Have a shower, rather than a bath to avoid exposing your genitals to the chemicals in your cleaning products for too long. Always empty your bladder

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1 Cystitis, Avenue Medical Practice Neat Guideline Introduction Cystitis means 'inflammation of the bladder'. It causes: an urgent and frequent need to urinate, and Pain, or stinging, when passing urine. Cystitis is usually the result of an infection in the bladder, but it can also be caused by irritation or damage. Cystitis caused by a bladder infection is sometimes called 'bacterial cystitis'. Untreated bladder infections can cause kidney infections. Cystitis in females Cystitis is more common in women because women have a short urethra (the tube that passes from the bladder out of the body), and its opening is located very close to the anus. This makes it easy for bacteria from the anus to reach the bladder and cause an infection. Almost all women will have cystitis at least once in their lifetime. Around one in five women who have had cystitis will get it again (recurrent cystitis). Cystitis can occur at any age, but it is more common in: pregnant women, sexually active women, and Post-menopausal women (after the menopause). Cystitis in males Cystitis is less common in men, but potentially more serious. This is because it could be caused by: an underlying bladder, or prostate, infection, such as prostatitis, or an obstruction in the urinary tract, such as a tumour, or an enlarged prostate (the gland located between the penis and the bladder). Male cystitis is not usually serious if treated quickly, but it can be very painful. Sexually active gay men are more likely to get cystitis than other males. Outlook Mild cystitis usually clears up within 4-9 days. It can be treated at home by drinking plenty of water (around 1.2 litres, or 6-8 glasses, every day) and taking painkillers, such as paracetemol and ibuprofen. More severe cystitis can also cause abdominal pain, or a fever, and may need treatment with antibiotics. Children and men should always see their GP if they have cystitis. Women should always see their GP the first time they have the condition. They should also return to see their GP if they have the condition more than three times in one year. Symptoms Symptoms of cystitis, in both men and women, include: pain, burning, or stinging sensations when passing urine, needing to urinate frequently and urgently, but only passing small amounts of urine, urine that is dark, cloudy, or strong smelling, urine that contains traces of blood (haematuria), pain directly above the pubic bone, or in the lower back, or abdomen, and Feeling unwell, weak, or feverish. Cystitis can also affect children. Their symptoms may include: weakness, irritability, reduced appetite, vomiting, and Pain when passing urine. 1

2 The symptoms described above could be caused by conditions other than cystitis. This it is why it is important to see your GP the first time you experience symptoms such as these. The symptoms could be confused with: sexually transmitted infections (STIs) - such as gonorrhoea, or chlamydia, being infected with a bacterium, such as E-coli, vaginal thrush, also known as candida (a yeast infection), inflammation of the urethra (urethritis), urethral syndrome (women only), or inflammation of the prostate gland, also known as prostatitis (men only). Causes The most common cause of cystitis is a bacterial infection. If bacteria reach the bladder, they can multiply and irritate the bladder lining, causing the symptoms of cystitis. A bacterial infection can be caused by not emptying the bladder fully. You may not be able to empty your bladder fully if: you are pregnant - as there is pressure on the pelvic area, or you have a blockage somewhere in your urinary system. This could be caused by a tumour or, in men, an enlarged prostate (a gland located between the penis and the bladder). Cystitis in females In women, the opening of the urethra (the tube that passes from the bladder out of the body) is very close to the opening of the anus. There are often bacteria around the anus, which can be transferred to the urethra. From there, the bacteria can enter the bladder and cause irritation. In women, cystitis is often caused by transferring bacteria in this way. This can happen when you are: inserting a tampon, having sex, wiping back to front when you go to the toilet (instead of front to back), or using a diaphragm (a soft dome made of latex or silicone) for contraception. In menopausal women, the lining of the urethra and the bladder become thinned due to a lack of the hormone oestrogen. The thin lining is more likely to become infected and damaged. Women also produce less mucus around the vagina after the menopause. Without the mucus, bacteria are more likely to multiply. Other causes Cystitis can also be caused by damage, or irritation, in the area around the urethra in both men and women. This could be the result of: damage caused when changing a catheter (a tube inserted into the urethra to allow urine to flow into a drainage bag, which is often used after surgery), damage, or bruising, caused by vigorous, or frequent sex, sometimes called honeymoon cystitis, wearing tight clothing, chemical irritants - for example, in perfumed soap or talcum powder, other bladder, or kidney, problems, such as a kidney infection, or prostatitis, or diabetes (a long term condition caused by too much glucose in the blood). Diagnosis If you have had cystitis before, you may be able to recognise the symptoms and diagnose the condition yourself. However, men and children with cystitis should always see their GP. You should also see your GP if: this is the first time you have had cystitis, there is blood in your urine (haematuria), you have a high temperature (fever) of 38C (100.4F), 2

