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Genitourinary system
Cystitis is an inflammation of the lining of the bladder that causes a frequent need to urinate and a burning sensation when urinating. It can affect men and women, but occurs more commonly in women. Nearly half of all women will have an attack of cystitis at sometime during their life. Some women will have just one attack, others will have frequent attacks. Cystitis occurs most often during pregnancy, after the menopause and in women who are sexually active.
There are two types of cystitis - bacterial and non-bacterial.

Most attacks of cystitis are caused when bacteria from the bowel enter the bladder through its opening, the urethra. Because the opening from the bowel and bladder are so close together in women it is very easy for bacteria to pass from one to the other, often due to poor toilet hygiene. This is why cystitis is more common in women than men. Bacterial infection may also occur as a result of not being able to empty the bladder completely (as can occur during pregnancy), from inserting tampons or contraceptive diaphragms, or from injury during sexual intercourse. During the menopause, a decrease in the level of oestrogen thins the tissues of the urethra making it more prone to attack by bacteria.

Non-bacterial cystitis is the result of the bladder being irritated by perfumed soaps, bath additives or vaginal deodorants.

Cystitis is less common but potentially more serious in men. It may be due to an enlarged prostate, an infection of the prostate, a sexually transmitted infection, or a deformity that prevents the bladder from emptying completely that allows bacteria to grow within the bladder.

In women or men, left untreated, cystitis may cause kidney damage.
The most common symptoms of cystitis include an urge to pass urine more frequently, the sensation of not being able to 'hold on', a sharp, burning or stinging sensation when passing urine and a feeling of not emptying the bladder completely. Urine may be darker than normal, cloudy and foul smelling. Attacks of cystitis are often accompanied by lower back pain and pain above the pubic bone.

Over-the-counter remedies containing potassium citrate, sodium citrate or sodium bicarbonate work by alkalising the urine which neutralises the painful acid produced by the bacteria, and creates an environment that makes it harder for the bacteria to grow and multiply. If these products do not work, there are antibiotics such as ciprofloxacin available on prescription from your doctor.

Lubricating gels, for example Aquagel or K-Y Jelly, may help avoid bruising during intercourse, thereby reducing the risk of cystitis.
When to consult your pharmacist
Visit your pharmacist if you think that you may have cystitis. The pharmacist will talk in confidence to you about your symptoms. If your pharmacist thinks that you do have cystitis there are a number of OTC medicines that can be supplied without a prescription that will help treat the problem and ease the pain. If your pharmacist thinks that what you describe are symptoms of a more serious condition, you will be advised to see your doctor.

Always tell your pharmacist if you have heart or kidney problems or high blood pressure and if you are taking any medicines to treat these conditions. Some of the OTC preparations contain potassium and may interact with medicines such as ACE inhibitors or A2 blockers (angiotensin 2 antagonists) used to treat these conditions. Similarly, some OTC cystitis remedies contain high levels of sodium which should be avoided by people with high blood pressure.
When to see your doctor
If you are a woman having more than three bouts of cystitis in a year, you should see your doctor. You should also see your doctor if there is blood in your urine, if you have a heavy vaginal discharge, or if you are pregnant or have a high temperature. Any pain in the lower back, groin or abdomen should also be reported to your doctor. You should also visit your doctor if you have kidney or heart disease, high blood pressure or diabetes. Men and children with cystitis should always see a doctor.

Your doctor will be able to diagnose whether it is cystitis or some other condition responsible for your symptoms. If you have tried OTC medicines and they have not worked, your doctor may take a urine sample to test for bacteria and may then prescribe an antibiotic.

Living with cystitis
A few simple precautions can reduce the risk of getting cystitis. When urinating, women should sit well back on the toilet seat. This helps the bladder empty. When drying or wiping your bottom, dry from front to back as this reduces the chances of bacteria being spread from the anus to the urethra. Drink plenty of water, do not ignore the call to go to the toilet and try to urinate frequently throughout the day.

At the first sign of an attack of cystitis, drink as much fluid as possible to flush out the bacteria. Drinking cranberry juice may also help.

If the cystitis is caused by irritation, try to identify what is causing the problem. Suspect things such as soaps, bubble bath, shower gels and vaginal deodorants which are perfumed, and avoid using them again.
Useful Tips
  • Drink plenty of fluid throughout day
  • Go to the toilet when you feel the need and don't 'hang-on'
  • Women should wipe themselves from front to back when they go to the toilet
  • Avoid perfumed vaginal deodorants, soaps, bubble baths and shower gels
  • Avoid tight and synthetic clothing
  • Use a lubricating gel if you experience discomfort during sexual intercourse

Reviewed on 22 September 2010