Always feel like you need to urinate and then only passing a bit or just a few drops of urine. Pain when urinating, cloudy urine, blood in the urine. Vague abdominal pain. A general feeling of sickness. In short, annoying complaints. You might be suffering from cystitis.
What is cystitis?
Cystitis is an infection of the mucous membrane of the bladder by bacteria or viruses that do not belong in the bladder. Often the urethra is inflamed as well.
What is the cause of cystitis?
In 80% of cases, the cause of cystitis is a bacterium from the intestine, the Escherichia coli in general called E.coli. The bacteria enters the bladder through the urethra. The E.coli has hooks with which it clings to the bladder wall and then nestles in the bladder wall.
In combination with the following factors, there is an increased risk of cystitis:
Women are more likely to have cystitis than men. The urethra of women is close to the vagina and the anus. There are many bacteria in the pubic area that can easily enter the urethra during sex, or if you wipe your buttocks from the back to the front. Also, the urethra of women is only 4 cm long, in men it is about 20 cm. In women, the distance that the bacteria have to travel to reach the bladder is therefore shorter when they end up in the urethra. In men, an inflammation of the bladder is often accompanied by an inflammation of the prostate.
- Narrowing or obstruction
Bacteria thrive in urine, including harmful bacteria. If there are problems emptying the bladder due to a narrowing, there is an increased risk of infection. In women, this may be due to a prolapse of the bladder or the uterus. In men, an enlarged prostate with or without inflammation or a narrowing of the urethra can cause incomplete emptying of the bladder.
Women with diabetes, in particular, have an increased risk of cystitis.
- STD (sexually transmitted disease)
STDs such as Chlamydia or gonorrhoea can cause a bladder infection in men. In women, on the other hand, STDs are more likely to cause infection of the vagina.
- The transition
In women, the change in hormones during menopause causes the mucous membrane of the vagina and urethra to become thinner. The vagina also produces less moisture. The acidity of the moisture provided protection against harmful bacteria, and this protection is now also reduced. These harmful bacteria can reach the bladder from the vagina through the nearby urethra and cause an infection of the bladder.
Pregnancy increases the risk of cystitis because the uterus can press on the bladder.
- Bladder and/or kidney stones
Bladder and kidney stones can cause minor damage to the urinary tract walls, making it even easier for E-coli bacteria to attach themselves to the urinary tract walls.
- Chemical causes
The use of soap or shampoo when washing the pubic area, the chemicals disrupt the natural defences.
- Object from the outside
A bladder catheter (a tube in the bladder to drain the urine) can cause cystitis. Bacteria can easily enter the urethra when a catheter is inserted; there is also an increased risk of bacteria coming with it while it is being inserted.
What types of bladder infections are there?
There are different types of bladder infections that are subdivided as follows:
- acute cystitis in healthy persons
- acute cystitis in healthy pregnant persons
- recurrent cystitis
How can you recognise cystitis?
You can recognise cystitis by the following symptoms:
- pain and burning sensation when urinating;
- frequent urge to urinate;
- small amounts of urine;
- cloudy urine or blood in the urine;
- the urine has a strong smell;
- pain or vague complaints in the lower abdomen;
- pain or vague complaints in the lumbar region;
- temperature increase is possible, usually no fever;
- general feeling of sickness.
Sometimes the symptoms are very vague and you do not realise that you have cystitis.
Can I do something myself about cystitis?
You can do a lot yourself to prevent cystitis. Drinking a lot of water is important for women and men. Urinate well. Ensure proper bowel movements so that your bladder has more room to empty your bladder properly. You can benefit from Vitamin C and cranberry juice. Wear loose clothing and underwear. Preferably made of cotton. Eat healthily with lots of fruit and vegetables. Little or no alcohol useful. Do not smoke. Women are advised to wipe the buttocks from front to back to avoid wiping the bacteria towards the urethra. Avoid soap and vaginal showers when washing your pubic area. After sexual contact, it can help to go to the toilet for a while to urinate.
What are the forms of treatment?
The first choice of the doctor is to wait with the advice to drink a lot of water and, if necessary, to take a painkiller. Cranberry capsules or drink can help. The condition often heals within a week. If this is not the case, the doctor will prescribe antibiotics. To confirm the diagnosis, you can use a urine strip in the urine to check whether it is an inflammation. In order to know which bacterium causes the inflammation, a culture of the urine can also be taken. Then you provide a jar of urine to be sent to the laboratory for examination. The doctor can wait for the results of the culture or can immediately prescribe antibiotics, in which case the antibiotics can be adjusted after the results, if necessary.
In most forms of cystitis, antibiotics are the appropriate medicine. Always read the package leaflet before you start taking the medicine. For all antibiotics, a course of treatment must always be completed. However, with antibiotics it is always the case that when allergies occur, they must be stopped immediately. If you have had an allergic reaction to a certain antibiotic before, you are not allowed to (re)use this medicine. If you notice that the antibiotics treatment does not work properly or if you get a fever, contact a doctor.
- In case of acute cystitis in healthy individuals, the following antibiotics to be taken by mouth may be prescribed:
Nitrofurantoin. This antibiotic reacts well against the E-coli bacterium which in most cases (80%) is the cause of an inflammation of the bladder. Nitrofurantoin can turn urine yellow or brown. Nitrofurantoin should not be used in case of renal impairment.
Phosphomycin. This antibiotic is in principle prescribed as a single dose, preferably before going to bed on an empty stomach.
