The following © information is an extract from
“Sexplained One – Sex & Your Health” by Helen J Knox used here with permission.
What is cystitis?
Cystitis means inflammation of the bladder:
* cyst means ‘closed sac’ — of which the bladder is an example;
* itis means ‘inflammation of’.
It is more common in women than men.
Cystitis is also called honeymoon cystitis or honeymoon disease, although there is also a type called interstitial cystitis, which is a recurrent form of the condition, and is of unclear cause.
Where does cystitis come from?
There are many causes of cystitis, such as:
* E-coli – the most common bacteria to cause cystitis is the bowel germ Escherichia coli (E-coli). Sexual infections, such as chlamydia and gonorrhoea may also be involved;
* other bacteria – when bacteria that are harmless in the bowel or on surrounding skin enter the short
female urethra (urine passage) they can easily travel to the bladder where they multiply rapidly and cause irritation and inflammation;
* irritants – scented soaps, talcum powder and vaginal deodorants can irritate delicate mucous membranes and trigger cystitis;
* sexual activity – the pressure of thrusting during sex increases the chance of cystitis occurring, especially if the bladder is not emptied shortly after vigorous sex;
* diaphragm or cap use – women who use a contraceptive diaphragm or cap may experience cystitis more often than non-users because the diaphragm can press through the vaginal wall and against the bladder, trapping urine within it;
* pregnancy – pressure on the bladder from enlargement of the uterus can reduce bladder emptying and encourage stagnation of urine;
* prolapse – pressure on the bladder from a prolapsed uterus can stop the bladder emptying properly;
* menopause – post-menopausal women develop cystitis more easily because of hormonal changes that affect the urethra and vagina;
* clothing – tight trousers, tights (pantyhose) and nylon underwear encourage sweating or moisture in the genital area that germs thrive on;
* diabetes – diabetics are more prone to infection;
* catheterisation — bacteria can easily enter the bladder of people using a urinary catheter to pass urine, especially if it is not cared for very carefully;
* retention – ‘holding on’ or being unable to empty the bladder fully when the need is felt to pass urine is not sensible since it allows trapped germs the opportunity to multiply rather than be flushed out;
* prostatitis – men with prostatitis (inflammation of the prostate gland) and people with kidney stones are also more prone to cystitis;
* interstitial cystitis: recurrent, interstitial cystitis occurs where no infection is found although the bladder is inflamed and painful; and with time, it may also shrink in size;
* fistulae – rarely a fistula (abnormal passage) may develop between the vagina and the bladder (vesico-vaginal fistula), or the intestine and the bladder (vesico-enteric fistula) allowing bowel germs to enter the bladder very easily;
* gender — in general, men and children rarely experience cystitis — it most commonly affects women.
What might I notice if I have cystitis?
Women with cystitis may notice one or more of the following:
* a burning or stinging pain, with perhaps a dragging sensation whilst passing urine;
* an urgent need to pass urine more often but, when passed, little may flow;
* nocturia – the need to pass urine at night;
* raised temperature;
* low back pain;
* pain in the area of the pubic bone (under the mons pubis/area of pubic hair);
* haematuria – blood in their urine;
* cloudy or darker urine that may have an unusual smell (and may contain pus);
* air, passed in urine, when a fistula is present;
* generally feeling unwell.
Men with cystitis may notice:
* the same as women, but in addition, they may have an inflamed, swollen prostate gland which reduces the
flow of urine;
* pain during ejaculation, which may be blood-tinged.
People with interstitial cystitis may typically notice urgency (the urgent need to pass urine, often more than 40-50 times a day), which hurts and may induce a sensation of spasm or of pressure in the vagina, abdomen and urethra (urine passage).
How is cystitis passed on?
Cystitis is not a sexually acquired infection but a condition that develops.
It may occur after sexual activity and can be caused by transmittable bacteria
(e.g. chlamydia or gonorrhoea) but it can also develop in other ways.
How long does cystitis take to show?
Cystitis usually starts within a few hours of whatever has triggered it.
When is it important to seek medical advice for cystitis?
It is important to seek medical advice if you develop cystitis because the underlying cause needs to be understood, investigated and appropriate treatment given.
Depending on the cause, further and more serious kidney problems could develop.
Don’t guess or self-medicate.
In particular, you should seek medical advice if:
* you are sexually active;
* your symptoms include raised temperature, nausea, vomiting, lower back or abdominal pain;
* you have diabetes, kidney stones or another related medical condition;
* you have difficulty passing urine;
* the cystitis is recurrent;
* you are using any prescribed medication for a blood clotting disorder;
* you are caring for a child with
this condition or you are over 60 years of age.
What tests are there to check if I’ve developed cystitis?
