, inserting a tampon or using a diaphragm. If you do suffer from cystitis and use a diaphragm you might want to think about changing your method of contraception.

Infections can also occur as a result of not emptying your bladder fully when you urinate. If you find that you are not emptying your bladder properly, it might be because of a blockage in your urinary system. Pregnant women can sometimes find it hard to fully empty their bladders as pregnancy can lead to pressure on the pelvic area.

Cystitis can also be more common in women who have been through the menopause, as they produce fewer vaginal secretions, allowing bacteria to multiply.

Damage or irritation of the urethra

In both men and women, damage to the urethra can cause cystitis. The urethra may be damaged by:

• sex
• chemical irritants (most commonly fragranced soaps or powders)
• kidney infections or prostatitis
• diabetes
• damage caused by a catheter

Menopausal women are also at increased risk because they produce less oestrogen, meaning the lining of their bladder and urethra becomes thinner and more prone to damage.

What can I do to avoid cystitis?

The best thing to do is familiarise yourself with the cystitis causes listed above and assess whether you might be at risk. Once you have done this, you could try out some preventative methods such as:

• wearing loose cotton underwear
• avoid wearing tight jeans or trousers
• wiping from front to back after going to the toilet
• not holding in urine when you feel the urge to go
• emptying your bladder as soon as possible after having sex
• using unscented soaps to wash around your genitals, and avoiding over-washing
• avoiding constipation

If you are a woman you should make sure you see your GP if:

• this is the first time you have ever had cystitis
• you have blood in the urine
• you’ve had cystitis 3 or more times in the last 1 year or twice in the last 6 months
• if your symptoms recur within 2 months of completing a course of antibiotics or do not improve after having taken antibiotics
• you are pregnant
• you have a catheter
• you have a condition that suppresses your immune system
• if you have a high fever, severe pain or if your symptoms worsen you should see a doctor immediately

Men with cystitis symptoms should always see their GP.

Cystitis and sex

As stated above, sex can often be a cause of cystitis. This may be partly due to the movements during sex which may push bacteria up into your bladder. There may also be slight damage to your urethra, which encourages bacteria to thrive. This is more likely if your vagina is dry during sex.

To avoid cystitis, go to the toilet to empty the bladder after sex. If your vagina is dry use a lubricant during sex. The normal mucus in and around your vagina may also be upset if you use spermicides or diaphragm contraceptives, therefore if you suffer from cystitis it might be worth avoiding these and using an alternative method of contraception. If you would like to consider alternative contraceptive options, you can visit our contraception information page or contraception clinic.

Where possible, you should be open with your sexual partner about the precautions you want to take. Remember not to feel embarrassed - cystitis is incredibly common and in most cases nothing to worry about.

Cystitis is not contagious and cannot be passed to your partner during sex.

Cystitis treatment

In many cases, mild cystitis will pass on its own after a few days. The first time you get cystitis, however, you should always visit your GP. After this you will be familiar with the symptoms and be able to decide whether you require antibiotics or not. If your symptoms are not improving or you think you would like to treat it medically, you can get a prescription for a course of antibiotics from your GP or one of our doctors.

If you are prescribed antibiotics, your symptoms should start to improve after the first day of taking them. If your symptoms don't improve after a course of antibiotics, go back to see your GP.

Read our article on cystitis treatment for more information.