1. What is cystitis? Is it the same as urethritis?

  The lower urinary tract refers to the urethra and the urinary bladder. The bladder is like a smooth bag that helps to store urine. The urethra is a tube-like structure which joins the bladder. During voiding, urine will be evacuated from the bladder and pass out our body through the urethra. The bladder neck refers to the site at which the urethra joins the bladder. As the urethra and the bladder is so close to one another, bacteria that happen to enter the urethra can easily go upwards and involve the bladder as well. It is common to have infection involving both the urethra and the bladder. Therefore, urethritis and cystitis basically will often occur together and means more or less the same in practice.

When the term cystitis is used in our daily practice, it usually means that the infection is caused by bacteria, commonly E. Coli. There are a number of “cystitis” not caused by bacterial infection but the symptoms of these conditions are the same as those of bacterial cystitis. These “non-bacterial” cystitis will therefore not be cured by antibiotics. We would confine our discussion only to bacterial cystitis in the subsequent discussion.

2. What are the symptoms of cystitis？

  The typical symptoms include frequency of urination, urgency (strong and sudden desire to pass urine), burning sensation and lower abdominal pain. About one third of sufferers will have haematuria (blood-stained urine). Fever is not a common occurence. These symptoms are usually abrupt in onset and usually cause significant discomfort to the woman especially during voiding.

3. Who are mostly at risk of cystitis？

A.  Women who are teachers, receptionists/secretory are more prone to have cystitis if they do not drink enough water, and/or they hold the bladder for too long unnecessarily because of the nature of their job.

B. Women who have frequent sexual activity are also prone to develop cystitis. This is because the female urethra is short and is close to the vagina and anal opening. Bacteria can easily get into the urinary tract during intercourse. The term “honeymoon cystitis” therefore refers to cystitis that occur during honeymoon of a newly married couple!

C. Women who have diabetes mellitus.

D. Women who have congenital abnormality of the urinary system. These are uncommon.

4. Is it easy to get a recurrence？
  It is true that a woman who gets the first attack of cystitis can have another attack or even more attacks in the months to come. In general this is more likely to be related to the drinking and bladder habit, as well as the frequency of sexual activity of the woman.

5. How is cystitis managed？

  Acute bacterial cystitis is usually treated by oral antibiotics. The recent tend is to use a shorter duration of treatment, from 3-5 days depending on the exact type of antibiotic, rather than the traditional 7 days of treatment. There is also a single dose preparation in the market. However there is not sufficient good evidence that it is better and more effective than the multiple doses treatment. In general, the symptoms will improve greatly once the treatment has been commenced for 2-3 days. It is advisable not to buy and take antibiotics lightly without a doctor’s prescription. A more thorough and accurate assessment should be performed by a qualified doctor first. Drinking adequate water during the treatment phase helps to flush the bladder and is to be recommended.

6. How to reduce the chance of getting cystitis？    

A. Drink a normal and sufficient amount of water especially in hot environment. Do not get into the habit of holding a full bladder unnecessarily.

B. Adequate exercise and rest to maintain normal body immunity.

C. After toileting, the correct way of cleansing the genital area is to wipe from the front towards the back. i.e. begins from the urethral region and backward down to the anus (not the reverse). Otherwise, you are bringing the bacteria around to the region of the urethral opening.

D. Avoid wearing tight and thick jeans for too long in a day.

E. There are observations in the literature that drinking cranberry juice can help reduce the chance of getting cystitis or recurrence.

F. For those women who easily get cystitis shortly after intercourse, they should void immediately after each coital activity. Some women may need to take a smaller dose of antibiotics before the intercourse after discussion with their doctors.

We hereby thanks Dr. Lau Chung Ting for the provision of the above information