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    Bacterial cystitis: when to see a doctor

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      Bacterial cystitis is one of the commonest urinary tract infections (UTI) in the UK – about 40% of women will experience it at some point in their life. Suspected UTIs are responsible for 3% of all GP consultations in England, which could be as many as 10.2 million GP consultations each year in the UK.

      For women who have previously experienced cystitis, recognise the symptoms and know how to control it, is there a need to see a doctor at all? What should you do if cystitis sachets aren’t working? Should cystitis antibiotics be made available over-the-counter without a prescription? And are there any circumstances in which you should definitely see a GP?

      Can cystitis clear up on its own?

      Since infections are usually mild and often clear up on their own without the need for antibiotics, many have come to view cystitis as a pesky rather than dangerous infection. So, as a commonplace, often recurrent and reasonably benign infection, when should women see a doctor?

      How to manage cystitis at home

      Mild cases of cystitis will often get better by themselves within a few days and women who have had cystitis before may not necessarily need to see a GP. As a first course of action, try the following.

      Recognise cystitis symptoms quickly

      For those who have experienced it before, cystitis symptoms are easily recognisable:

      • A burning sensation when urinating
      • The need to urinate more frequently
      • Uncontrollable urgency to urinate
      • Dark and cloudy urine with a strong smell

      Give your body the best fighting chance

      • Drink lots of water to help flush the bacteria in your bladder out, and make sure you empty your bladder completely. Although this doesn’t sound ideal when cystitis makes it painful to urinate, it’s one of the best natural defences against early infection.
      • Avoid washing your genital area with perfumed soaps which can irritate your urethra. Similarly, avoid using harsh detergents or perfumed tampons which have the same effect. Only touch the area with clean hands and rinse thoroughly to remove all traces of soap. Opt for a shower over a bath, which can prolong exposure to irritating chemicals.
      • Avoid having sex until your cystitis has passed, as this may aggravate the infection further. Cystitis often develops as a result of bruising or damage to the urethral area.
      • Avoid wearing synthetic underwear or tight clothes for similar reasons – cotton underpants and loose trousers are a good solution.

      Cystitis relief at home

      Many women take dissolvable cystitis sachets containing sodium citrate or potassium citrate, which can help to relieve cystitis symptoms. These potassium or soidum citrate cystitis sachets work to reduce the acidity of your urine and thus reduce the burning sensation when urinating. It’s important to note that these won’t actually kill the bacteria in your bladder or fight the infection.

      Soidum citrate cystitis relief sachets don’t require a prescription, and can be bought over-the-counter at most pharmacies. You can also take anti-inflammatories like ibuprofen or aspirin to ease painful symptoms.

      Adjust your diet

      Some people believe certain ‘trigger foods’ can increase the discomfort caused by cystitis. Alcohol, coffee, acidic fruits, spicy foods and sweeteners in particular are believed to cause further bladder irritation.

      Cranberry juice has historically been linked to preventing cystitis, although there is very little scientific evidence to support any significant benefits. Most recently, research carried out by the Cochrane Collaboration concluded that cranberries were no more effective in preventing cystitis than drinking water.

      When to see a GP about cystitis

      In the following circumstances, you should definitely see a doctor if you believe you may have cystitis:

      • Minor cystitis symptoms do not clear up in 2 days
      • Cystitis symptoms become more severe (e.g. blood in urine or fever)
      • You get cystitis frequently
      • You are diabetic or have an impaired immune system
      • You are pregnant
      • You are over 65
      • Antibiotics to treat cystitis don’t appear to be working
      • Symptoms reappear shortly after finishing a course of antibiotic

      It is important to see a doctor in such cases so that they can run further tests or prescribe antibiotics to treat cystitis. If you suffer from recurrent bacterial cystitis, a doctor will need to examine you to rule out other serious health complications including diabetes, kidney stones, and abnormalities in the urinary tract.

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      Cystitis treatment

      Antibiotics are the only effective treatment for persisting bacterial cystitis, and you should start feeling better within a day or two of taking them.

