Living with recurrent bacterial cystitis can be frustrating, and I know from reader questions that there’s a lot of confusion about prevention, treatment, and the difference between bacterial cystitis and other bladder conditions. This FAQ addresses the questions I hear most often.

Q: Should I drink cranberry juice all the time, or only during an attack?

A: This is probably the question I get asked most frequently. The short answer: cranberry is better for prevention than treatment.

Cranberry products have a bacteriostatic effect, meaning they inhibit bacterial growth rather than killing bacteria outright. The active compounds (proanthocyanidins) work by preventing E. coli from adhering to the bladder wall 1. If bacteria cannot attach, they get flushed out when you urinate.

However, once an infection is established, cranberry juice has limited effect. The bacteria are already attached and multiplying, so prevention mechanisms are no longer relevant.

A few practical points:

If you’re using cranberry for prevention, choose low-sugar or unsweetened options. The high sugar content in many commercial cranberry juice cocktails can actually encourage bacterial growth by providing fuel for the bacteria.
Cranberry supplements (capsules or tablets) offer a more concentrated dose without the sugar.
A 2023 Cochrane review found that cranberry products reduced the risk of recurrent UTIs in women by about 26% compared to placebo 1.

My honest take: cranberry is not a miracle cure, but for women with frequent recurrences, it’s a reasonable addition to your prevention strategy alongside adequate hydration and good toilet habits.

Q: I get bacterial cystitis after sex. What can I do to prevent this?

A: Post-coital (after sex) cystitis is extremely common, and you’re far from alone. Sexual intercourse can introduce bacteria from the perineal area into the urethra, and for women with a short urethra, those bacteria have a quick path to the bladder.

Here are practical steps that can help:

Before and after intercourse:

Urinate before sex to empty your bladder
Urinate within 15-20 minutes after sex to flush out any bacteria that may have entered the urethra
Wash your genital area before and after sex (this goes for your partner too)
Don’t forget hand hygiene - hands can transfer bacteria during intimate contact

Lubrication matters:

If vaginal dryness is an issue, friction can irritate the urethral opening and make infection more likely
Water-based lubricating gels from the pharmacy can help reduce trauma
Avoid lubricants with added sugars, flavours, or warming agents which can irritate sensitive tissues

Consider your contraception:

If you use a diaphragm, have your GP check that it fits correctly. An ill-fitting diaphragm can put pressure on the urethra and interfere with complete bladder emptying
Spermicides can alter vaginal flora and may increase infection risk in some women

When prevention isn’t enough: If you’ve tried these measures and still get infections after intercourse, your GP may recommend post-coital prophylaxis - taking a single low-dose antibiotic immediately after sex. Studies show this approach is effective for women with recurrent post-coital UTIs 2. Common choices include nitrofurantoin, trimethoprim, or a fluoroquinolone.

I should mention that some women find D-mannose helpful as a non-antibiotic prevention option. It’s a simple sugar that interferes with bacterial attachment in a similar way to cranberry. The evidence is weaker than for antibiotics, but it’s worth discussing with your doctor if you want to avoid long-term antibiotic use.

A: This one requires a bit of explanation because the terminology can be confusing.

Cystitis glandularis is a descriptive term for a particular appearance of the bladder lining under cystoscopy. It’s typically seen in cases of chronic urinary tract infection or long-standing bladder irritation. The normal bladder lining undergoes changes in response to ongoing inflammation:

Cystitis cystica (milder form): The bladder lining develops multiple tiny fluid-filled blisters
Cystitis glandularis (more developed form): The blisters have thicker walls, and the bladder lining takes on a cobblestone-like appearance

These changes are essentially the bladder’s way of protecting itself from persistent irritation.

Now, is this related to interstitial cystitis (IC)?

They are distinct conditions, but they can coexist. The key differences:

Cystitis glandularis is primarily caused by chronic bacterial infection or other identifiable irritation
Interstitial cystitis (also called bladder pain syndrome) is diagnosed based on clinical symptoms, cystoscopic findings, and urodynamic testing - and importantly, by ruling out bacterial infection

If you’ve been told you have both conditions, that’s not unusual. Someone with a long history of recurrent bacterial cystitis might develop cystitis glandularis as a consequence, while also meeting the criteria for IC/BPS. Treatment would need to address both the infectious component and the chronic pain/urgency symptoms.

Contribution from Mr Paul Irwin MCh FRCSI(Urol)

Q: Do I need antibiotics every time I get cystitis symptoms?

A: Not necessarily, and this is an important question given concerns about antibiotic resistance.

