Cystitis in women

What is cystitis?

Cystitis is inflammation of the bladder. There are two main types. The only sure way to tell the difference is by a urine test.

Bacterial cystitis is caused by bacteria (germs). These bacteria, mainly Escherichia coli (E. coli for short), normally live in and around the anus (back passage). In men, the urethra goes along the length of the penis and is about 24–30 cm long but, in women, it is only about 6 cm long. So in women, bacteria on the skin can easily get into the bladder by using the short urethra as a ladder. This probably explains why cystitis is much more common in women than in men. Some women find that bacterial cystitis is related to boisterous sex, which can bruise the urethra and may squeeze bacteria up into the bladder. For more information see our section on how to prevent further attacks of cystitis.

Painful bladder syndrome (also called, interstitial cystitis, non-bacterial cystitis, urgency and frequency syndrome) is inflammation of the bladder without any bacteria being present. Most sufferers (90%) are women. It can occur at any age, but is most common in women in their early 40s. It is a bit of a mystery, and no one really knows what causes it.

One theory is that a substance called glycosaminoglycan is deficient in the bladder. This substance is part of the slimy layer that covers and protects the lining of the bladder.
Another theory is that it is a type of allergy, because cells common in allergy (mast cells) are present in the bladder wall in interstitial cystitis.

Symptoms of cystitis

The symptoms of cystitis are:

a burning, stinging or aching pain when you pass urine
a need to pass water very frequently, often only a small amount each time
bloody or cloudy urine (severe cystitis).

Bacterial cystitis. With bacterial cystitis, you usually experience only the burning pain and frequent urination. However, it is possible for the infection to travels upwards to the kidney. Fortunately, this is unusual. Infection in the kidney needs proper medical treatment, so see your doctor straight away if you also have:

blood (or a smoky appearance) in the urine
backache or stomach ache
fever and weakness.

Painful bladder syndrome. With painful bladder syndrome (interstitial cystitis) the symptoms are diverse. You have to pass urine frequently (including at night), and maybe urgently, and passing the urine may be uncomfortable. You may notice discomfort in the lower abdomen when the bladder is filling (pelvic pain), which is relieved by passing small amounts of urine. Sex may be painful. Often, symptoms are worse in the week before a period.

What else could I have?

Not all urine problems are cystitis. For example:

if you have soreness or itching around the opening of the urethra (pee hole) you might have a herpes infection, thrush or a chlamydia infection
if your only problem is having to pass urine frequently, you might have diabetes (especially if you are thirsty all the time), so see your doctor
if your main problem is having to rush to the toilet, you may have a continence problem.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Tuesday, December 13th 2011

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