Self-help information for women suffering recurrent attacks of cystitis: Frequently asked questions

What is cystitis?

Cystitis is an inflammation of the bladder lining. It is common for the water outlet pipe (the urethra) to be affected as well. This makes the bladder and urethra very sensitive, a situation which is often made worse by acids in the urine.

The usual symptoms are one or more of the following:

• a feeling of discomfort when you pass urine, usually a stinging or burning pain in the urethra
• a constant feeling that you want to pass urine; although you may be bursting to go, there is hardly any urine in the bladder
• a dragging ache in your lower abdomen
• dark or ‘strong’ urine which may contain visible blood from the inflammation

What is the cause?

Cystitis is a common problem which affects over half of the women in this country at some time in their lives. Quite a few women are subject to repeated attacks.

The commonest cause is that bacteria enter the bladder through its entrance (the urethra). This occurs because the entrances to the urethra, vagina and anus are very close together allowing easy access to the bladder. The commonest bacteria which cause cystitis are E coli; these are found in large quantities in the bowel where they do no harm. Urine normally contains no bacteria but, if these germs do get into the bladder, they can cause cystitis.

In a few cases, cystitis can be triggered by sexual intercourse.

In most cases, the infection is more of a nuisance than a danger. It is possible, however, for infection to spread up from the bladder to the kidneys and this can be more serious.

What can I do about it myself?

There is a lot you can do for yourself both to relieve an attack and to prevent another one, but you should always see your doctor.

• As soon as you feel the first twinges, start drinking water. Avoid strong coffee, tea or alcohol.
• Consider taking one teaspoon of bicarbonate of soda dissolved in water and repeat this every three to four hours, or buy an over the counter cystitis remedy containing potassium citrate. These both act to reduce the acidity of the urine and help to relieve the stinging.
• Keep warm and place a hot water bottle over your tummy or between your thighs to ease the abdominal discomfort.
• Take a mild painkiller such as ibuprofen or paracetamol.
• Do not self-medicate with antibiotics left over from previous infections or from other people.
• If you have been prescribed ‘self-start antibiotics’ by your doctor or urologist, start taking the tablets after you have provided a urine sample for your doctor to send to the laboratory.

How can I prevent further attacks?

• Drink plenty (2 litres) of fluid (water) each day.
• Use plain water for washing around the perineum and vaginal area - always wipe from ‘front to back’.
• Avoid bubble baths, talcum powder, all personal (vaginal) deodorants and feminine wipes.

If your symptoms are related to sexual intercourse, you should wash carefully with plain water before having intercourse. It is helpful to empty out your bladder immediately after intercourse to flush out any germs which may have entered the urethra.

Some women, however, continue to suffer problems despite these measures experiencing recurrent cystitis after sexual activity. In this situation, it is best to take a single antibiotic tablet (nitrofurantoin, trimethoprim or cephalexin) immediately after intercourse and to take regular cranberry juice or tablets.

Cranberry preparations (tablets) can help prevent infections

When should I contact my GP?

You should always contact your GP for a sudden attack of cystitis and he/she will normally ask you for a mid-stream urine specimen. If you have a vaginal itch or discharge, a vaginal swab may also be taken. If the infection persists or has spread to your kidneys, a referral for an ultrasound or to a specialist in urinary disease may be arranged.

What treatment will my GP give me?

The causes of cystitis are different for different people. Your doctor will advise you on what is best for you. He/she may give you antibiotics but may not prescribe anything at all, simply giving you advice along the lines mentioned above. If you are prescribed antibiotics, it is important to complete the course as instructed; you should also produce a post treatment mid-stream urine specimen, approximately one week after you have finished the antibiotics.

Some patients’ attacks of cystitis can be controlled by long term, low dose antibiotics or other treatments and your GP will advise you on the need for this.

Other information

This patient information leaflet provides input from specialists, the British Association of Urological Surgeons, the Department of Health and evidence based sources as a supplement to any advice you may already have been given by your GP. Alternative treatments can be discussed in more detail with your urologist or specialist nurse.

Who can I contact for more information?

Oncology nurses

Uro-oncology nurse specialist
01223 586748

Bladder cancer nurse practitioner (haematuria, chemotherapy & BCG)~
01223 274608

Prostate cancer nurse practitioner
01223 274608 or 216897 or bleep 154-548

Surgical care practitioner
01223 348590 or 256157 or bleep 154-351

Non-oncology nurses

Urology nurse practitioner (incontinence, urodynamics, catheter patients)
01223 274608 or 586748 or bleep 157-237

Urology nurse practitioner (stoma care)
01223 349800

Urology nurse practitioner (stone disease)
01223 349800 or bleep 152-879

Patient advice and liaison service (PALS)
Telephone: 01223 216756
PatientLine: *801 (from patient bedside telephones only)
Email: CUH - PALS

Mail: PALS, Box No 53,
Cambridge University Hospitals NHS Foundation Trust,
Hills Road, Cambridge CB2 0QQ

Chaplaincy and multi faith community
Telephone: 01223 217769
Email: CUH - Chaplaincy

Mail: The Chaplaincy, Box No 105,
Cambridge University Hospitals NHS Foundation Trust,
Hills Road, Cambridge CB2 0QQ

MINICOM System ("type" system for the hard of hearing)
Telephone: 01223 217589

Access office (travel, parking and security information)
Telephone: 01223 596060