Cystitis: treatment, symptoms, causes and how long it lasts

NHS inform lists the symptoms of cystitis in adults as:

• Pain, burning or stinging when you pee.

• Needing to pee more often and urgently than normal.

• Feeling like you need to pee again soon after going to the toilet.

• Pee that is dark, cloudy or strong-smelling.

• Pain low down in your tummy.

• Feeling generally unwell, achy, sick and tired.

• Blood in your urine.

• The NHS adds needing to pee more often at night, and says a UTI can also cause a high temperature or feeling hot or cold and shivery, and feeling tired or weak.

NHS inform says that in adults cystitis does not usually cause a high temperature. If you have a temperature of 38C or above and pain in your lower back or sides, it may be a sign of a kidney infection. The NHS says some symptoms could be a kidney infection, which can be serious if not treated because it could cause sepsis.

NHS inform says mild cystitis will usually clear up on its own within a few days, although sometimes you may need to take antibiotics. Women who have had cystitis before do not necessarily need to see their GP if it returns, and mild cases often get better without antibiotics.

The NHS says that if you are a woman or girl aged between 16 and 64 and are not pregnant or breastfeeding, you can see a pharmacist if you think you have a UTI, as a pharmacist can give the same medicines as a GP.

If a GP thinks you have a UTI, they may do a urine test, though this is not always needed. They may offer self-care advice and recommend a painkiller, give you a prescription for a short course of antibiotics, or ask you to wait 48 hours before getting antibiotics in case your symptoms go away on their own. Take all the medicine you are prescribed, even if you start to feel better.

The NHS and NHS inform suggest the following to ease symptoms:

• Take paracetamol (up to 4 times a day) or ibuprofen, checking the leaflet or with a pharmacist first.

• Rest and drink enough fluids so you pass pale pee regularly during the day.

• Use a hot water bottle on your tummy or between your thighs to reduce discomfort.

• Avoid drinks that may irritate your bladder, such as fruit juices, coffee and alcohol.

• Avoid having sex until you feel better.

• Some people use cranberry products or cystitis sachets, but NHS inform says there is no evidence they help symptoms or treat cystitis once it has started.

NHS inform says cystitis is usually caused by a bacterial infection, and sometimes by the bladder being irritated or damaged. The NHS says UTIs are usually caused by bacteria from poo entering the urinary tract through the urethra, and that women have a shorter urethra than men, so bacteria are more likely to reach the bladder.

Things that can cause or raise the chance of bacteria reaching the bladder include having sex, wiping your bottom from back to front, inserting a tampon or urinary catheter, using a diaphragm or spermicide for contraception, a blockage in the urinary tract such as kidney stones, pregnancy, conditions that make it hard to empty the bladder fully such as an enlarged prostate or constipation, having been through the menopause, diabetes, and a weakened immune system.

The NHS and NHS inform describe cystitis as usually caused by bacteria entering the urinary tract, for example bacteria from the bowel, and do not describe it as spread from person to person. They list sex as one of several things that can cause bacteria to reach the bladder, and advise avoiding sex while you have symptoms.

If symptoms keep returning or do not improve, NHS inform advises contacting your GP practice, who can look for other causes.

NHS inform says mild cystitis will usually clear up on its own within a few days. NICE CKS describes uncomplicated lower UTI as usually self-limiting, resolving within a few days.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if your symptoms get worse quickly or do not improve within 48 hours (2 days) of starting treatment or treating it yourself. NHS inform says to contact your GP practice if symptoms have not improved within a few days or have not gone away after antibiotics.

The NHS says you need to see a GP if you have 2 UTIs in 6 months or 3 within 12 months. NICE CKS uses the same definition of recurrent UTI. A GP may prescribe a different antibiotic or a low-dose antibiotic to take for up to 6 months, a vaginal oestrogen product if you are perimenopausal or have gone through the menopause, or refer you to a specialist.

NHS inform describes stand-by antibiotics, a prescription you take to a pharmacy next time you have symptoms, and continuous antibiotics taken for several months, with a dose within 2 hours of sex if cystitis usually follows sex. The NHS says some people take D-mannose or cranberry products to help prevent UTIs coming back, and to speak to your doctor first in pregnancy and avoid cranberry products if taking warfarin.

The NHS also describes long-term (chronic) UTIs, where symptoms do not go away and urine tests may not show an infection. If you have been treated but still have symptoms, speak to your GP and ask to be referred to a specialist.

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 aged 65 or older, or your child is aged 15 or younger.

• You have a very high or low temperature, feel hot or cold, or are shivering.

• You are a man, or are trans or non-binary and were assigned male at birth.

• You have diabetes, are pregnant, use a catheter or have a weakened immune system.

• Your symptoms get worse quickly or do not improve within 48 hours.

• You keep getting UTIs.

• You have pain in the lower tummy or in the back under the ribs.

• You have blood in your pee: it may look bright pink, red or dark brown.

• Call 999 or go to A&E now if you or your child are confused, drowsy or have difficulty speaking.

The NHS lists pregnancy among the situations where you should ask for an urgent GP appointment or call NHS 111 if you think you have a UTI, and NHS inform says to contact your GP practice if you are pregnant and have symptoms of cystitis. NICE CKS has separate guidance for UTI in pregnancy and for asymptomatic bacteriuria in pregnancy.

In children, NHS inform says symptoms include a temperature of 38C or above, weakness and tiredness, irritability, reduced appetite and vomiting, and children can also have adult symptoms such as pain when peeing. The NHS says babies and young children may be irritable and not feed, eat or drink properly, or wet the bed. A child with these symptoms should be seen urgently by a GP or NHS 111.

The NHS and NHS inform suggest the following steps, particularly if you get cystitis often.

• Wipe from front to back after going to the toilet.

• Empty your bladder as soon as possible after sex, and wash the skin around the vagina with water before and after sex.

• Drink plenty of fluids, particularly water, so you regularly pee during the day.

• Do not hold your pee in, and fully empty your bladder.

• Keep the genital area clean and dry, wear cotton underwear and change soiled nappies or incontinence pads promptly.

• Do not use scented soap, bubble bath or talcum powder around the genitals.

• Do not use spermicide with a diaphragm or condoms: try lubricant without spermicide or a different contraception.

Most people with uncomplicated cystitis are helped by a pharmacist or GP. The NHS says a pharmacist can treat a suspected UTI in women and girls aged 16 to 64 who are not pregnant or breastfeeding, giving the same medicines as a GP, and can direct you to other help if needed.

Some people choose a private GP, urology or gynaecology appointment for recurrent or persistent symptoms. Ask whether a urine culture will be sent so that treatment can be matched to the bacteria, and keep your NHS GP informed.