3 you are in a lot of pain, or you have had cystitis three times in one year. Your GP should be able to diagnose cystitis from asking about your symptoms. In some cases, they may also use a dipstick to test your urine. This is when a chemically treated strip of paper is dipped into a sample of your urine. The paper will react to the presence of certain bacteria and reveal which kind of infection you have. Urine culture In some cases, your GP may wish to send a sample of your urine to a laboratory for further testing. This sample is called a urine culture. This may be necessary if: you have recurrent cystitis (more than three times in one year), it is possible that you may have a kidney infection - cystitis can be a symptom of this, you are on immunosuppressant medication (medication that suppress your immune system) - these affect your body's defences so you may be more prone to infections, you have diabetes (a long term condition caused by too much glucose in the blood) - cystitis can be a complication of diabetes, you may have a sexually transmitted infection (STI) - such as gonorrhoea, chlamydia, or it is possible that you may have another infection - such as thrush (candida). The urine culture will confirm which bacteria are causing your cystitis. Alternatively, it may reveal that your cystitis is caused by another condition. Your GP will be able to advise you about the most appropriate treatment for you. Further tests If you have recurrent cystitis that does not respond to antibiotics, even after a urine culture has been tested, you may be referred to a specialist. You may need to have some other tests such as: an ultrasound scan, an X-ray, or a cystoscopy. A cystoscopy is when a fibre-optic camera, called a cystoscope, is used to examine your bladder. The cystoscope is a thin, fibre-optic tube that has a light source and a camera at one end. It is inserted into your urethra (the tube that passes from your bladder out of your body) so that images of the inside of your bladder can be transmitted to a screen. Any further tests that you require will be explained to you by the healthcare professional treating you. Treatment Children and men should always see their GP if they have cystitis. Women should always see their GP the first time they have the condition. They should also return to see their GP if they have the condition more than three times in one year. The symptoms of cystitis usually clear up without treatment within 4-9 days. There are some self-help treatments that can ease the discomfort of any symptoms, or your GP may prescribe antibiotics. Self-help treatments If this is the first time that you have had cystitis, you should go to see your GP. If you are sure that you have mild cystitis, and do not need to see your GP, then there are some treatments you can try yourself. Over-the-counter (OTC) painkillers, such as paracetamol, or ibuprofen, can be taken to reduce discomfort. Always read the label and check with your pharmacist first, particularly if you have any other medical condition, you are taking other medicines, or you are pregnant or breastfeeding. 3

4 Drinking plenty of water is often recommended as a treatment for cystitis. There is no evidence that this is helpful, although drinking around 1.2 litres (6-8 glasses) of water a day is generally good for your health. You should also avoid alcohol. Do not have sex until your cystitis has cleared up because it can make it worse. The following treatments are no longer recommended because there is not enough evidence to suggest that these are effective at treating the symptoms of cystitis: urine alkanising agents - such as sodium bicarbonate, or potassium citrate, or Drinking cranberry juice - although it may help prevent outbreaks of recurrent cystitis. There are some more useful tips for avoiding cystitis in the prevention section. Antibiotics If your symptoms are moderate, or severe, your GP may prescribe a short course of antibiotics. This will usually be in the form of a tablet to be swallowed 2-4 times a day, for three days. For a more complicated case of cystitis, such as cystitis with another underlying infection, you may be given antibiotics to take for 5-10 days. Research suggests that antibiotics can shorten the duration of the cystitis by 1-2 days. If your cystitis symptoms are only mild, your GP may prefer not to prescribe antibiotics to avoid 'antibiotic resistance'. This is when the bacteria that cause cystitis adapt and learn to survive despite the use of antibiotics. Over time, this means that treatment becomes less effective. Recurring cystitis If you have recurring episodes of cystitis, you may be prescribed stand-by antibiotics, or continuous antibiotics. A stand-by antibiotic is a prescription for you to take the next time you have cystitis, without needing to visit your GP again. Continuous antibiotics are antibiotics that you take for several months to prevent further episodes of cystitis occurring. These may be prescribed for two reasons: if your cystitis usually occurs after having sex, you may be given a prescription for antibiotics to take within two hours of having sex, or If your cystitis is not related to having sex, you may be given a low-dose antibiotic to take for a trial period of six months. If you are prescribed antibiotics, your symptoms should start to improve after the first day of treatment. If your symptoms do not improve after your course of antibiotics, you should go back to see your GP, or call NHS Direct on Complications While most cases of cystitis clear up either on their own, or with antibiotics, some people may experience almost constant symptoms, or recurring episodes. If no cause can be found, and the cystitis does not respond to antibiotics, you may have interstitial cystitis. Some GPs may also use the term 'painful bladder syndrome' (PBS) to describe a condition that causes pain, but does not quite meet the criteria to be diagnosed as interstitial cystitis. Prevention It is not always possible to prevent cystitis, but there are some steps that you can take to avoid the condition. Do not use perfumed bubble bath, soap, or talcum powder around your genitals. 4

5 Have a shower, rather than a bath to avoid exposing your genitals to the chemicals in your cleaning products for too long. Always empty your bladder fully when you go to the toilet. Do not wait to go if you need to urinate - holding on can place extra stress on your bladder and could make it more susceptible to infections. Wear cotton underwear and avoid wearing tight jeans and trousers. Always wipe from front to back, not back to front, when you go to the toilet. Some people find certain types of food and drink makes their cystitis worse - for example, coffee, fruit juice, or spicy foods. If there is anything that triggers your cystitis, you may wish to avoid it. Cystitis and sex Below are some prevention tips that you may find useful if your cystitis is triggered by having sex: make sure that you wash your genital area and your hands before and after sex, use a lubricant when having sex to avoid damaging your genital area, if you use a diaphragm for contraception, you may wish to change to another method of contraception, and After having sex, make sure that you empty your bladder as soon as possible to get rid of any germs. There is currently no evidence that oestrogen products, used to treat women after the menopause, are effective at preventing cystitis. 5

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