woman with chronic cystitis lying in bed

Chronic cystitis is a recurrent bladder infection. Women get it more often than men. The main symptoms are chronic pain when peeing and a constant urge to go to the bathroom. Acute cystitis is often correlated with underlying diseases (e.g. diabetes). An acute bladder infection often resembles a simple case of cystitis, but with much more severe symptoms.

Chronic cystitis is more common in women over 30 and even more so in women in their 50s. The problem is that very often there is no obvious reason for the infection, making it hard to treat. However, the first line treatment is identical to that for usual cystitis. 

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What Causes Chronic Cystitis?

Bladder infections happen when the E.coli bacteria, which usually live in the bowel, get into the urethra and migrate up to the bladder where they multiply and cause an infection.

E.coli bacteria are regularly passed with excrement and can be found in small amounts on the skin around the anus. When women wipe their bottom from back to front (instead of front to back), they move these bacteria closer to the opening of the urethra.

Since the urethra in women is very short, it is easier for foreign bacteria to reach the bladder and start an infection in an environment that is normally “germ-free”.

Other Causes Of Chronic Cystitis & Risk Factors

Many women don't get cystitis, thanks to the natural acidity of the vaginal area, which prevents bacteria from multiplying in this area. However, it's possible that under certain conditions, this natural defense system is weakened, allowing bacteria to thrive and enter the urethra.

For this reason, a weak immune system can be one of the causes of chronic cystitis, especially if the infection has been able to spread.

There are several risk factors which can facilitate recurrent bladder infections:

  • Bladder or kidney stones
  • Diabetes
  • Congenital abnormalities in the urinary tract that can cause incomplete emptying of the bladder
  • It seems that the lower urinary tract (from the bladder to urethra) reacts to oestrogen levels, which may explain why some women get recurrent bladder infections after the menopause – a time during which hormonal changes occur.

Women who have had infectious cystitis (with lab tests confirming the presence of bacteria) at least twice in six months, should see a doctor or urologist to establish the cause and find the best treatment.

Causes Of Acute Cystitis

In many cases it remains unclear why some women suffer from severe bladder infections. However, acute cystitis can also occur when some pre-existing conditions worsen or cause the infection.

Women who suffer from diabetes, a blockage in the kidney or bladder (e.g. stones, congenital abnormalities) as well as women who have problems emptying their bladder, are more likely to suffer from cystitis.

The symptoms of acute cystitis are largely the same as those of a “normal” cystitis, but often more intense. They include: urges to urinate very frequently, pain during urination, cloudy and smelly urine, pain in the lower abdomen or back.

The treatment options are also similar, although it helps to have a urine sample tested to ensure that your doctor can prescribe you the best antibiotic. If the pain is too intense, you can get a prescription for pyridium, which is a painkiller that works specifically for the urinary tract.

How Common Is Chronic Cystitis?

Chronic Cystitis affects 5% of women who seek medical help for cystitis each year. However about one in five woman will get a re-infection, mostly because of poor hygiene or sexual activity.

The risk of chronic cystitis increases with age, especially from the age 60 onwards.

Recurrent Bladder Infections In Men

There is very little research and evidence on the causes of chronic cystitis in men, because it’s a very rare condition. There are, however, some factors which are suspected to contribute to recurrent bladder infections in men:

  • Sexually transmitted infections, specifically chlamydia;
  • Prostate infection (prostatitis) and other issues with the urinary tract that usually appear in men in their 50-60s;
  • Kidney stones.

The recommended antibiotics for cystitis in men are trimethoprim or nitrofurantoin.

Treatment For Recurrent Bladder Infections

Antibiotics are the most common treatment for chronic bladder infections.

However, when the symptoms are mild, you'll probably be told to wait for the results of a urine test. This way, your doctor can make sure he is prescribing the antibiotics most suited for fighting the bacteria which are causing you trouble.

In many cases, women are given antibiotics in advance (the usual 3-day course) so that they can treat their infection without having to visit their doctor. If antibiotics seem to work well for you, but bladder infections keep on coming back, you doctor may give you a long-term antibiotic treatment which consists of a much lower dose. Some patients need to take this every day for several months (from 6-24 months).

When Antibiotics Fail

Unfortunately, it's not uncommon for antibiotics to fail to cure recurrent bladder infections. You should consider consulting a urologist, if you are worried. It is possible that further tests can determine the cause.

In these cases, it is also recommended to change your daily habits:

  • Drink plenty of liquids (preferably water)
  • Go to the toilet as frequently as you need to
  • Wipe your bottom from front to back (not from back to front)
  • Avoid irritating your anus and vagina while washing (no harsh rubbing) – use mostly water and avoid using soap
  • Avoid using a diaphragm and spermicide as well as anything that “messes” with your normal vaginal balance
  • Pee after sex in order to evacuate any bacteria that could have reached the opening of your urethra

Many women report, that they find cranberry juice helps their cystitis. A 2011 study suggests, that you would need quite a lot of cranberry juice for it to make a difference in protecting your bladder.

It's recommended to take it as a capsule rather than as a liquid, simply because you'd need much more liquid to obtain the same effects as a single capsule containing about 200mg.

Be careful if you are taking blood thinning medication, because cranberry juice can interact with it.

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