Why you keep getting cystitis and how to treat it

Some describe it as peeing barbed wire. Others feel that passing ‘burning knives’ or ‘flaming arrows’ is more accurate. However you refer to the physical sensation of trying to wee while you have cystitis (trying being the operative word- sometimes only an excruciating drop comes out), it’s an ordeal that you probably wouldn’t wish on your worst enemy.

Given that at least 50 per cent of women will experience it, it seems especially unjust that treatment options are limited and often reduced to old wives tales, with interstitial cystitis (long-term pelvic pain combined with issues/ actual torture when peeing) being poorly understood in particular. From cranberry juice to painkillers to methods of contraception, here’s what helps to put out the fire, what could make the flames worse and possible reasons to you’re getting the cursed cystitis in the first place.

What is cystitis?

In a nutshell, your bladder in a very distressed state. According to the NHS  cystitis is typified by bladder inflammation, usually triggered by a bladder infection. Your bladder can become infected due to bacteria being where it shouldn’t (more on that in a moment), and once it’s there, causing mild discomfort or sheer agony, depending on how severely you’re suffering and how often you get it. There’s a biological reason you get it and your boyfriend/ husband/ brother doesn’t too...

Why women get cystitis

It’s pretty much down to anatomy, as  Wonder Down Under  authors, doctors and women’s health experts Nina Brochmann and Ellen Støkken Dahl explain:

“Urinary-tract infections are crappy and as a woman you’re particularly prone to them. Our short urethra is to blame. As is the fact that our anus is in close quarters to the urethral opening. Bacteria from our anus work best if they stay where they belong, but it’s difficult to fence bacteria in. They can easily climb into the urethral opening and move up through it until they have settled on the mucous membranes inside the urethra and bladder. Once there, they cause inflammation.”

Male cystitis is possible, but it’s rarer and more often an indicator of an underlying condition, so the NHS recommend that men always see their GP if they suspect that they’re suffering with cystitis (you can also find more information on UTIs in men on the Patient Info website ).

You’re also more prone to cystitis is you use a diaphragm (or cap) for contraception  or wipe ‘back to front’ rather than ‘front to back’ after going to the loo. Sex can trigger it, and definitely makes it worse, but peeing after sex will reduce the chances of harmful bacteria hanging around. Speaking of which, delaying going for a wee when you need to makes you more likely to develop it  (43 per cent of us regularly ‘hold it’ according to Canesten ) and dehydration can also bring about cystitis. Long hot baths, particularly using perfumed bubble baths and the like, can be precursors to cystitis, and even the wrong pants can provide a cystitis bacteria breeding ground- choose cotton over lace and nylon, every time. Basically wear your big comfy granny pants on medical advice. Finally, even having your period  can give rise to a cystitis attack , depending on the sanitary protection you choose, as Canesten reports that 94 percent of women are unaware that inserting tampons can cause cystitis. At this point, what doesn’t invite cystitis may seem like a more pertinent question, but if you’re in any doubt, here’s how to tell if you have it, if the pee sting hasn’t given the game away yet…

How to know you’ve got cystitis

Tiny knives aside:

• You need to pee like, now, yet there’s not a lot of pee coming out.
• Your wee is cloudy, darker than normal or strong smelling.
• You’ve got pain in your abdomen.
• You generally feel nauseous, tired and a bit achey.

It’s all in all pretty horrible, but that should be your lot for your average case of cystitis, although be on wary of worsening symptoms. Nina and Ellen explain the rarer implications of cystitis:

“The vast majority of urinary-tract infections in young women, as many as 95 per cent, are what we call uncomplicated. This simply means that the infection is considered to be less dangerous and requires simple treatment or none at all.

“Of course, you should always be alert to any deterioration. If you develop a fever or the pain worsens, especially if it moves up towards your back, you must visit your doctor as soon as possible, at the out-of-hours surgery if need be. This may be a sign that the bacteria have caused pyelonephritis  and there’s a risk that you may end up with a messed-up kidney.”

By that, they mean that you could be at risk of developing a kidney infection, which can make you feel extremely unwell, or if left untreated, permanent kidney damage. This is rare, but if your cystitis symptoms have progressed to intense pain, fever or you notice blood in your urine, get thee to the doctor’s. Equally, if you’re pregnant and have cystitis, don’t hesitate to get it checked out by your GP, and if you experience symptoms frequently, you could be suffering with interstitial cystitis . As above, this punishing condition is somewhat shrouded in mystery, but Nina and Ellen shed a bit of light:

“It’s often necessary to investigate more closely what kind of bacteria are involved, and sometimes checks will be carried out to see if you have an underlying condition that makes it easier for you to become infected. Having said that, some women get urinary tract infections again and again without our knowing why. It is suspected that these women may have slightly different immune defences in the mucous membranes of their urinary tract, which makes it easier for the bacteria to gain a foothold.”