      They need to be prescribed by a doctor, who will be able to work out the right course for you – a common one is nitrofurantoin.

      Crucially, you need to complete the whole antibiotic course you are prescribed, even if cystitis symptoms disappear soon after taking medication. Failing to complete the course can lead to bacterial resistance  and it will be harder to treat the infection.

      Antibiotic courses for cystitis
      One-off, straightforward cases of cystitis can be treated with an antibiotics course for 3 to 7 days. More severe cases or kidney infection may require a 14-day course.

      Those with recurrent cystitis can get a stand-by antibiotic prescription which they can take to a pharmacy in the event of a future attack. Alternatively, in exceptional cases a doctor may prescribe a continuous low-dose course of antibiotics to be taken for 6 to 12 months.

      Need cystitis treatment today? If you do have cystitis but do not have time to see a GP in person – or can’t afford to wait for the infection to become severe – you can request a same-day prescription for cystitis antibiotics online via our cystitis service. Our doctors will be able to confirm whether antibiotic treatment is necessary.

      Over-the-counter antibiotics for cystitis
      Since cystitis is common and fairly straightforward to treat, some argue that cystitis treatment should be made available without the need for prescription, as in the case of the morning after pill.

      This would provide women with quicker access to treatment, whilst also freeing up GP time for more critical appointments.

      However, in the face of growing microbial resistance to antibiotics many doctors are cautious about making antibiotics more easily available. The more routinely people take antibiotics, the higher the chances of bacterial resistance.

      Antibiotics are the main line of defence for many bacterial infections and many doctors believe they should only be used once all other treatment options have failed. In mild cases of cystitis, antibiotic treatment might not even be necessary at all.

      Health concerns linked to cystitis

      If you experience more than two UTIs within six months or three within a year, you will be classed as having recurrent cystitis. There are a whole host of health concerns linked to recurring cystitis, so it’s important to see your doctor to test for these.

      Interstitial cystitis
      Interstitial cystitis (IC) is a long-term chronic inflammation of the bladder wall. Crucially, it is not caused by bacteria so cannot be treated with antibiotics. It is commonly misdiagnosed as bacterial cystitis, as it shares common symptoms, although IC also causes intense pain in the bladder and pelvic region which can increase after sex or during menstruation.

      IC requires a completely different treatment to bacterial cystitis and unfortunately cannot be cured – only treated. You should see your doctor if you experience any of the above; they will be able to prescribe antispasmodic medicines and a type of anti-depressant to ease the pain, and may also refer you to a urologist for further tests.

      Kidney infection
      If an established bout of cystitis is left untreated, bacteria can travel from the bladder through your urinary apparatus to infect the kidneys. Kidney infection (pyelonephritis) can be very serious and needs to be treated as soon as possible. Kidney infection symptoms include fever, pain in the back or abdominal region, nausea and fatigue, alongside UTI symptoms.

      Misdiagnosed STI
      Cystitis shares similar symptoms with some common sexually transmitted infections (STIs), such as chlamydia and gonorrhoea. If you experience unusual vaginal discharge as well as a stinging sensation when urinating, you may well have an STI. In such cases, you should see your doctor as soon as possible. If you have ever had unprotected sex or believe you may have been exposed to an STI, take an STI test.

      Diabetes
      Diabetes can increase your risk of getting cystitis, as the high sugar content of diabetics’ urine encourages bacteria to grow. Your doctor may test for diabetes if you get recurrent cystitis.

      Kidney stones
      Recurring cases of severe cystitis can also be due to the presence of kidney stones. In such cases, cystitis symptoms might be accompanied by a persistent pain in the lower back or groin, nausea or blood in your urine. You should visit your doctor if you experience any of these severe symptoms or if you get cystitis regularly.

      References
      https://www.bbc.co.uk/news/uk-england-derbyshire-49031625
      https://www.cochrane.org/CD001321/RENAL_cranberries-for-preventing-urinary-tract-infections

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