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Informed Health Online.

Fact sheet: Cystitis in women

Last Update: January 16, 2013.

photo of young women
Many women know only too well the symptoms of cystitis, an inflammation of the bladder also often referred to as a urinary tract infection (UTI): frequently having to go to the bathroom, stinging and burning when passing urine. These symptoms are often very unpleasant, but they can be successfully treated. Uncomplicated cystitis usually clears up without any problems. Unfortunately, there is no sure-fire way to reliably prevent cystitis – and a lot of the prevention strategies that women use in everyday life have not yet been tested in scientific studies.

There is more information on this topic in our feature.

In this fact sheet we explain what causes bacterial cystitis and what prevention and treatment options there are. We will not discuss chronic cystitis such as interstitial cystitis, which is not caused by bacteria, in this fact sheet. We will also not get into the specifics of treatment in pregnant women here.

What is cystitis?

Uncomplicated cystitis is an inflammation of the mucous membrane of the bladder. It is normally caused by bacteria that get into the urethra and enter the bladder. Once in the bladder, the bacteria stick to the bladder wall and multiply, leading to an inflammation of the tissue lining the inside of the bladder. You can read more about the urinary system in our information "How does the urinary system work?"

Cystitis is far more common in women than in men, because women’s urethras are shorter, so the bacteria do not have as far to travel. More than half of all women get cystitis at least once in their life. And half of those who have had cystitis get it again within a year.

What are the symptoms of cystitis?

People who have cystitis have to pass urine frequently and this can be associated with a stinging and burning pain. So they not only have to go to the bathroom more often, but this can be far more unpleasant, too. Many women find that it is particularly painful when their bladder is almost or completely empty. The urge to pass urine often comes very suddenly and they quickly have to go to the toilet, but then usually only a small amount of urine comes out. Some women also have difficulties holding back urine, which can be very distressing. The urine sometimes has blood in it, may be cloudy in color and have an unusual smell.

Women report that the pain  can radiate into the entire abdomen or even the back. They may generally feel unwell and groggy, have difficulties sleeping, or feel tired, irritable and unable to concentrate.

If symptoms are limited to the lower urinary tract – the bladder and the urethra – an uncomplicated cystitis is assumed. If someone belongs to a certain risk group or the inflammation spreads to the kidneys, this is called complicated cystitis. This can happen if bacteria travel up the ureters and into the kidneys, leading to an inflammation of the renal pelvis, called pyelonephritis. The risk groups include people with reduced immune system or people with an existing kidney condition, for example. Changes or anatomical peculiarities in the urinary tract can favor complications too.

Especially the following symptoms can indicate complications and a spreading to the kidneys:

  • pain in the kidney area (flank pain)
  • possible nausea and vomiting

Pyelonephritis can be dangerous and should be treated quickly to avoid further health problems. This disease is very rare however – in otherwise healthy women cystitis usually has no serious consequences.

How is cystitis diagnosed?

Based on your medical history and symptoms, your doctor can assess whether or not you have uncomplicated cystitis. In addition, you can provide a urine sample to the doctor’s office to be tested for bacteria, white and red blood cells, proteins and nitrite (a salt that can serve as an indirect indicator of bacteria). But this test is usually not necessary if the symptoms are clear. You can read more about things that can be found out with a urine test in our information "Understanding urine tests."

Using an ultrasound device your doctor can look at your kidneys and bladder. This examination, called sonography, is generally only needed in complicated cases or if pyelonephritis is suspected. Cystoscopies and x-rays are also done in very rare cases, for example in severe cystitis that frequently recurs. A cystoscopy is a procedure that involves inserting a tube with a small camera at the end of it (an endoscope) into the urethra and guiding it through to the bladder. The camera produces pictures showing any changes that might occur on the bladder wall.

Do antibiotics help relieve acute symptoms?

Antibiotics have been proven to help in acute cystitis. They can make the symptoms go away completely. The pain and burning subside quickly – usually within one to three days.

