Cystitis: Bladder Pain, Inflammation Causes, Relief (2024)

Cystitis is inflammation of your bladder or lower urinary tract. In its chronic version, it is called interstitial cystitis. When it occurs as an acute infection (occurring suddenly or with rapid onset), it is a form of a urinary tract infection (UTI).

Treatment varies based on the cause of your problem. Infections can be treated with antibiotics. Home treatments, procedures, and certain drugs can help relieve symptoms.

This article explains cystitis types, causes, and symptoms. It also discusses diagnosis and treatment options.

Cystitis Is Also Known as Painful Bladder Syndrome

Cystitis is also known as painful bladder syndrome or bladder pain syndrome since it typically involves symptoms of pain and pressure in your bladder and surrounding area.

Specifically, painful bladder syndrome is interstitial cystitis, the chronic (long-term) form of cystitis that lasts longer than six weeks. It can also involve pain in your pelvis, genital area, or other parts of your body, with mild to severe symptoms that vary by individual.

Not "Just a UTI," Though They Are Related

While cystitis differs from a UTI, the conditions are related. Cystitis is a condition that only involves your bladder. The most common cause of cystitis is bacteria, though it can also occur from a wide range of noninfectious causes such as medications or chemicals.

By definition, a UTI involves an infection of your urinary tract. This can involve any part of your urinary tract, such as your ureter (the tube that leads to your bladder), bladder, or kidneys.

Based on their definitions, cystitis and a UTI differ in these two key ways:

• While a UTI is always caused by an infection, cystitis can involve both infectious and noninfectious causes. Therefore, a UTI can be cystitis, but cystitis is not always a UTI.
• Cystitis always involves your bladder. However, a UTI can affect your bladder or any part of your urinary system.

Acute vs. Chronic Cystitis

Cystitis can occur as an acute disease that begins suddenly. It happens as a result of germs, typically bacteria, that enter your bladder through your urethra. While some germs can be cleared from your body during urination, some can remain or grow so fast that they can't be removed naturally; they remain and cause an infection.

Cystitis can also occur as a chronic condition that involves long-term inflammation of your bladder. Chronic cystitis can irritate and inflame your bladder wall, scarring your bladder or making it stiff. Chronic cystitis involves urinary tract symptoms that last longer than six weeks.

Cystitis can be classified as infectious or noninfectious based on the cause of the condition. Common types of cystitis include:

Infectious Cystitis

Infectious cystitis typically involves the bacterium Escherichia coli(E. coli), in 75% to 90% of all UTIs. Other bacteria that cause infectious cystitis include:

• Proteus mirabilis
• Klebsiella pneumoniae
• Staphylococcus saprophyticus
• Group BStreptococcus
• Lactobacillus
• Enterococci

Noninfectious Cystitis

This includes:

• Chemical cystitis: This type of cystitis can occur from the use of chemical agents orally, intravenously, or topically through direct contact. Chemical cystitis can result in chemotherapy treatments, spermicides, soaps, bubble baths, and dyes.
• Drug-induced cystitis: Chronic use of certain drugs can cause cystitis, including ketamine (an anesthetic), tiaprofenic acid (a type of nonsteroidal anti-inflammatory drug, or NSAID), mitomycin C (a form of chemotherapy), penicillins (a group of antibiotics), and some immune checkpoint inhibitors (ICIs).
• Foreign body cystitis: This type of cystitis is linked with the repeated or chronic use of urinary catheters or stents, tubes used to drain and collect urine from your bladder. These devices can bring bacteria into your bladder, causing recurrent UTIs, including cystitis.
• Radiation cystitis: This type of cystitis is a complication of pelvic radiotherapy used for pelvic cancers. Radiation cystitis can include symptoms that range from mild irritation during urination to life-threatening hemorrhagic cystitis.
  

