Cystitis or UTI

03.07.2020

If you are a female and you suddenly have symptoms like painful and frequent urination you may have cystitis. This also called urinary tract infection (UTI), affects women almost exclusively. Actually, almost half of all of them will experience at least one episode of cystitis during their lifetime.

Most of the time, women have uncomplicated cystitis. It means that it can be sporadic or recurrent and is limited to non-pregnant women with no comorbidities and without relevant anatomical and functional abnormalities within the urinary tract.

Risk factors include sexual intercourse, use of spermicides, a new sexual partner, a mother with a history of UTI, and a history of UTI during childhood. Most cases of uncomplicated cystitis are caused by E. coli.

The diagnosis of uncomplicated cystitis can be made based on symptoms, like painful, frequent, urgent urination and the absence of vaginal discharge. In these cases, urine dipstick or urine analysis is optional. Taking a urine culture is recommended in patients with atypical symptoms, pregnant, suspect of kidney infection or who fail to respond to appropriate antimicrobial therapy.

The first-line treatment is empiric and has high chances to be effective. The following antibiotics can be used when available:

  • Fosfomycin trometamol 3 g single dose
  • pivmecillinam 400 mg three times a day for three to five days
  • nitrofurantoin (e.g. nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for five days)

For recurrent bladder infections, work with your doctor to develop a strategy to reduce recurrences and the discomfort that cystitis can cause. 

Cystitis in pregnancy

Urine analysis and culture are strong guidelines recommendations. Short courses of antimicrobial therapy can also be considered for the treatment of cystitis in pregnancy, but not all antimicrobials are suitable during pregnancy.

Cystitis in men

Cystitis in men without the involvement of the prostate is uncommon and should be classed as a complicated infection. Therefore, treatment with antimicrobials penetrating the prostate tissue is needed in males with symptoms of UTI. A treatment duration of at least seven days is recommended, preferably with trimethoprim-sulfamethoxazole or a fluoroquinolone if in accordance with susceptibility testing.

Q&A section

Q: how cystitis occurs and  why cystitis is more common in females?

A: The female urethra is short and it is easy for the bacteria coming from the bowel and contaminating the perineal area, to enter and to replicate inside the bladder. Risk factors include low water intake, sexual intercourse, use of spermicides, a new sexual partner, a mother with a history of UTI, and a history of UTI during childhood.

Q: how cystitis is diagnosed?

A: in adult woman non-pregnant, without comorbidity or any anatomical and functional abnormalities within the urinary tract, the diagnosis is based on symptoms of painful, frequent, and urgent urination. Urine culture is recommended in patients with atypical symptoms, pregnant, suspect of kidney infection, or who fail to respond to appropriate antimicrobial therapy.

Q: will cystitis go away on its own without antibiotics?

A: in some cases of mild cystitis, the self-recovery is possible. However, by increasing the water intake, low bacterial count inside the bladder can be washed-out with frequent urination.

Q: can cystitis cause blood in urine?

A: yes, 10% of patients with cystitis/UTI can have hematuria.

Q: which antibiotics are used to cure cystitis?

A:  Fosfomycin trometamol 3 g single dose, pivmecillinam 400 mg three times a day for three to five days or nitrofurantoin (e.g. nitrofurantoin monohydrate/macrocrystals 100 mg twice daily for five days) is the first line of treatment for uncomplicated acute cystitis.

Q: can cystitis cause fever?

A: uncomplicated cystitis does not cause fever. Symptoms of cystitis with fever can occur when the infection spread up to the kidney. In this case, cystitis becomes kidney infection This infection needs to be treated immediately.

Q: can cystitis cause itching?

A: yes. However, itching is less frequent than painful, frequent and urgent urination.

Q: can cystitis be caused by stress?

A: yes, stress can lead to unhealthy eating, irregular bowel movements and gout changes, low water intake, poor hygiene, and weakness of the immune system. All these conditions can facilitate bacterial growth.

Q: can cystitis cause bloating?

A: yes, in some cases irritation of the bladder causes some visceral nervous reflex that can affect the bowel function.

Q: are cystitis and UTI the same?

A: yes, cystitis is commonly referred to as UTI or Urinary Tract Infection.

Q: are sachets safe in pregnancy?

A: Some antibiotics are considered safe during pregnancy. In general, penicillins, cephalosporins, fosfomycin, nitrofurantoin (not in case of glucose-6-phosphate dehydrogenase deficiency, and during the end of pregnancy) can be considered in a pregnant patient.

Q: when cystitis doesn't go away and when to see a doctor?

A: Usually, the recovery is fast. The day after treatment, most of the symptoms should be solved. However, persistent symptoms can be due to anatomical or functional abnormalities of the urinary tract or antibiotic resistance. Self-treatment using the first line of antibiotic treatment has recommendations in the guidelines in order to improve the quality of life in selected cases with recurrent uncomplicated cystitis. In regular cases, prescriptions have to be issued by a physician. Seeing a doctor is also a good idea in cases of delayed, no recovery or in case of pyelonephritis.

Q: why cystitis just before and on period?

A: Estrogen and progesterone drop during the beginning of the menstrual cycle. This doesn't mean that lowered estrogen levels during menstruation cause UTIs but it may have some worsening effect on an existing otherwise mild UTI. It is generally thought that this hormone plays a role in a woman's susceptibility to UTIs and that it has anti-inflammatory properties that help to fight the effect of a UTI.

Q: why cystitis during pregnancy?

A: the pregnancy increases the risk of getting acute cystitis. During pregnancy, the tract becomes relaxed and dilated, the bladder is compressed, and the chances of bacterial growth increase. This puts the patient at a higher risk of UTIs.

Q: Are there home remedies for cystitis?

A: home remedies can be used to treat mild cystitis or in association with first-line antibiotic therapy to treat regular cystitis. They are:

  • Use a heating pad. A heating pad placed on the lower abdomen can soothe and possibly minimize feelings of bladder pressure or pain.
  • hydration. Drink plenty of fluids to keep yourself hydrated. Avoid coffee, alcohol, soft drinks with caffeine and citrus juices - as well as spicy foods - until your infection clears. These items can irritate the bladder and aggravate a frequent or urgent need to urinate.
  • Take a sitz bath. Soak in a bathtub of warm water (sitz bath) for 15 to 20 minutes to help relieve pain or discomfort.