Acute Cystitis: The Facts You Need to Know

What is acute cystitis?

Acute cystitis is a condition during which acute inflammation affects your bladder. Acute cystitis is usually the result of a urinary tract infection (UTI) caused by bacteria. Acute cystitis is the most common type of UTI, and it most frequently affects females.

This condition is so common that it has been estimated to affect 40 percent of all women, at some point in their lives. Acute cystitis is also a relatively common UTI during pregnancy, affecting anywhere between 0.3 and 1.3 percent of all pregnancies. 

For many women, acute cystitis can become a recurrent problem. Approximately 27–46 percent of women who suffer from acute cystitis will develop another UTI within a year of the initial infection.

Common acute cystitis symptoms

Many women will recognize the tell-tale symptoms of acute cystitis immediately. Some of the most common acute cystitis symptoms include:

• Dysuria (painful urination)
• Increased urinary frequency
• Feeling the urge to urinate, even after you’ve emptied your bladder
• Urine with a foul or strong smell
• Passing small amounts of urine frequently
• Lower abdominal discomfort or cramping
• Feeling like your bladder is always full
• Cloudy urine
• Hematuria or bloody urine (although it’s important to note that most cases of acute cystitis occur without hematuria)

There are other symptoms which might be associated with acute cystitis; however, they’re more common in upper UTIs or systemic infections. If these symptoms occur as a result of acute cystitis, they could indicate a serious infection.

• Fever
• Chills
• Malaise
• Nausea
• Vomiting
• Headache
• Lower back pain

Acute cystitis: causes and risk factors

In most cases, acute cystitis is caused by bacteria that are normally present in our gastrointestinal tract. The most common pathogens that cause acute cystitis include:

• Escherichia coli (86%)
• Staphylococcus saprophyticus (4%)
• Klebsiella sp. (3%)
• Proteus sp. (3%)
• Enterobacter sp. (1.4%)
• Citrobacter sp. (0.8%)
• Enterococcus sp. (0.5%)

The human urinary tract is sterile under normal, healthy conditions. However, bacteria can migrate from the rectum, perineum, or vagina to the urinary tract and colonize it, causing a UTI.

Women get UTIs much more frequently than men because the female urethra is much shorter and wider than the male urethra. The female urethra is only 3–4 centimeters long, whereas the male urethra measures approximately 18–20 centimeters. The shorter distance and wider entrance makes it easier for bacteria to travel up the urethra.

Once bacteria or other pathogens reach the bladder, they begin to multiply and cause inflammation, which leads to the usual symptoms of acute cystitis. If the infection is left untreated, it can spread to the ureters (the tubes that connect the kidneys to the bladder) and kidneys, and even cause sepsis.

Other risk factors for acute cystitis include:

• Sexual activity
• Using a diaphragm
• Spermicidal agents
• Hormonal changes during menopause
• Kidney stones
• Urinary tract abnormalities
• Recent urinary surgical procedures
• Pregnancy
• Recent or frequent use of antibiotics
• Diabetes
• Having a urinary catheter
• Being immunosuppressed
• High stress levels
• Uterine or bladder prolapse
• Wiping from back to front

Asymptomatic bacteriuria (elevated levels of bacteria in the urine that don’t cause symptoms), especially in elderly patients and pregnant women, can also cause acute cystitis.

It’s important to keep in mind that acute cystitis isn’t always caused by a UTI. There are other things which can cause acute bladder inflammation, including:

• Certain chemotherapy agents
• Pelvic radiotherapy
• Sensitivity to certain feminine hygiene products
• Autoimmune conditions

Acute cystitis treatment and management

If you suspect that you have acute cystitis, you’ll need to go to the doctor. They’ll perform a physical examination and take your history to diagnose the condition. Certain tests can be ordered to confirm the diagnosis and rule out other possible conditions, including:

• Urinalysis
• Urine culture
• Cystoscopy
• Ultrasound
• Complete blood count (CBC)

If your acute cystitis is caused by a bacterial infection, you’ll need to complete a course of antibiotics. Your doctor will prescribe the correct antibiotic depending on the pathogen that is causing the infection. 

A course of antibiotics usually lasts around seven days, but sometimes it may take longer, depending on the exact antibiotic that you’re taking. It’s very important to take the full course of antibiotics as prescribed by your doctor, even if you already feel better. 

Interrupting your antibiotics before you complete the course can increase your risk of developing a recurrent infection, and it can lead to growth of bacteria with resistance to multiple antibiotics. If you have recurrent infections, your doctor could prescribe a longer course of antibiotics.

You might not feel better immediately after starting your antibiotics, since it usually takes around 36 hours for symptoms to improve. Other recommendations often include:

• Making sure you stay hydrated
• NSAIDs to relieve pain, fever, or chills
• A urinary tract pain reliever, such as phenazopyridine 
• Avoiding feminine hygiene products or birth control methods which cause urinary irritation

Certain natural substances, including cranberry, rosemary, centaury, and lovage, may also be recommended to aid in the treatment of acute cystitis.

How to prevent acute cystitis

There are many simple techniques which can help you prevent acute cystitis, including:

• Urinating after engaging in sexual activity
• Avoiding feminine hygiene products that cause irritation
• Consuming a balanced diet which includes fruits and protein
• Not delaying urination
• Drinking cranberry juice
• Increasing water intake
• Washing genitals everyday
• Wiping genitals front to back after using the bathroom
• Discussing using vaginal estrogen therapy with a doctor, during or after menopause

The acute cystitis takeaway

Acute cystitis is a very common UTI that affects many people, especially women. If you suspect that you’ve developed this condition, it’s very important to go to the doctor to confirm the diagnosis. Once you have a diagnosis, you’ll be able to start treatment and feel better.

Simple measures such as drinking plenty of water and wiping your genitals properly can help prevent recurrent UTIs. Although acute cystitis is uncomfortable, it can be easily treated if you get an early diagnosis and medical assistance.