Cystitis: Symptoms, Causes and Treatments

Some patients with risk factors tend to have recurrent episodes of difficult-to-treat hemorrhagic cystitis. Despite this, there are many effective antibiotics.
Cystitis: Symptoms, Causes and Treatments
Diego Pereira

Written and verified by el médico Diego Pereira.

Last update: 09 April, 2021

Cystitis is a disease characterized by inflammation of the lining of the urinary bladder. This may have an infectious origin, although a small proportion of cases are due to other reasons.

When bacterial infections are responsible, a wide variety of antibiotics that can be administered. However, their indiscriminate use should be avoided, due to the risk of antimicrobial resistance.

We have prepared this short article so that you’ll know the most important aspects about this disease. Keep reading!

How is cystitis classified?

Depending on the frequency with which the disease occurs, it’s possible to distinguish two types: sporadic and recurrent. We’ll tell you about them below.


Many patients develop cystitis at a certain time in their lives and it doesn’t recur. This is known as a sporadic episode.

In general, it’s characterized by being a medical condition without complications, as long as patients receive an early diagnosis and timely treatment.


This term is used to describe cases of cystitis that recur constantly over time. This can happen in patients with some type of immunosuppression or who need urinary catheters to urinate.

Why does this disease occur?

Cystitis is more common in women.
Cystitis and other urinary infections are more common in women. This type of problem in men implies a deeper analysis of the cause.

From an epidemiological point of view, urinary infections are more frequent in women. This is due to anatomical and physiological factors such as the following:

  • The urethra is too short
  • An abundance of bacteria in the genital region.
  • The closeness of the external urethral orifice to the anal region.

All this favors the entry of microorganisms to the urinary tract through the urethra. Therefore, a large proportion of cystitis cases are infectious in origin. The bacteria that are usually involved are Escherichia coli, responsible for other urinary tract infections.

It isn’t always the result of an infection

This group includes any other cause of inflammation in the bladder whose origin isn’t related to infection by pathogenic microorganisms. For example, the long-term use of some medications (such as cyclophosphamide) and pelvic radiation can cause some types of cystitis.

The same happens in female patients who tend to use chemical products for genital hygiene, which can sometimes generate local allergic reactions capable of spreading to the bladder mucosa.

Risk factors

Some conditions can increase the likelihood of cystitis, such as the following:

  • Having benign prostatic hyperplasia or any disease that increases the size of the prostate
  • Immunosuppression, as in patients receiving long-term corticosteroids

In women, having sex without the use of condoms and having gone through menopause are additional risk factors that can make them more prone to recurrent cystitis.

Most frequent symptoms

The clinical manifestations of cystitis are similar to other lower urinary tract infections, including the constant and urgent need to urinate. This is closely related to pain, discomfort, and burning during urine output. Sometimes the odor of this liquid is foul and cloudy in appearance.

How is cystitis different from an upper urinary tract infection?

Acute pyelonephritis is the infection of the kidney tissue, and it’s considered to be an upper urinary infection. The characteristic clinical picture is different from that of cystitis, as there’s usually a high fever, general malaise, low back pain, nausea, and vomiting.

In general, the risk of complications in patients with pyelonephritis is higher, although it can also occur with cystitis.

Complications of cystitis

In a small group of patients who don’t receive appropriate treatment, the disease can progress and cause damage to other organs. This is the case with hemorrhagic cystitis, characterized by the obvious appearance of blood through the urine. This is called gross hematuria.

In the event that the bacteria reproduce quickly, they can ascend through the whole urinary tract to reach the kidneys and cause pyelonephritis. These cases may require hospitalization for the administration of intravenous antibiotics.

If the affected patient doesn’t seek medical attention in a timely manner, the infection is likely to affect organs and systems. This can lead to septic shock, an immediate life-threatening condition.


Although the clinical manifestations of cystitis are usually very evident, doctors often resort to complementary studies to confirm the diagnosis. This doesn’t only mean they can determine an infection, but they can also discover the causative organism.

