Cystitis (bladder infection): symptoms, treatment and prevention

The NHS groups cystitis with other urinary tract infections (UTIs): cystitis is infection of the bladder, urethritis is infection of the urethra and kidney infection involves the kidneys. NICE says a lower UTI is an infection of the bladder usually caused by bacteria from the gastrointestinal tract entering the urethra and travelling up to the bladder. The NHS says women have a shorter urethra than men, which makes it easier for bacteria to reach the bladder or kidneys.

The NHS lists the following symptoms of a UTI:

• Pain or a burning sensation when peeing.

• Needing to pee more often than usual, including at night, or suddenly and urgently.

• Cloudy pee, sometimes with blood in it.

• Lower tummy pain, or pain in the back just under the ribs.

• A high temperature, feeling hot or cold and shivery, or a very low temperature below 36C.

• Feeling tired or weak.

The NHS says children with a UTI may have a high temperature, seem generally unwell, be irritable, not feed or drink properly, wet the bed or themselves, or be sick. In older, frail people, including those with dementia, and people with a urinary catheter, symptoms may include changes in behaviour such as agitation or confusion (delirium), worse than usual leaking of pee and new shivering or shaking. The NHS lists being aged 65 or older among the reasons to ask for an urgent GP appointment or help from NHS 111.

The NHS says to see a pharmacist if you are a woman or girl aged between 16 and 64 and not pregnant or breastfeeding. It advises asking for an urgent GP appointment or help from NHS 111 if you are aged 65 or older, if a child is aged 15 or younger, if you are a man or were assigned male at birth, if you have diabetes, are pregnant, use a catheter, have a weakened immune system, have blood in your pee, have pain in the lower tummy or back under the ribs, have a very high or low temperature or shivering, your symptoms get worse quickly or do not improve within 48 hours, or you keep getting UTIs.

The NHS says some of these could be symptoms of a kidney infection, which can be serious if not treated because it could cause sepsis. It advises calling 999 or going to A&E if you or your child are confused, drowsy or have difficulty speaking, and not driving yourself.

The NHS says a GP who suspects a UTI may do a urine test, though this is not always needed. They may offer self-care advice and a painkiller, prescribe a short course of antibiotics, or ask you to wait 48 hours before getting antibiotics in case symptoms go away on their own. It stresses taking all of any prescribed course even if you feel better.

NICE guideline NG109 tells prescribers to consider a back-up antibiotic prescription, used if symptoms do not start to improve within 48 hours or worsen at any time, or an immediate antibiotic prescription for non-pregnant women, taking account of severity, risk of complications, previous urine culture results, previous antibiotic use and the woman's preferences. For pregnant women and men, NICE says to offer an immediate prescription and obtain a midstream urine sample for culture before antibiotics are taken. For children and young people under 16, an immediate antibiotic is recommended with a urine sample taken beforehand.

The NHS suggests paracetamol up to 4 times a day for pain and a high temperature, resting and drinking enough fluids to pass pale pee regularly during the day, and avoiding drinks that may irritate the bladder, such as fruit juices, coffee and alcohol. It says some people who are not pregnant take cystitis sachets or cranberry products to prevent UTIs, but that there is no evidence they help ease symptoms or treat an infection that has already started.

If a UTI returns after treatment, or you have 2 in 6 months or 3 in 12 months, the NHS says you need to see a GP. They may prescribe a different antibiotic, or a low-dose antibiotic to take for up to 6 months, a vaginal oestrogen product if you are in perimenopause or have gone through the menopause, or refer you to a specialist for tests. The NHS also describes long-term (chronic) UTIs where symptoms persist and urine tests may not show an infection; it advises speaking to your GP and asking for referral to a specialist if symptoms continue after treatment.

The NHS advice includes wiping from front to back, keeping the genital area clean and dry, drinking plenty of fluids, washing the skin around the vagina with water before and after sex, peeing as soon as possible after sex, changing nappies or pads promptly, wearing cotton underwear and not holding pee in when you feel the urge. It advises against scented soap around the genital area and against spermicidal lubricant on condoms, diaphragms or caps. For people who keep getting cystitis, it says there is some evidence that daily D-mannose or cranberry products may help, that both can contain a lot of sugar, and that cranberry products should be avoided if taking warfarin.