Health & Wellness Journal

💧 Cystitis: causes of bladder inflammation, symptoms and preventing recurrences

Cystitis — inflammation of the lining of the bladder — is one of the most common urological conditions. According to statistics, every second woman experiences an episode of acute cystitis at least once in her life, and in 25–30% of them the condition recurs within six months. Although cystitis is rarely life-threatening, it significantly reduces the quality of everyday life and, if treated incorrectly, can lead to complications.

Anatomy of the urinary system

The urinary system includes the kidneys, ureters, bladder and urethra. The kidneys filter the blood and produce urine, which flows through the ureters into the bladder — a hollow muscular organ that can hold 300–500 ml of fluid. As the bladder fills, its walls stretch, receptors send a signal to the brain, and the person feels the urge to urinate. Urine is expelled through the urethra.

In women the urethra is short (3–4 cm) and located close to the vagina and rectum — the main reservoirs of bacteria. In men the urethra is longer (18–20 cm), which creates a more reliable barrier against infection. It is these anatomical features that explain why cystitis is many times more common in women.

What cystitis is and its types

Cystitis is inflammation of the bladder wall, most often caused by a bacterial infection. By course, the following types are distinguished:

  • Acute cystitis — sudden onset with pronounced symptoms; it lasts 5–7 days without treatment and 1–3 days with appropriate therapy
  • Chronic (recurrent) cystitis — two or more episodes in six months or three or more in a year; between flare-ups, symptoms may be absent or persist in a mild form
  • Interstitial cystitis (bladder pain syndrome) — a chronic non-infectious inflammation in which no bacteria are found and the cause is not fully understood; it manifests as long-lasting pain and frequent urination

Causes and pathogens

In the vast majority of cases (75–90%), the pathogen is Escherichia coli (E. coli) — a normal inhabitant of the intestine that enters the urethra when hygiene is poor or under certain anatomical conditions. Less often, cystitis is caused by other bacteria: Staphylococcus saprophyticus, Klebsiella, Proteus, Enterococcus. Viral and fungal cystitis are much rarer, mainly occurring in people with weakened immunity.

Bacteria enter the bladder by the ascending route — travelling up the urethra. A healthy bladder has defence mechanisms: its lining produces antimicrobial substances, and regular urination mechanically "flushes out" bacteria. When these defences weaken, bacteria attach to the bladder wall, multiply and cause inflammation.

Risk factors

  • Anatomical features — the short urethra in women and its proximity to the vagina and rectum
  • Sexual activity — during intercourse bacteria are mechanically pushed into the urethra; so-called "honeymoon cystitis" develops when an active sex life begins or resumes
  • Poor hygiene — washing incorrectly (from back to front), changing underwear infrequently, using harsh intimate products that disrupt the microflora
  • Holding in urine — the habit of "holding it" creates conditions for bacteria to multiply in stagnant urine
  • Getting chilled — local cooling of the pelvic area reduces local immunity and the blood supply to the bladder lining
  • Hormonal changes — falling oestrogen levels during menopause thin the lining of the urethra and bladder, weakening its barrier function
  • Contraception — spermicides and diaphragms alter the vaginal microflora and promote bacterial colonisation
  • Weakened immunity — in diabetes, when taking immunosuppressants, in chronic diseases
  • Impaired urine outflow — stones, tumours, urethral strictures and, in men, an enlarged prostate

Symptoms of cystitis

Acute cystitis develops suddenly and presents with a characteristic triad of symptoms:

  • Frequent urination — urges every 15–30 minutes, often urgent (impossible to postpone), with only a tiny amount of urine passed each time
  • Pain and burning when urinating (dysuria) — especially at the end of urination
  • Lower abdominal pain — above the pubic bone, aching or dragging, getting worse as the bladder fills

Additional signs: cloudy urine, a change in the smell of urine, blood in the urine (haematuria — especially in the last portion), a feeling that the bladder has not emptied completely. A temperature above 38 °C is not typical of uncomplicated cystitis and may indicate that the kidneys are involved.

Cystitis in special groups

Cystitis in men

In men cystitis is much less common and is almost always secondary — it develops against the background of obstructed urine outflow (benign prostatic hyperplasia, urethral stricture), chronic prostatitis or after medical procedures (catheterisation). Cystitis in a young man without predisposing factors is rare and requires in-depth examination.