- In case of acute cystitis during pregnancy, a culture is usually taken first. Then antibiotics are started right away. In case of pregnancy, the following antibiotics, which are taken via the mouth, can be prescribed:
Nitrofurantoin. However, not at the end of the pregnancy. Nitrofurantoin can turn urine yellow or brown. Nitrofurantoin should not be used in case of renal impairment.
Phosphomycin. This antibiotic is in principle taken as a single dose via the mouth, preferably before going to bed on an empty stomach.
Trimethoprim. These antibiotics should not be given in case of severely disturbed liver and kidney functions and certain forms of anaemia.
Amoxicillin/clavulanic acid treatment, by mouth. Do not use if there is a history of jaundice, hepatic impairment and severe skin reaction.
Once the results of the urine test are known, it may be possible to change for a more targeted treatment of antibiotics.
- In case of recurrent cystitis in healthy persons, the
first choice is to drink a lot, to urinate well, to urinate immediately when there is an urge to do so and to urinate immediately after sex. Cranberry capsules or drink can help. If none of this helps, medication can be prescribed.
- In case of recurrent cystitis in healthy persons.
One of the following antibiotics, depending on the effectiveness of the medication for the first cystitis, is prescribed for a longer period of 6 to 12 months:
Nitrofurantoin, oral intake preferably before going to bed. During prolonged use, side effects such as nerve disorders and shortness of breath with a stimulus cough may occur. Nitrofurantoin can also turn urine yellow or brown. Nitrofurantoin should not be used in case of renal impairment.
Trimethoprim, oral intake preferably before going to bed. These antibiotics should not be given in case of severely disturbed liver and kidney functions and certain forms of anaemia.
The doctor may also choose to prescribe one of these antibiotics only after there has been sexual contact. It is advised to take a dose within 2 hours and not more than 1 dose per day.
- In women around the transition.
Around the transition, the mucous membrane of the bladder and vagina may become thinner as a result of a decrease in oestrogen, which may lead to more frequent bladder infections and recurrent bladder infections. The doctor can then prescribe oestrogens:
Estriol. These medicines are inserted vaginally. They are preferably not used for breast cancer (or when you have had breast cancer), acute liver and kidney disease, and heart disease.
Always read the package leaflet before you start taking the medicine.
Possible alternative treatment of cystitis could be cranberry extract and lactobacillus preparations.
Drink plenty of water, eat healthily with lots of fruit and vegetables. Moderate alcohol and bladder pain syndrome make it better not to consume alcohol at all, because it exacerbates the pain. Do not use soap in the pubic area. Stop smoking. Avoid piquant herbs. Urinate after sexual contact. Wear loose underwear, skirts and/or trousers so that the bladder is not pinched off. Make sure you have good bowel movements. Do not keep your urine in too long. It is best to urinate as soon as you feel the urge. Urinate, i.e. empty the bladder completely.
If the bladder infection is untreated, the bacteria can nestle in the bladder wall and cause inflammation on a regular basis. In addition, an untreated bladder infection can rise to the upper urinary tract and to the kidneys, where it can cause inflammation of the kidney pelvis. It is more difficult to treat than an inflammation of the bladder. An inflammation of the renal pelvis can take on a chronic form, which in turn can have serious consequences for the entire kidney, with eventual kidney failure. In addition, the bacteria of an untreated bladder infection can spread through the blood all over the body and cause blood poisoning. This can be very serious up to a life-threatening situation, with high fever and chills. This should be dealt with immediately. In the last trimester of pregnancy, untreated cystitis can cause contractions.
Another risk is if the E coli bacterium is resistant to antibiotics, then more expensive medication must be used.
How can you prevent cystitis?
Inflammation of the bladder cannot always be prevented. But the same tips as with "Can I do something myself about cystitis" will help to prevent cystitis.
Apotheek.nl (Last updated KNMP: 06-02-2019/
Last updated NHG: 20-11-2014). Cystitis. (Consulted on 20 April 2019). https://www.apotheek.nl/klachten-ziektes/blaasontsteking#!
KiesBeter (z.d.). Research. (Consulted on 20 April 2019). https://www.kiesbeter.nl/onderwerpen/blaasontsteking
Kidney foundation folder. Urinary tract infections. (Publication date February 2017). How does cystitis occur? (Consulted on 18 April 2019). https://cms.nieren.nl/sites/default/files/media/2018-04/documents/folder-Urineweginfecties-201804.pdf
Tailor-made medicines (z.d.). Alternative treatment. (Consulted on 20 April 2019). http://www.medicijnen-op-maat.nl/nieren-en-urinewegen/urineweginfecties.htm
Thuisarts.nl (z.d.). Treatment of cystitis. (Consulted on 20 April 2019). https://www.thuisarts.nl/blaasontsteking/medicijnen-voor-blaasontsteking
Pharmacotherapeutic compass (z.d.). Urinary tract infection/treatment plan/medication. (Consulted on 20 April 2019). https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/urineweginfecties#urineweginfecties_ongecompliceerde_urineweginfectie_literatuur
Rivm (Publication date 20-03-2012 | 00:00 Amendment date 02-11-2018 | 18:16). e-coli folder. (Consulted on 20 April 2019). https://www.rivm.nl/sites/default/files/2018-11/ecoli_folder_LR.pdf
Urineweginfecties.nl (2016). Risks of untreated cystitis. (Consulted on 20 April 2019). http://www.urineweginfectie.nl/urineweginfectie/symptomen.asp