Cystitis

Overview

Cystitis refers to inflammation of the bladder wall. While most people associate cystitis with bacterial infection, the term encompasses numerous conditions that share common symptoms but have different underlying causes. The bladder’s inner lining becomes irritated and swollen, leading to pain, urinary urgency, and other uncomfortable symptoms.

Understanding the specific type of cystitis is essential because treatment varies considerably depending on the cause. Bacterial cystitis responds to antibiotics, whereas interstitial cystitis requires an entirely different approach. Some forms resolve quickly with treatment while others require long-term management strategies.

Cystitis affects people of all ages but is more common in women due to their shorter urethra, which allows bacteria easier access to the bladder. Men, particularly those with benign prostatic hyperplasia, may also develop cystitis when urine retention creates conditions favourable for bacterial growth.

Types of Cystitis

Bacterial Cystitis is the most common form, occurring when bacteria enter the bladder through the urethra and multiply. This is also referred to as a urinary tract infection (UTI). Women who experience multiple episodes may have recurrent UTIs, requiring investigation for underlying causes.

Radiation Cystitis develops as a side effect of pelvic radiation therapy for cancers of the bladder, prostate, or reproductive organs. Radiation damages the bladder lining and blood vessels, sometimes causing hemorrhagic cystitis with significant bleeding. Symptoms may appear during treatment or months to years afterward. See our dedicated radiation cystitis page for detailed information.

Chemotherapy-Induced Cystitis results from certain cancer treatments, particularly cyclophosphamide and ifosfamide. BCG immunotherapy, given directly into the bladder to treat bladder cancer, can also cause bladder inflammation. The drug Mesna is often administered alongside chemotherapy to protect the bladder lining.

Interstitial Cystitis, also called painful bladder syndrome, is a chronic condition causing bladder pressure, pain, and sometimes severe urgency without evidence of infection. Its exact cause remains unknown, making diagnosis and treatment challenging. Visit our interstitial cystitis page for comprehensive information.

Cystitis Glandularis and Cystitis Cystica are chronic inflammatory conditions where the bladder lining undergoes changes in response to persistent irritation, often from recurrent urinary tract infections. The bladder surface develops a characteristic cobblestone appearance visible during cystoscopy.

Eosinophilic Cystitis is a rare condition caused by accumulation of eosinophils (a type of white blood cell) in the bladder wall. It occurs more commonly in people with allergies and produces symptoms similar to interstitial cystitis.

Trigonitis involves inflammation specifically at the trigone, the triangular area at the bladder base. Normal bladder lining cells are replaced by squamous cells, typically affecting postmenopausal women or those with hormonal fluctuations.

Ketamine Bladder results from recreational or prolonged medical use of ketamine. This drug causes severe bladder damage, dramatically reducing bladder capacity and causing intense pain with urination.

Symptoms

Most forms of cystitis share similar symptoms, though severity varies depending on the underlying cause. The hallmark symptom is dysuria—a burning or stinging sensation during urination. Patients typically experience a persistent, urgent need to urinate despite passing only small amounts each time. Frequent urination both day and night disrupts normal activities and sleep.

Bladder discomfort manifests as pressure, heaviness, or aching in the lower abdomen or pelvic region. Some patients notice cloudy or strong-smelling urine. Hematuria—blood in the urine—may occur, particularly in radiation cystitis, hemorrhagic cystitis, and some infectious forms.

In bacterial cystitis, symptoms typically develop rapidly over one to two days. Chronic forms such as interstitial cystitis produce symptoms that wax and wane over months or years. Radiation and chemotherapy-induced cystitis may cause bleeding that ranges from microscopic to severe.

Causes

Bacterial infection remains the most common cause of cystitis. Escherichia coli (E. coli), normally present in the bowel, accounts for most cases. Bacteria reach the bladder via the urethra, where they adhere to the bladder wall and multiply. Sexual activity, certain contraceptives, and incomplete bladder emptying increase risk.