For mild symptoms in otherwise healthy women, some doctors recommend a “wait and see” approach for 24-48 hours with:

Increased fluid intake (aim for 2-3 litres per day)
Paracetamol for discomfort
Urinary alkalinisers (like sodium citrate sachets) which can ease burning

A study published in JAMA Internal Medicine found that increased water intake reduced the frequency of cystitis episodes by about 48% in women prone to recurrence 3. Sometimes, catching symptoms early and flushing the system aggressively is enough to avoid antibiotics.

However, you should seek medical attention promptly if:

You have fever, back pain, or feel generally unwell (signs the infection may have spread to the kidneys)
Symptoms don’t improve within 48 hours
You see blood in your urine
You’re pregnant
You have diabetes or a weakened immune system
You’re a man (UTIs in men are considered complicated and require investigation)

I want to be clear: antibiotics remain the gold-standard treatment for confirmed bacterial cystitis. I’m not suggesting you avoid them when they’re needed. But for straightforward, mild symptoms, having a conversation with your GP about whether watchful waiting might be appropriate is reasonable.

Q: What’s the difference between cystitis, UTI, and bladder infection?

A: People use these terms interchangeably, which causes a lot of confusion.

Urinary tract infection (UTI) is the broadest term. It refers to an infection anywhere in the urinary system - kidneys, ureters, bladder, or urethra.

Cystitis specifically means inflammation of the bladder. It can be bacterial (caused by infection) or non-bacterial (caused by irritation, radiation, chemicals, or unknown factors as in interstitial cystitis).

Bladder infection is another way of saying bacterial cystitis.

So when your GP says you have a UTI, they usually mean a lower urinary tract infection affecting the bladder (bacterial cystitis) and/or urethra (urethritis). Upper UTIs affecting the kidneys are called pyelonephritis and are more serious.

For more detailed information about UTIs, see our comprehensive guide to urinary tract infections.

Q: Can men get bacterial cystitis?

A: Yes, although it’s much less common than in women due to anatomy - men have a longer urethra, which makes it harder for bacteria to reach the bladder.

When men do develop UTIs, it’s often associated with:

Benign prostatic hyperplasia (enlarged prostate) which can cause incomplete bladder emptying
Urinary catheterisation
Recent urological procedures
Abnormalities of the urinary tract
Uncontrolled diabetes

Because UTIs in men are uncommon and often indicate an underlying problem, your GP will likely want to investigate further rather than simply treating with antibiotics and moving on.

Q: Are recurrent infections damaging my bladder permanently?

A: I understand this worry - if you’ve had multiple infections, it’s natural to wonder about long-term consequences.

For most women with recurrent UTIs, the good news is that infections don’t cause permanent kidney damage as long as they’re treated appropriately. The bladder lining recovers well once the infection clears.

However, repeated infections can lead to:

Changes in the bladder lining (like the cystitis glandularis discussed above)
Increased sensitivity and urgency symptoms
Anxiety about triggering another infection, which can affect quality of life

If your infections are truly resistant to treatment, or if you have structural abnormalities, your urologist may want to investigate more thoroughly.

Q: Can stress cause cystitis?

A: Stress doesn’t directly cause bacterial infections - you need bacteria for that. However, stress can make you more susceptible to infections by:

Suppressing immune function
Leading to poor self-care habits (not drinking enough, holding urine too long)
Affecting sleep, which impacts immunity

Stress is more strongly linked to non-bacterial bladder conditions like interstitial cystitis, where symptom flares often correlate with stressful periods. If you notice a pattern between stress and your cystitis symptoms but your urine cultures are negative, it’s worth discussing with your doctor whether you might have IC/BPS rather than recurrent bacterial infections.

Q: Should I see a specialist?

A: Most straightforward cases of bacterial cystitis can be managed by your GP. However, consider asking for a referral to a urologist if:

You have more than 3 infections per year despite preventive measures
Your infections don’t respond to standard antibiotics
You have blood in your urine between infections
You’re experiencing chronic pelvic pain
Your symptoms don’t match typical bacterial cystitis
You’re male (men with UTIs warrant urological investigation)

A urologist can perform cystoscopy to examine your bladder directly, order specialised tests, and help distinguish between bacterial cystitis, interstitial cystitis, and other bladder conditions.

Final thoughts

Bacterial cystitis is common and, for most people, readily treatable. But if you find yourself dealing with frequent recurrences, don’t settle for simply taking antibiotics each time. Work with your doctor to identify triggers, explore prevention strategies, and rule out underlying conditions.

For more information on diet and lifestyle approaches, see our article on BC diet and nutrition.

References

Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012;10(10):CD001321.
Stapleton A, et al. Postcoital antimicrobial prophylaxis for recurrent urinary tract infection: a randomized, double-blind, placebo-controlled trial. JAMA Intern Med. 1990;150(7):1428-1432.
Hooton TM, et al. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. JAMA Intern Med. 2018;178(11):1509-1515.