How Cystitis Bladder Inflammation Feels

Cystitis bladder inflammation can cause feelings that range from mild to severe. These symptoms can include:

• A compelling and persistent urge to urinate frequently
• Painful urination
• Burning sensation during urination
• Urinary incontinence
• Hematuria (blood in your urine)
• Urine that is cloudy or strong-smelling
• Nocturia (frequent nighttime urination)
• Pelvic discomfort
• Pressure in your abdomen (the area below your belly button)
• Pain during sexual intercourse
• Genital pain
• Low-grade fever
• Fatigue

In older adults, cystitis may occur without symptoms common to the condition. However, they may experience different symptoms that include:

• Fever
• Confusion
• Delirium (an acute change in attention and awareness)

If cystitis remains untreated and spreads to your kidneys, you can develop a kidney infection, which requires immediate medical treatment. Symptoms of a kidney infection include:

• Fevers
• Upper back pain, usually on one side or the other
• Nausea
• Vomiting
  

Symptoms in Females

Symptoms in women may fluctuate with their menstrual cycle. Women often report experiencing a flare during ovulation (egg is released from an ovary about midway through the menstrual cycle) and/or just before menstruation.

In addition to common symptoms of cystitis, women may also experience pain in the vulva or vagin*.

Women may also experience pain that spreads across the abdomen or into the back. This pain often worsens with a mostly or completely empty bladder.

Symptoms in Males

Cystitis in men becomes more common with age. While rare in young men, men in their 50s and older are more likely to develop the condition as the prostate gland becomes enlarged and blocks the flow of urine from the bladder.

In addition to general cystitis symptoms, men may also experience:

• Clear fluid or a small amount of pus discharged from the penis
• Back pain as a result of a prostate infection or kidney infection
• Feelings of pressure, pain, and tenderness between the anus and scrotum
• Pain in the penis, scrotum, testicl*, or rectal area

Do I Have a UTI or Cystitis?

A UTI and cystitis have several symptoms in common, often complicating the process of making a crucial, accurate diagnosis. While mild cases of cystitis can improve within a few days, a bladder infection or other UTI typically requires antibiotics for seven to 14 days.

If hemorrhagic cystitis is diagnosed, it requires prompt treatment to prevent severe blood loss and permanent bladder damage. This complication of radiotherapy or chemotherapy results in persistent diffuse bleeding from the bladder tissue and can lead to severe blood loss if untreated.

Your healthcare provider uses the following tests to diagnose infectious and noninfectious cystitis:

• Physical examination: This involves an abdominal and pelvic examination to identify anatomical or functional abnormalities of the urinary tract
• Urine culture: This test evaluates a urine sample for white blood cells, red blood cells, bacteria, and other particles to help a healthcare provider prescribe the correct antibiotic.
• Ultrasound or computed tomography (CT) scan: These noninvasive diagnostic tests create real-time pictures of urinary tract structures, including the bladder and urethra.
• Cystoscopy: This test allows your healthcare provider to examine the inside of your bladder. The procedure involves the insertion of a thin telescope with a camera through your urethra and into your bladder.

Diagnostic Delays

Laboratory tests can identify infectious acute cystitis. However, there is no single test to diagnose interstitial cystitis. In addition, symptoms of interstitial cystitis resemble symptoms of other urinary disorders, making diagnosis a challenge.

Diagnostic delays can be avoided by contacting your healthcare provider for an accurate diagnosis. This also involves following through with your healthcare provider's recommendations for diagnostic tests.

Cystitis Causes: How Bladder Gets Inflamed

Cystitis is usually caused by external bacteria that travel up the urethra into your bladder. As the bacteria reproduce and grow, they cause irritation and swelling in the mucous membrane lining of your bladder.

Bacteria can come into contact with your urethra as a result of:

• vagin*l intercourse
• Anal intercourse
• Poor bladder control
• Fecal incontinence or inadequate cleansing following a bowel movement
• Having a catheter inserted into your urethra
• Uncircumcised penis in men

Factors that increase your risk of acute cystitis include:

• Being female
• Being sexually active
• Use of spermicide
• New sexual partner
• History of acute cystitis

Factors that increase your risk of complicated cystitis include:

• Diabetes
• Weak immune system
• Pregnancy
• Menopause
• Bladder catheter in place or recently used
• Neurogenic bladder (lack of urinary control due to problems in nerves controlling the bladder0
• Renal (kidney) insufficiency
• Kidney stones
• Problems in the urinary tract that slow the flow of urine or bladder control
• History of kidney transplant
• Tumor
• Endometriosis (when tissue similar to that growing in the uterus grows outside the uterus)
  

Cystitis Home Remedies for Relief

Acute infectious cystitis typically requires treatment with an antibiotic to kill the bacteria. The appropriate treatment for noninfectious cystitis depends on the cause. However, home remedies such as drinking more water and using heat therapy may help relieve symptoms until medications or other treatments take effect.

