Cystitis is inflammation of the bladder. It has various causes, the most common of which is bacteria. When bacteria causes cystitis, it is also called a lower urinary tract infection (UTI). It’s a common condition that responds well to treatment and usually resolves without complications.

Bacteria sometimes enters the body through the urethra, the thin tube that connects the bladder to the exterior of the body; urine passes through it. In theory, the normal flow of urine removes harmful bacteria from the body before an infection develops—but sometimes bacteria ends up travelling up the urethra to the bladder, causing cystitis.

Women get cystitis much more often than men, and the incidence of cystitis rises as women get older. Menopause increases the risk of the condition, due to hormone changes.

A course of antibiotics is often all that’s needed to cure cystitis. However, if cystitis is painful or uncomfortable, additional treatments may be prescribed to ease symptoms.

Cystitis is the term that refers to inflammation or irritation of the bladder, which is part of the lower urinary tract. (Upper urinary tract infections affect the kidneys.) When caused by bacteria, it is considered a urinary tract infection or UTI.

Bacteria is commonly found in and around the anus and the vagina. In women, the end of the urethra is located close to both openings, which is why bacteria from fecal matter or sexual intercourse more often ends up entering the urethra. Urination usually helps to clear bacteria from the body. But when some bacteria are able to enter the urethra, they have the ability to multiply and spread, causing an infection.

Though men do get cystitis, it happens much less frequently than in women. Anatomical differences are partly to blame: Women have shorter urethras than men, and the end of a woman's urethra is in a moister environment, allowing bacteria to proliferate. In addition, the end of a woman's urethra is closer to the anus (where bacteria may be present) than a man's urethra.

However, men who perform insertive anal sex increase their risk of cystitis because this exposes the end of the urethra to fecal matter. Having an uncircumcised penis also increases the risk of cystitis because the foreskin creates a moist environment where bacteria may become trapped near the end of the urethra. Men with a urethral obstruction due to an enlarged prostate or other anatomical change are also at higher risk of UTI.

Cystitis is usually caused by bacteria in the lower urinary tract. Most often—in 95% of cases—the bacteria Escherichia coli is the cause.

Sometimes, when bacteria comes into contact with the urethra, it travels to the bladder, leading to cystitis. This exposure may occur:

• During vaginal intercourse
• During anal intercourse
• Among people with poor bladder control
• Among people with fecal incontinence or those who don’t fully cleanse themselves following a bowel movement
• Among people who have had a catheter inserted into the urethra
• Among men with uncircumcised penises

Other, non-bacterial causes of cystitis include medications, chemicals, radiation, foreign bodies, interstitial cystitis, or other medical conditions.

People who have cystitis may experience uncomfortable symptoms, such as:

• Painful urination
• A burning sensation while urinating
• Cramps or pressure in the lower back or abdomen
• A strong urge to urinate often
• Frequent bathroom visits, including after bedtime
• Urinary incontinence
• Cloudy or dark-colored urine
• Blood in the urine
• Foul-smelling urine
• Pain during sexual intercourse
• Genital pain
• A low-grade fever in some people
• Fatigue

Sometimes older adults have cystitis without any of the symptoms listed above. However, they may have:

• Fever
• Confusion
• Delirium

Women who are at increased risk of cystitis include those who:

• Have had sex recently
• Use spermicide or diaphragms as birth control
• Have a history of urinary tract infections
• Are in menopause
• Are pregnant
• Have diabetes
• Experience urinary or fecal incontinence
• Have kidney stones or a history of kidney stones
• Have a prolapsed bladder wall (cystocele)
• Have difficulty fully emptying the bladder
• Have had a catheter inserted into the urethra
• Lack of adequate bladder control due to brain, nerve, or spinal cord problems, such as multiple sclerosis, Parkinson’s disease, or diabetes

Men who are at greater risk of cystitis include those who:

• Are uncircumcised
• Participate in insertive anal sex
• Have an enlarged prostate or other anatomical blockage of the bladder
• Have trouble fully emptying their bladder
• Have diabetes
• Have had a catheter inserted into the urethra
• Lack adequate bladder control due to brain, nerve, or spinal cord problems, such as multiple sclerosis, Parkinson’s disease, or diabetes

When you have symptoms of cystitis, you may be diagnosed after sharing your medical history, getting a physical exam, and undergoing diagnostic tests that evaluate your urine.

You should inform your doctor about the symptoms you’ve been experiencing, such as burning during urination, as well as increased frequency and urgency. Also let your doctor know if you have a personal or family history of urinary tract infections, if you’re in menopause, are pregnant, or if you have diabetes or another condition that may lead to nerve damage. It’s also important to mention if you have fecal or urinary incontinence.

In many cases, doctors can diagnose cystitis in women based solely on her symptoms. Usually, a physical exam isn’t necessary, but if a doctor decides to perform one, they may gently press on the stomach or back to determine whether certain spots are sensitive to the touch. If a woman has symptoms characteristic of other conditions, such as vaginitis or urethritis, the doctor may perform a pelvic exam. Doctors may also tap a man’s stomach or back to check for discomfort during a physical exam for suspected cystitis. They may also perform a digital rectal exam to check the prostate for inflammation. Prostatitis, or inflammation of the prostate gland, can cause symptoms similar to cystitis.

People with suspected cystitis may be asked to give a urine sample. Doctors test the urine to check for bacteria and nitrites—a specific chemical that appears in the urine when there are some types of bacteria present. Diagnostic urine tests may identify the specific bacteria causing cystitis, enabling doctors to prescribe a targeted treatment. Urine tests can also diagnose or rule out other conditions.

Other diagnostic tests may be offered when a patient has chronic cystitis or if urine tests are inconclusive. You may need an ultrasound exam or a computed tomography (CT) scan, imaging tests that allow doctors to view the bladder, urethra, and other urinary tract structures. This may help to identify a bladder obstruction or a kidney stone blocking urine flow.

Antibiotics are the main treatment for bacterial cystitis. Usually, a 3- to 7-day course is necessary, but in some cases, a single dose of an antibiotic called fosfomycin is sufficient.

Other treatments may be offered, along with antibiotics, if symptoms cause discomfort. Possibilities include:

• Phenazopyridine, which helps relieve pain in the urinary tract
• Warm/hot sitz baths, which may relieve discomfort
• Vaginal estrogen cream, which may improve symptoms for menopausal women
• Anticholinergic drugs, which may help to relax the bladder, improving symptoms

If the cause of chronic cystitis turns out to be a physical obstruction to the urethra or bladder, which is only rarely the case, surgery may be needed to improve urine flow.

Most people who receive treatment for cystitis are cured quickly, in just a few days. Minor cases may even go away on their own without treatment.

If cystitis isn’t identified and treated, it may spread to the kidneys, causing an upper urinary tract infection that is more difficult to treat. Fever, chills, and flank pain (pain on the lower back or sides) are symptoms that often accompany upper urinary tract infections.

“Yale Urology is a state-of-the-art center for evaluation and treatment of patients who experience cystitis,” says Yale Medicine urologist Marianne Casilla-Lennon, MD. “This includes short-term treatment with antibiotics or longer-term evaluation and management for patients who haven’t had success with their treatment. We have excellent, fellowship-trained providers with both urology and gynecology backgrounds to provide individualized care, offering the most up-to-date diagnostic technology and surgical options.”