It depends on the type of antibiotic how long it needs to be taken. Most antibiotics nowadays are taken for three days, or for more than five days. Previously, single doses were prescribed more frequently, which often was enough to relieve symptoms. But surviving bacteria often caused a relapse.

Three days of treatment is usually enough to relieve symptoms in most women. Taking antibiotics for longer does not improve symptom relief, but it does lead more frequently to adverse effects, such as fungal infections of the vagina, stomach and bowel problems or skin rashes. But more bacteria are left over in the bladder after the shorter course of antibiotics. It is not clear whether this leads to more frequent recurrences of cystitis.

So the choice of antibiotics needs to be considered individually: Women who want to be as sure as possible that the infection is completely gone might choose antibiotics that are taken for five or more days. Women who want to minimize the risk of adverse effects might prefer a medication that only needs to be taken for a short time. You can talk to your doctor about which antibiotic can be used in your case. Once you have decided on a medication it is important to take it as prescribed and not to stop therapy early.

You can read more about what should generally be considered when using antibiotics in our text "Using antibiotics correctly." And there is more information about research on using antibiotics in cystitis in "Urinary tract infections: Do antibiotics help?"

What else can I do if I have cystitis?

Many women try to “flush out” the bacteria by drinking a lot of water or tea. Home remedies like applying heat (for example, with a hot water bottle, electric blanket or warm bath) are also used to try to relieve pain and to relax. But there is no research on how effective these home remedies are.

Numerous herbal and homeopathic remedies are also used to treat cystitis, for example:

  • diuretic herbal products like birch leaf, horsetail or stinging nettles
  • products with bearberry leaves, cranberries or bilberries

None of these remedies has been scientifically proven to help, though, and some might even do harm when used long-term. The same is true for homeopathic products and procedures used in traditional Chinese medicine.

For women with recurrent cystitis, bladder irrigations are available, which aim to prevent bacteria from sticking to the bladder. Whether or not these bladder irrigations help has not been studied enough. German statutory health insurances do not cover the costs of this therapy.

In acute cystitis, pain killers can reduce the burning pain while passing urine. You will find more information about the possible adverse effects in the package insert of the drug. If you are not sure whether it makes sense to take a painkiller, or which one would be suitable for your situation, ask your doctor.

What increases the risk of getting cystitis?

Sexual intercourse increases the risk of getting cystitis, because that makes it more likely that bacteria will get into the urethra. Using sperm-killing agents (spermicides) and contraceptive diaphragms can also increase the risk somewhat.

Pregnant women are more likely to get cystitis. Other risk groups include people who have a bladder catheter, people who have anatomical changes in their urinary tract, and people who have diabetes mellitus, multiple sclerosis or a urological disease.

Women who have already had cystitis are also more likely to get it again. Cystitis is also more common after menopause.

How can cystitis be prevented?

Although cystitis is usually not a serious problem from a medical point of view, the symptoms are so unpleasant that they can interfere severely with everyday life. People who have recurrent cystitis may feel less like having sex or may be afraid to take part in certain leisure activities like swimming. Some women also find their symptoms embarrassing. For these reasons it is very important for many women to try to avoid getting cystitis.

Sometimes cystitis comes “out of the blue” and it is not clear what has caused it. But many women have had good experience paying attention to what factors in everyday life increase their likelihood of getting cystitis, and making the necessary changes. If that is not enough to make a difference, and they still have recurrent cystitis, there are medication options.

Lifestyle

Various everyday measures are said to help prevent cystitis. Because it has been shown that sexual intercourse can cause more bacteria to enter the urethra, one common piece of advice is to urinate soon afterwards in order to flush bacteria out of the urethra. Drinking a lot of water or tea is recommended for the same reason. Since sperm-killing agents and diaphragms can also increase somewhat the risk of getting cystitis, it can be worth to try out other methods of contraception.