The most used tests are the following:

  • Urinalysis: The physical, chemical and microscopic evaluation of the urine allows the doctor to diagnose an infection.
  • Urine culture: With a urine sample, it’s possible to observe the growth of microorganisms in specific culture media.
  • Complete blood count: This allows you to see the white blood cell count, which is usually high in bacterial infections.
  • Urea and creatinine: These are compounds in the blood whose measurement allows you to evaluate kidney function.

There are also invasive procedures such as cystoscopy, which is used for non-infectious cases of cystitis.


Cystitis can be treated with antibiotics.
Despite resistance to antibiotics, these are still the best treatment for cystitis.

There are many types of effective antibiotics for cystitis. However, the doctor’s choice will depend on many factors, especially when urine culture results aren’t ready.

The epidemiological data available and the particular characteristics of the patient are the most important elements that the specialist takes into account.

According to a Mayo Clinic publication, some of the most useful antibiotics for these infections include the following:

  • Nitrofurantoin
  • Cephalexin
  • Trimethoprim/sulfamethoxazole
  • Ceftriaxone
  • And, sometimes, ciprofloxacin and levofloxacin

The duration of any of these treatments depends on the clinical severity and the number of recurrences that the patient has had throughout their life.

In case of complications, the doctor usually opts for hospitalization in order to administer other drugs intravenously.

Why is it important to avoid self-medication in cystitis?

Self-medication is a frequent practice in many countries of the world. A research work (2010) carried out in a Spanish university population revealed that 90.8% of the 501 respondents frequently self-medicated. A considerable proportion of the drugs were antibiotics.

The constant and indiscriminate use of antibiotics leads to a phenomenon known as bacterial resistance. Microorganisms develop molecular mechanisms designed to resist the effect of drugs. What’s even more dangerous is the fact that such resistance can be transmitted between various bacteria, making the problem worse.

The World Health Organization (WHO) considers antibiotic resistance one of the greatest threats to public health, according to one of its publications.

For this reason, he urges both health professionals and patients not to self-medicate. When in doubt, it’s always advisable to go to a trusted doctor.

Early diagnosis and timely treatment: that’s the solution

We recommend that if you suffer any of the aforementioned symptoms you should go to the doctor as soon as possible. Although, in most cases, it’s a mild infection, the chances of a complication developing increase as the days go by.

To make the process as easy as possible, follow the following recommendations :

  • Comply with medical instructions to the letter
  • Drink plenty of water
  • Go to the bathroom when you feel you need to go, don’t hold back!
  • Clean the genital region very well with water every time you have a shower or bath.

If in doubt, make an appointment with a trusted doctor. Many specialists are trained to treat a case of simple cystitis, including family doctors and internists.

  • Haldar S, Dru C, Bhowmick NA. Mechanisms of hemorrhagic cystitis. Am J Clin Exp Urol. 2014;2(3):199-208. Published 2014 Oct 2.
  • Echeverría-Zarate J, et al. Infección del tracto urinario y manejo antibiótico. Acta Med Per 2006;23(1):26-31.
  • Guzman N, et al. Novedades en el diagnóstico y tratamiento de la infección de tracto urinario en adultos. Revista Mexicana de Urología 2019;79(6):1-14.
  • Tan CW, Chlebicki MP. Urinary tract infections in adults. Singapore Med J. 2016;57(9):485–90.
  • Medina M, Castillo-Pino E. An introduction to the epidemiology and burden of urinary tract infections. Ther Adv Urol. 2019.
  • Villarraga JDA, Parra JDI, Diaz DA, Cardenas AM, Chavarriaga J, Godoy MP. Guía de práctica clínica de infección de vías urinarias en el adulto. Urol Colomb. 2018;27(02):126–31.

Este texto se ofrece únicamente con propósitos informativos y no reemplaza la consulta con un profesional. Ante dudas, consulta a tu especialista.