Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Cystitis announces itself: the sudden need to go, the burning when you do, and the feeling five minutes later that you need to go again. Half of women get it at some point and many get it repeatedly. Here's what actually shortens it, what only soothes it, and the point at which you stop self-treating and get antibiotics.
What is cystitis, and is it a UTI?
Cystitis is inflammation of the bladder, and in almost every case it's caused by infection, so yes, cystitis is a urinary tract infection, specifically the lower one, in the bladder. The upper kind, a kidney infection, is the one to watch for. Symptoms: burning or stinging when you pass urine, needing to go often and urgently, passing only a little, cloudy or strong-smelling urine, and a dull ache low in the tummy. Blood in the urine can happen with simple cystitis but always needs checking.
What causes cystitis?
Usually bacteria from the bowel, most often E. coli, getting into the bladder through the urethra, which is short in women and sits close to the back passage. Sex is the commonest trigger, along with not drinking enough, holding on when you need to go, wiping back to front, tight synthetic underwear, and the drop in oestrogen after the menopause, which thins the tissue that keeps bacteria out. Men get cystitis too, but far less often, and in men it always needs a GP.
How to get rid of cystitis fast
Start in the first hours. Drink plenty, plain water, to flush the bladder; two to three litres over the day. Take a painkiller: paracetamol or ibuprofen eases the burning and the ache far more than people expect. Cut out coffee, alcohol and fizzy drinks, which irritate the bladder, and empty it fully each time rather than holding on. A hot water bottle on the lower tummy helps the ache. Mild cystitis treated this way often clears in two to three days.
Do cystitis sachets work?
They don't kill the infection, but they make it hurt less while your body deals with it. Cystopurin and similar sachets are potassium citrate, which makes the urine less acidic so it stings less; one sachet in water three times a day for two days. They're for adults, not for anyone with kidney disease or on potassium-raising blood pressure medicines such as ACE inhibitors or spironolactone, so check with the pharmacist if you take regular medication. Everything in the cystitis range is a relief product, not a cure; if you're not clearly better after 48 hours, you need the next step.
Is cranberry juice good for cystitis?
Not for treating it. The evidence for cranberry curing an infection that's already started is poor, and the sugar in most juice is a bladder irritant. There's weak evidence that daily cranberry capsules reduce recurrences in women who get cystitis often, so it's a prevention question, not a treatment one.
When you need antibiotics
In England, the NHS Pharmacy First scheme lets a pharmacist assess uncomplicated cystitis in women aged 16 to 64 who aren't pregnant and, where it fits, supply a short course of antibiotics without a GP appointment; a three-day course of nitrofurantoin is the usual choice and most women feel better within a day of starting. See a GP rather than self-treating if symptoms haven't improved after three days, if you have a fever, shivering, pain in your back or side, or vomiting (signs the infection is reaching the kidneys, which is urgent), if there's blood in your urine, if you're pregnant, a man, under 16 or over 65, or if this is your third attack in a year. Recurrent cystitis has answers, from vaginal oestrogen after the menopause to a standby prescription, and our pharmacist can point you to them.
Cystitis in men, children and older people
The self-care route is for otherwise healthy women. Men get cystitis rarely, and when they do it's more likely to involve the prostate or kidneys, so it always needs a GP and a urine test. Children with pain on passing urine, a fever or wetting after being dry need a GP the same day; untreated infections can reach the kidneys. Over 65s often show few classic symptoms and instead become confused, unsteady or off their food; a sudden change like that in an older relative is worth a urine test. Anyone with diabetes, a catheter, a weakened immune system or kidney problems should also skip straight to the GP.
Cystitis after sex, and how to prevent it
Sex pushes bacteria towards the urethra, which is why cystitis often follows within a day or two. Passing urine soon after sex, drinking a glass of water beforehand, avoiding spermicides and diaphragms if you're prone to it, and using a lubricant to reduce friction all cut the risk. For women who get an infection after sex most times, a GP can prescribe a single low-dose antibiotic to take afterwards, which is far better than repeated full courses.
Cystitis in pregnancy
Any suspected urine infection in pregnancy needs a GP or midwife, not self-treatment: infections travel to the kidneys more easily in pregnancy and are linked to early labour. Pregnant women are also routinely tested for bacteria in the urine that cause no symptoms, for the same reason. Fluids and paracetamol are fine while you wait to be seen; avoid cystitis sachets and ibuprofen unless a professional says otherwise.
Is it cystitis or something else?
Thrush causes itching and a thick white discharge rather than urgency; vaginal dryness after the menopause causes burning that antibiotics don't fix and vaginal oestrogen does; a sexually transmitted infection can cause pain on passing urine with discharge, and needs a sexual health clinic. Interstitial cystitis, or bladder pain syndrome, is bladder pain and frequency with no infection on testing, often flaring with certain foods, and is diagnosed and managed by a GP or urologist. If tests keep coming back clear, ask about it.
What the pharmacist will ask
Under Pharmacy First a pharmacist checks that you're a woman aged 16 to 64, not pregnant, without a catheter, that symptoms have been present a short time, that you don't have the kidney-infection signs (fever, shivering, back or side pain, vomiting), and that you haven't had recurrent infections or treatment recently. If all of that fits, they can supply a three-day course of nitrofurantoin. If it doesn't, they'll direct you to the GP, and that's the right answer rather than a delay.
Frequently asked questions
Can cystitis go away on its own?
Mild cystitis often does, within three days, with fluids and painkillers. If it hasn't, or you're getting worse, get antibiotics rather than waiting.
How can I stop it coming back?
Drink enough, pass urine soon after sex, don't hold on, wipe front to back, and avoid perfumed washes. After the menopause, ask about vaginal oestrogen, which treats the cause.
Can stress cause cystitis?
Not directly, but stress, dehydration and rushing to the loo less often go together. Bladder pain without infection, sometimes called interstitial cystitis, is a different condition that a GP diagnoses.