While the scientific evidence on their usefulness is inconsistent, the following home remedies may provide relief of cystitis symptoms:

• Cranberries
• Cinnamon
• Bearberry
• Probiotics
• Diuretic botanicals (asparagus, birch, couch grass, horsetail)

The following nonprescription over-the-counter (OTC) medications may also help alleviate mild symptoms of cystitis:

• NSAIDs, such as Advil (ibuprofen) and Aleve (naproxen sodium)
• Tylenol (acetaminophen)
• Azo (phenazopyridine hydrochloride)
• Cystex (methenamine and sodium salicylate)

Cystitis Treatment Under Provider Supervision

If you have symptoms of cystitis, a urologist can provide appropriate treatment and supervision of your condition. Treatment is based on the type and cause of your condition.

Acute cystitis that does not improve on its own typically requires a course of oral antibiotics to prevent the infection from spreading to your kidneys. Home treatments may help relieve symptoms until the infection clears.

Treatment of interstitial cystitis/bladder pain syndrome is more complex since the cause of the condition is not clear. Treatments can include:

Pelvic floor physical therapy: This type of physical therapy is typically performed for one hour once weekly for at least 12 weeks. Its purpose is to decrease muscle tightness and pelvic pain.

Oral medications for bladder pain, including:

• PPS, Elmiron (pentosan polysulfate sodium)
• Uribel (methenamine, sodium phosphate, monobasic, monohydrate, phenyl salicylate, methylene blue, and hyoscyamine sulfate)
• Elavil (amitriptyline)
• Oral antihistamines

Intravesical installations (drugs administered into your bladder via a catheter) to repair the bladder lining and decrease nerve sensitivity include:

• Heparin
• Lidocaine
• Sodium bicarbonate
• Dimethyl sulfoxide (DMSO)

Cystoscopy with hydrodistention: This procedure involves filling the bladder with water to its full capacity to stretch the capacity.

Neuromodulation therapy: This advanced therapy uses harmless electrical impulses to nerves going to and from your bladder to change how they work.

Botox injections: Small doses of Botox (onabotulinumtoxinA) can paralyze the bladder muscles to relieve pain.

Major surgery: Makes permanent physical changes to the bladder.

How to Manage Cystitis Flares

Cystitis flares can differ by individual. They occur as a sudden increase in the intensity of symptoms even though symptoms previously may be under control. The key to managing cystitis flares is to develop coping strategies

Recognizing Triggers

Learning your triggers is an important part of managing cystitis flares. Common triggers include:

• Consuming certain types of food
• Medications
• Exercise
• Sexual intercourse
• Hormone fluctuations
• Stress
• Certain modes of transportation or long car trips
• Tight clothing

Heat Therapy

Heat therapy can often provide relief of symptoms. Place a heating pad or hot water bottle directly on your perineum (the area between the anus and vagin* in women, and between the anus and scrotum in men).

Lifestyle Changes

Management of cystitis flares can also involve the following strategies:

• Make dietary changes to reduce your intake of food and beverages that can contribute to bladder inflammation. This may involve cutting back on alcohol, tomatoes, chocolate, caffeinated and citrus beverages, and high-acid foods.
• Quit smoking.
• Establish and maintain an exercise routine.
• Reduce stress.

Be Proactive

Plan ahead for flares with the following strategies:

• Treat a flare-up as soon as it starts.
• Learn relaxation and meditation techniques.
• Learn self-hypnosis.
• Try self-massage.
• Visit a psychotherapist to learn coping skills and stress reduction techniques.
  

Summary

Most cases of cystitis can be cured quickly. Minor cases may resolve on their own without treatment.

Cystitis that remains untreated may spread to your kidneys and cause an upper urinary tract infection. This is a more complex condition to treat. Knowing the symptoms of acute cystitis can help you know when to get help as early as possible.

Having chronic cystitis can be a long-term challenge. Knowing your triggers and the treatments that work best can help you manage symptoms. Contact your healthcare provider if you have symptoms of cystitis that do not resolve so you can begin treatment early for the best results.