Another strategy that is often mentioned is good intimate hygiene to try to stop intestinal bacteria getting into the vagina and urethra. For example, women are advised to always wipe themselves from front to back after going to the toilet.

It is often recommended that women make sure that their feet and abdomen do not get cold. General advice like getting enough sleep and avoiding stress are also sometimes given.

Even if these tips seem to make sense and are generally easy to incorporate into everyday life, there is no scientific evidence to say whether they help or not. Many of them will most likely never be studied in good-quality research.

Cranberry products

Cranberry products are sometimes recommended for the prevention of cystitis. These are available in pharmacies and drugstores in the form of juices, powder, capsules and tablets. But studies indicate that cranberries cannot prevent cystitis. Many women also find it difficult to regularly take these products for a long time.

Antibiotics

Antibiotics can also be used as a preventive measure in women with recurrent cystitis. But they then have to be taken over very long time periods, often for six to twelve months. The optimal amount of time is still not known. Although women generally get cystitis less frequently when they take antibiotics, they also quite often have adverse effects. These are usually digestive problems, rashes and fungal infections in the vagina. This is why quite a lot of women stop taking them after a while. What is more, using antibiotics too often carries the risk of bacteria becoming increasingly resistant to antibiotics, which means that these drugs might no longer work. You can read more about the problem of antibiotic resistance in "The safe use of antibiotics."

Hormones

In menopause, women’s bodies start to produce less of the female sex hormone estrogen. In some women this makes the membranes lining the vagina thinner and drier, which means that it is easier for bacteria to colonize them, making cystitis more likely. Estrogen creams aim to prevent this from happening. They are applied to the inside of the vagina regularly and can help some women to get cystitis less frequently. But they can also have adverse effects, like vaginal itching and burning. Also, not much is known about the effects of using estrogen creams for longer periods of time (longer than eight months).

Estrogens are also available as vaginal tablets. It has not been studied yet whether applied in this form they also have an effect on preventing cystitis.

Taking estrogen tablets orally, on the other hand, cannot prevent cystitis. What is more, they can lead to adverse effects after a few months, such as breast tenderness, light vaginal bleeding, and rashes. You can read more about the long-term use of hormones in menopause in the text "Menopause: What are the benefits and risks of long-term hormone therapy?"

Drugs with inactive strains of bacteria

A vaccine against cystitis has been on the market in Germany since 2004. The vaccine has several inactive strains of bacteria in it and, according to the manufacturer, helps the body to fight bacteria better. There are also capsules to take orally containing inactive strains of bacteria and that aim to prevent recurrent cystitis. Whether or not these products and measures help has not been studied sufficiently yet. The German statutory health insurances do not cover the costs.

How can I cope with this problem in the long term?

For many women cystitis is a one-off unpleasant experience. In other women it keeps coming back. Whichever group you belong to: antibiotics usually provide quick relief in acute cystitis. Some products can prevent cystitis from recurring, but only if they are taken regularly, and they can have adverse effects. Besides, if antibiotics are taken too frequently, there is an increased risk of the germs becoming more resistant. If you have recurring cystitis, finding out for yourself what changes in everyday life can reduce your risk of getting cystitis could make it a lot easier to cope with this distressing problem.

Published by the Institute for Quality and Efficiency in Health Care (IQWiG)

Next planned update: January 2016. You can find out more about how our health information is updated in our text "Informed Health Online: How our information is produced."

References

  • IQWiG health information is based on research in the international literature. We identify the most scientifically reliable knowledge currently available, particularly what are known as “systematic reviews.” These summarize and analyze the results of scientific research on the benefits and harms of treatments and other health care interventions. This helps medical professionals and people who are affected by the medical condition to weigh up the pros and cons. You can read more about systematic reviews and why these can provide the most trustworthy evidence about the state of knowledge in our information “Evidence-based medicine.” We also have our health information reviewed to ensure medical and scientific accuracy.
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