Cystitis in children

In girls under 5, cystitis often develops against the background of vulvovaginitis, poor hygiene or abnormalities of the urinary tract. In boys it is more often linked to phimosis or vesicoureteral reflux. Symptoms in young children are non-specific: restlessness, crying when urinating, fever. Any urinary tract infection in a child requires a mandatory examination to rule out developmental abnormalities.

Diagnosis

Acute uncomplicated cystitis in women is usually diagnosed on the basis of the characteristic complaints. To confirm it, the following are ordered:

  • Urinalysis — detects white blood cells (a sign of inflammation), bacteria, red blood cells and protein
  • Urine culture — identifies the specific pathogen and its sensitivity to antibiotics; especially important in recurrent cystitis
  • Ultrasound of the bladder and kidneys — in recurrences, to rule out stones, tumours and abnormalities
  • Cystoscopy — examination of the bladder lining with an optical instrument; ordered in chronic cases and when interstitial cystitis is suspected

Correct collection of a midstream urine sample is critically important for a reliable result: morning urine, after thorough washing, into a sterile container.

Complications

The most serious complication is ascending pyelonephritis: the infection travels up the ureters to the kidneys. It presents with a high temperature (39–40 °C), chills, lower back pain and nausea. Pyelonephritis requires serious treatment, often in hospital. Chronic recurrent cystitis can lead to fibrosis of the bladder wall and a reduction in its capacity.

Prevention and lifestyle

To prevent episodes of cystitis and their recurrence, a set of measures is recommended:

Fluid intake

Drinking plenty of fluids (1.5–2 litres a day) is the foundation of prevention. A sufficient volume of urine ensures regular "flushing" of the bladder and mechanical removal of bacteria. You should urinate at least every 3–4 hours and always after intercourse.

Cranberry: what science says

Cranberry proanthocyanidins prevent E. coli from attaching to the bladder wall. Meta-analyses show a moderate reduction in the frequency of recurrences with daily intake of cranberry extract (not sugary juice). Cranberry does not replace antibiotics during an acute episode, but it can be useful as an additional preventive measure.

Hygiene rules

  • Wash from front to back, not the other way round — so as not to carry bacteria from the rectum into the urethra
  • Use mild intimate hygiene products with a neutral pH or simply warm water
  • Avoid douching — it disrupts the normal vaginal microflora
  • Wear cotton underwear and avoid tight synthetic briefs and thongs
  • Change your underwear daily and, during menstruation, change pads and tampons regularly

Other measures

  • Avoid getting chilled — do not sit on cold surfaces and dress for the weather
  • Urinate after intercourse — within 15–30 minutes
  • Do not hold in urine — go to the toilet at the first urge
  • Treat constipation promptly — an overfull bowel presses on the bladder and impairs urine outflow

Cystitis after menopause

The drop in oestrogen levels after menopause leads to atrophy of the lining of the vagina and urethra, a change in the composition of the microflora and weaker local defence mechanisms. This explains the rising frequency of cystitis in women over 50. Local (vaginal) oestrogen therapy reliably reduces the frequency of recurrences and is one of the main recommendations for this age group.

Managing recurrent cystitis

With frequent recurrences (3 or more episodes a year), a doctor may prescribe:

  • Low-dose preventive antibiotic therapy — daily or after intercourse
  • Immunoprophylaxis (bacterial lysates) — medicines that stimulate the local immunity of the urinary tract
  • D-mannose — a simple sugar that binds to bacteria and stops them attaching to the bladder wall
  • Local oestrogens — for postmenopausal women
  • Instillations — introducing therapeutic solutions directly into the bladder (in interstitial cystitis)

Myths about cystitis

  • "Cystitis comes from the cold" — getting chilled lowers immunity and triggers flare-ups, but it is not the cause; cystitis is caused by bacteria
  • "You can cure it with herbs alone" — herbal teas can ease symptoms, but bacterial cystitis requires an antibiotic; without one the infection can spread up to the kidneys
  • "Cystitis is not a serious illness" — complicated pyelonephritis or chronic cystitis significantly reduces quality of life
  • "If the symptoms are gone, you can stop the antibiotic" — stopping early promotes bacterial resistance and recurrences; the course must be completed

Cystitis is an unpleasant condition, but it responds well to treatment and prevention. Drinking enough fluids, following hygiene rules, urinating promptly and seeing a urologist at the first symptoms help avoid complications and minimise the risk of recurrence. Self-treatment of cystitis is not advisable: the wrong medicine can mask the symptoms and lead to the condition becoming chronic.

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