Tests for straightforward cystitis include:
* urine ‘dipstick’ — when a test stick is dipped into the urine, to check for abnormalities;
* laboratory analysis of a urine sample — which if you are sexually active may include a check for sexual infections as well as culture and sensitivity — to see which, if any, bacteria grow and which treatment will work.
Tests when it is recurrent or more complicated include:
* an IVU (intravenous urogram) – a special type of x-ray to check how the kidneys, ureters (tubes that take urine from the kidneys to the bladder) and bladder are working;
* an ultrasound and/or a type of scan called a CT or computed tomography scan are used to ‘see inside’ the bladder;
* voiding cystourethrography and/or retrograde urethrography. in other words, when the bladder and urethra are x-rayed in a special way to see the size, shape and action
of the different areas;
* cystoscopy – when the inside of the bladder is viewed with a special instrument and small, shallow areas of bleeding, ulceration, stones or other abnormalities may be detected.
Can cystitis be cured?
Yes. Cystitis can be treated but it may develop again. Interstitial cystitis is, though, more problematic and may require ongoing therapy.
What complications can happen if cystitis is not treated?
The main complications of untreated cystitis depend on the cause but can include:
* physical discomfort;
* interstitial cystitis;
* pyelonephritis (kidney inflammation);
* kidney scarring;
* anxiety and psychological trauma until the underlying cause is understood.
Which home treatments and lifestyle changes may help me treat cystitis?
If your doctor is sure there is no underlying infection, check with them or a pharmacist about trying home remedies such as:
* taking your usual painkiller;
* drinking more water or other fluid, to flush your system and dilute your urine (usual advice, two litres / four pints a day);
* trying products containing sodium or potassium citrate that your pharmacist can sell you to help to reduce the acidity of your urine;
* or, for a similar effect, add half a teaspoon of bicarbonate of soda to a cold drink two to three times a day, for two days;
* reducing the amount of sugar, alcohol and fat in your diet to improve your immune system and help fight infection naturally;
* stopping smoking — since there is an acknowledged link between smoking (known to suppress the immune system) and bladder cancer;
* some people find it helpful to eat pineapple, which contains an enzyme believed to protect against cystitis but it’s not helpful for everyone;
* keeping a food diary, since some foods trigger an allergy. if you do this you can see if a pattern appears after eating certain food — you are then able to avoid it;
* some people, who get recurrent cystitis find that acupuncture helps them, but not everyone;
* drinking cranberry juice or taking cranberry capsules are often recommended and can be helpful if taken regularly as a preventative measure — but should not be taken with blood-thinning medication.
NOTE: if you are taking any medication always check with your doctor or pharmacist about drug interactions first.
What medical treatment is available for cystitis?
Medical treatments include:
* antibiotics — a short course taken correctly and consistently, for the full duration of the prescription;
* antihistamines – which help to reduce inflammation and may reduce the need to get up to pass urine at night;
* anti-inflammatories — which help to reduce discomfort, such as ibuprofen or aspirin;
* antispasmodics — which help to reduce muscle spasm and the need to rush to the toilet;
* antidepressants — which may help with the pain as well as help with any associated depression;
* electrotherapy — a TENS (transcutaneous electrical nerve stimulator) machine, often used by women in labour or people with back pain, may be used to encourage the body to produce endorphins or (natural painkillers);
* bladder instils — medication inserted into the bladder to reduce inflammation;
* surgery — to repair the bladder lining;
* antibiotics, for several weeks – particularly for men who develop cystitis due to prostatitis.
How soon can I have sex after having cystitis?
You can have sex again after treatment when you feel comfortable enough
to do so – but don’t rush it!
How can I prevent cystitis?
To prevent cystitis, check the lifestyle changes (above) and try the following:
* don’t get into the habit of ‘holding on’ when you feel the need to pass urine;
* pass urine and wash your genital area before and after sex;
* change sexual positions so that your bladder or urethra are not bruised during deep penetration;
* use an oral dam when receiving oral sex: germs in the mouth can be passed to the urethra so it is wise to use protection during oral sex, especially if your partner has a sore throat, cold sores or mouth ulcer at the time;
* don’t have vaginal after anal sex without changing the condom;
* when opening your bowels, prevent bowel germs entering your urethra or vagina, by wiping yourself from front to back, not back to front;
* drink plenty of fluid (as above);
* change to a different method of contraception if you use a diaphragm (cap) with spermicide and experience repeat attacks;
* post-menopausal women may ask their doctor about using oestrogen replacement cream to reduce the risk;
* women who get recurrent cystitis should discuss ongoing antibiotic treatment with their doctor.
NOTE: if sexually active, don’t assume. Don’t self-diagnose and don’t use home treatments without seeing your doctor or sexual health clinic for correct diagnosis.
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