Non-infectious causes include radiation therapy to the pelvis, certain chemotherapy drugs, and autoimmune reactions. In interstitial cystitis, the bladder’s protective mucus layer may be defective, allowing irritating substances in urine to penetrate and inflame the bladder wall.

Atrophic vaginitis in postmenopausal women reduces protective vaginal bacteria, increasing susceptibility to bladder infections. Urinary catheter use, bladder instrumentation, and foreign bodies also promote cystitis by introducing bacteria or causing direct irritation.

Certain substances irritate the bladder in susceptible individuals. Caffeine, alcohol, artificial sweeteners, and highly acidic foods may trigger or worsen symptoms in people with sensitive bladders or interstitial cystitis.

Diagnosis

Diagnosis begins with a detailed medical history focusing on symptom onset, duration, and any precipitating factors. Urine analysis detects white blood cells, red blood cells, and bacteria. Urine culture identifies the specific organism in bacterial cystitis and determines which antibiotics will be effective.

When symptoms persist despite treatment or recur frequently, further investigation is warranted. Cystoscopy allows direct visualisation of the bladder interior using a thin camera inserted through the urethra. This procedure identifies abnormalities such as the cobblestoning of cystitis glandularis, the ulcers of interstitial cystitis, or the damaged vessels of radiation cystitis.

Urodynamic testing measures bladder function, including capacity, pressure, and emptying efficiency. Imaging studies such as ultrasound or CT scan may reveal structural abnormalities contributing to recurrent infections.

For suspected interstitial cystitis, the potassium sensitivity test assesses bladder lining integrity. A bladder biopsy during cystoscopy helps confirm the diagnosis and rule out bladder cancer, which can mimic chronic cystitis symptoms.

Treatment

Treatment depends entirely on the underlying cause. Bacterial cystitis responds to antibiotics, with the specific drug chosen based on urine culture results. Uncomplicated infections typically require three to seven days of treatment. Recurrent bacterial cystitis may require longer antibiotic courses or low-dose preventive therapy.

Radiation and chemotherapy-induced cystitis treatments aim to reduce inflammation and promote healing. Options include intravesical instillations of hyaluronic acid, pentosan polysulfate (Elmiron), or hyperbaric oxygen therapy for severe cases. Hemorrhagic cystitis may require bladder irrigation, cauterisation of bleeding vessels, or other interventions to control bleeding.

Interstitial cystitis requires a multimodal approach. Oral medications include pentosan polysulfate, amitriptyline, and antihistamines. Bladder instillations with various solutions coat and protect the bladder lining. Physical therapy for pelvic floor dysfunction benefits many patients. Dietary modification to avoid bladder irritants provides symptom relief.

Chronic inflammatory forms such as cystitis glandularis, follicular cystitis, and eosinophilic cystitis may require corticosteroids to reduce inflammation. Long-term antibiotic therapy eradicates persistent infection in cystitis glandularis.

Ketamine bladder treatment centres on complete cessation of ketamine use. Early intervention may allow some recovery, but severe cases may require surgical bladder reconstruction.

When to See a Doctor

Seek medical attention promptly if you experience urinary symptoms for the first time, particularly burning with urination, blood in urine, or fever. These may indicate bacterial infection requiring antibiotic treatment to prevent progression to pyelonephritis (kidney infection).

Return to your doctor if symptoms persist after completing prescribed treatment, or if they return shortly after finishing antibiotics. Recurrent infections warrant investigation for underlying causes such as structural abnormalities or incomplete bladder emptying.

Seek urgent care for high fever with urinary symptoms, severe back or flank pain, inability to urinate, or significant blood in urine. These may indicate serious complications requiring immediate treatment.

Chronic pelvic pain with urinary symptoms lasting weeks or months suggests a condition like interstitial cystitis that requires specialist evaluation. Early diagnosis and management of chronic cystitis improves long-term outcomes and quality of life.