Joy of joys, and at present there’s no cure for interstitial cystitis- your GP or specialist will devise a plan of action depending on your individual medical history and any test results, but lifestyle changes are almost always recommended to ease your pain, possibly combined with painkillers, physiotherapy, medication to relax bladder muscles and repair the lining and, as a last resort, surgery, which could involve stretching the bladder, cauterize ulcers or inflamed areas and even using Botox for pain relief. Be reassured that this type of cystitis is rare, but if you are a sufferer, or know one, you can seek support through the Bladder Health UK  charity.

How to cope with and treat cystitis

Cystitis and I are familiar bedfellows, in that the dreaded pee knives have left me bedridden on more than one occasion. One particularly memorable cystitis flashback was when it decided to aggressively come along for a short holiday with my boyfriend and I in Rome. I’d actually felt the twinges before I left, but like 31 per cent of women, according to a survey of 2000 adults by Pharmacy Outlet , I ignored it, and merrily continued swigging espressos and red wine as my main fluid intake while shunning sleep for more fun activities and trying to hold the sensation of needing a wee (s) while we queued our way around the Vatican. Boy did I pay for that lax behaviour. I ended up feverish in my Best Western, with blood in my wee that eventually led to a trip to A&E, where I was leap frogged by nuns in the queue (true story) and then had to mime my issue to the bemused and time pressed nursing staff. After the best part of a day I was duly dispatched with antibiotics after a urine test confirmed the bacterial invasion, plus a list of ‘do’s and don’ts’ in Italian. I speak Spanish and French so roughly deciphered through Latinate similarities that this meant I should avoid coffee, wine, tomatoes, lemons, sweet things and sex. So basically all of the things you came to Italy to enjoy in the first place.

The ‘do’s’ corresponded with sensible NHS advice- to recover fully, R&R is essential, as is…

• Drinking lots of fluid that isn’t aforementioned caffeine or alcohol. Keep it vaguely clear and watery- I replaced the macchiatos with herbal teas and didn’t feel too deprived.
• Try the hot water bottle approach, in the same way as you might if you hadperiod pain. It takes the edge off, if only temporarily.
• Wipe the right way to prevent things getting any worse.
• Avoid sex. You won’t want that anyway.

Take painkillers if you need to, but this is where recent research gets interesting, in a bad way for cystitis sufferers.  A recent Norwegian trial  involving 383 women diagnosed with cystitis showed that taking ibuprofen delayed recovery compared to antibiotic treatment. Half of the women involved in the study took ibuprofen, while the other half were given a standard three day course of antibiotics. After four days, 74 per cent of antibiotic takers had made a full recovery, compared to 39 per cent in the ibuprofen group. Overall, women taking ibuprofen took three days longer to recover, with 46 per cent needing to make a return trip to the GP within a month to treat symptoms that had either gotten worse or recurred, compared to just 10 per cent of those who had taken a course of antibiotics.

Considering the growing danger of antibiotic resistance , GPs and doctors are now increasingly reluctant to prescribe antibiotics for mild cases of cystitis, and more often than not the infection clears up by itself when following the lifestyle guidance above. Painkillers can help to reduce discomfort, but the study’s authors caution that, until cystitis is better understood, ibuprofen in particular (often recommended as it’s an anti-inflammatory) can’t solve your cystitis woes:

“Reducing the use of antibiotics came at the cost of stronger symptom burden, longer duration of symptoms, and more complications.

“Until we can identify those women who will develop complications, we cannot recommend ibuprofen alone as initial treatment to women with uncomplicated urinary tract infections.”

Researchers point out that following lifestyle advice, taking ibuprofen and having a “sit it out and see” approach could help to cap antibiotic use, as over 50 per cent of women did see cystitis symptoms clear up without antibiotic treatment, but always make an appointment with your GP if your cystitis doesn’t clear up over three days, if symptoms worsen or if they keep returning.

You may also be five litres into the cranberry juice by now, but unfortunately, we’ve got bad news in that department too.

The cranberry juice fable

If, like me, you may as well have bought shares in Ocean Spray with your cranberry vs. cystitis chugging over the years, you’ll be disheartened to hear that guidelines issued by the National Institute of Health and Care Excellence  state that there’s not sufficient evidence to recommend cranberry juice as a means of relief from cystitis. That said, Ellen and Nina reassure us that a glass of cranberry juice shouldn’t do any harm either:

“It’s a common folk remedy that’s been used for centuries, and while it’s been indicated that cranberries have no protective effect, if you like cranberry juice there’s nothing to stop your trying it and there are no side-effects.”

Taking concentrated aloe vera has been suggested as a means to improve symptoms, reduce pelvic pain and decrease the frequency, urgency and burning sensation of peeing in interstitial cystitis sufferers in particular, although the latest study results were based on a self-reporting survey  and further clinical research is required. Consult your doctor before downing aloe vera juice, but a little every now and again is unlikely to do any harm. H2O is probably just as helpful to flush the bacterial buggers out, however, and at least it costs sweet nothing.

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