Acute cystitis (bladder infection): symptoms, treatment and prevention

Cystitis means inflammation of the bladder, and in most cases it is caused by infection. The NHS explains that UTIs are usually caused by bacteria from poo entering the urinary tract through the urethra, the tube that carries pee out of the body. NICE CKS identifies Escherichia coli as the most commonly identified cause, in up to 77% of cases of bacteria found in urine.

The NHS says women have a shorter urethra than men, which makes it easier for bacteria to reach the bladder or kidneys. Cystitis can also affect men, children and older adults, for whom the NHS gives separate advice.

The NHS lists pain or a burning sensation when peeing, needing to pee more often than usual including at night, needing to pee suddenly or more urgently, cloudy pee, blood in the pee, lower tummy pain or back pain just under the ribs, a high temperature or feeling hot, cold and shivery, a very low temperature below 36 degrees Celsius, and feeling tired or weak. Pee may also be dark or smell, but the NHS notes that if this is your only symptom it might simply mean you have not been drinking enough water.

Symptoms can look different in some groups. The NHS says children may have a high temperature, appear generally unwell, be irritable and not feed properly, wet the bed or be sick. In older frail people, including those with dementia, and in people with a urinary catheter, symptoms may include agitation or confusion, worse leaking of urine and new shivering or shaking.

• Burning or stinging when you pass urine.

• Needing to go often or urgently, including at night.

• Cloudy, dark or strong-smelling urine.

• Lower tummy discomfort.

• Blood in the urine, which always needs medical attention.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if you think you, your child or someone you care for may have a UTI and: you are 65 or older, your child is 15 or younger, you have a very high or low temperature or are shivering, you are a man, or trans or non-binary and were assigned male at birth, you have diabetes, your symptoms get worse quickly or do not improve within 48 hours, you keep getting UTIs (2 in 6 months or 3 in 12 months), you use a catheter, you are pregnant, you have pain in the lower tummy or back just under the ribs, you have blood in your pee, or you have a weakened immune system.

The NHS adds that some of these could be signs of a kidney infection, which can be serious if untreated as it could cause sepsis. Call 999 or go to A&E if you or your child are confused, drowsy or have difficulty speaking, and do not drive yourself.

In many uncomplicated cases the diagnosis is made from the symptoms. The NHS says that if a GP thinks you may have a UTI they may do a urine test, though this is not always needed. NICE CKS says a diagnosis should be considered in a woman under 65 if there are key symptoms such as pain on passing urine, new night-time urination or cloudy urine, and in women over 65 or with a catheter if there is new painful urination or two or more urinary or non-specific symptoms. A urine dipstick and, depending on the situation, a culture to identify the bacteria and the antibiotics they respond to may be used.

NICE says a midstream urine sample should be obtained before antibiotics for pregnant women and men and sent for culture. A pregnancy test may also be arranged for women.

The NHS says a GP may offer self-care advice and a painkiller, prescribe a short course of antibiotics, or ask you to wait 48 hours before taking antibiotics in case symptoms clear on their own. It is important to take all the medicine you are prescribed, even if you start to feel better. NICE guidance on antibiotic choice for lower UTI recommends considering back-up (delayed) prescriptions in non-pregnant women where immediate antibiotics are not considered necessary, and offering an immediate prescription to pregnant women, men and children. Which antibiotic is used depends on your history, previous urine results and local resistance, and is decided by the prescriber.

NICE says people should be advised about possible side effects of antibiotics, particularly diarrhoea and nausea, and to seek medical help if symptoms worsen rapidly or significantly, do not start to improve within 48 hours of taking the antibiotic, or they become systemically very unwell. It also says to reassess for other diagnoses such as pyelonephritis.

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

To help prevent infection the NHS recommends wiping from front to back, keeping the genital area clean and dry, drinking plenty of fluids, washing around the vagina with water before and after sex, peeing soon after sex, changing nappies or incontinence pads promptly, and wearing cotton underwear. It advises not using scented soap around the genitals, not holding your pee in, fully emptying your bladder, and avoiding spermicidal lubricants, condoms, diaphragms or caps. For recurrent bladder infections the NHS says there is some evidence that D-mannose or cranberry products may help, that they can contain a lot of sugar, to speak to a doctor before taking them in pregnancy, and that people taking warfarin should avoid cranberry products.

The NHS says that if a UTI comes back after treatment, or you have 2 in 6 months or 3 in 12 months, you should see a GP. They may prescribe a different antibiotic, or a low-dose antibiotic to take for up to 6 months, or a vaginal oestrogen cream, gel, tablet, pessary or ring if you are in perimenopause or have gone through the menopause, or refer you to a specialist for further tests and treatments. NICE CKS also mentions considering methenamine hippurate as an alternative to daily antibiotic prevention.

The NHS also describes long-term, or chronic, UTIs in which symptoms persist, short antibiotic courses do not work and urine tests may not show infection. These can be hard to diagnose and affect quality of life; if you still have symptoms after treatment, speak to your GP and ask about specialist referral.

Factors that raise risk, according to the NHS, include pregnancy, kidney stones and other blockages, difficulty emptying the bladder such as an enlarged prostate or constipation in children, catheters, a weakened immune system including poorly controlled diabetes, having been through the menopause, spermicide use and not drinking enough.

On the NHS, an uncomplicated bladder infection in a woman aged 16 to 64 who is not pregnant can often be handled by a pharmacist, and others by a GP or NHS 111. The NHS says recurrent cases may be referred to a specialist for further tests and treatments, and waiting times for specialist appointments vary.

Some people choose private urology or urogynaecology for faster assessment of recurrent infections, imaging or cystoscopy. Ask what tests are planned and why, since many infections need only a urine culture and review of risk factors, and ask for results to be shared with your GP.