Cystitis: what it is, how to recognize it and what are the solutions?

Cystitis: what it is, how to recognize it and what are the solutions?

Publication date: 13-11-2023

Updated on: 13-11-2023

Topic: Urology

Estimated reading time: 1 min

Cystitis is a very troublesome bladder disorder that mainly affects women and can be of a bacterial origin. It is not always easy to recognize it, so it is important to rely on a specialist who will be able to recommend the most correct exams and treatment. How is it treated? Can it be prevented? We asked Dr. Maurizio Cremona, urologist at the Istituto Clinico San Siro and Palazzo della Salute.

Causes of cystitis

"Bacterial or non-bacterial in nature, cystitis affects women more than men in a ratio of 4 to 1," Dr. Cremona explains.

Cystitis in women

"In women, the main cause is the proximity of the urethral meatus (i.e., the urine outlet channel) to the vaginal mucosa (in the case of women) and also to the intestines. As a result, migration of bacteria from the genital or intestinal tract along the urethra to the bladder can easily occur. It is more common in women because a woman's urethra measures about 3 cm," the doctor elaborates.

Cystitis in men

"In men, the urethra, in addition to being 12-15 cm long, is protected by acidic prostatic juices that have an antibacterial function. This makes it more difficult for bacteria to take root because they start from the outside (anus). On the other hand, prostatitis is more likely to develop than cystitis."

Causes of bacterial cystitis

Sometimes, bacterial cystitis can be related to reduced antibodies. In women with cystitis, a reduction in IgA, antibodies present in the bladder, has, in fact, been shown. Sometimes, particularly aggressive or spreading bacteria cause recurrent cystitis. 

Bad habits that promote cystitis

"Bad habits, such as infrequent emptying of the bladder, can promote this disorder: if the bladder is emptied infrequently, a lot of urine and bacteria accumulate, facilitating infection. So, on the contrary, frequently emptying the bladder can be a protective mechanism; therefore, it is important to drink plenty of water to dilute the urine as much as possible by eliminating bacteria.

Other unfavorable factors include:

  • prolonged use of undergarments;
  • wet costumes;
  • poor or improper intimate hygiene," the expert adds

Acute and chronic cystitis: what are the differences?

Cystitis can manifest in two forms:

  • Acute: is characteristic because the symptoms consist mainly of urinary problems, particularly:
    • burning to urinate,
    • continuous need to empty the bladder.

In severe cases, blood also appears in the urine, and this is called hemorrhagic cystitis. It is therefore an acute, strong disorder; in acute cystitis, there are rare episodes of fever.

  • Chronic: it is difficult to diagnose and treat because there are no particular changes that distinguish it, and profound investigations are often needed to diagnose it.

Chronic cystitis and depression: link and remedies

Chronic cystitis can also be brought on by a lowered mood or outright depression, In these cases, therapy refers to antidepressants, which provide excellent results; or another type of therapy consists of instilling substances, such as hyaluronic acid, inside the bladder. In extreme cases, moreover, surgical treatment may be used to increase bladder capacity or, at worst, bladder removal. 

Causes of non-bacterial cystitis

"Nonbacterial cystitis can be caused by mycetes (fungi) or parasites, but it can also be due to physical agents as happens, for example, in radiotherapy: radiation, by damaging the mucosa of the bladder, can cause so-called actinic or radiation cystitis.

Still there are also non-bacterial cystitis due to chemotherapeutics that are administered into the bladder by instillation (e.g., mitomycin, epirubicin); immunotherapeutics, such as BCG (bacillus Calmette-Guerin), can also, through irritation, cause cystitis.

Other non-bacterial types may include:

  • postcoital or honeymoon cystitis, which occurs following too much sexual intercourse;
  • frigor cystitis (or cold cystitis), which occurs due to too low temperatures that cause irritation of the bladder, inflaming it;
  • interstitial cystitis, a chronic type, which includes the full range of symptoms of classic cystitis, but has a duration that exceeds 6 months and does not respond to traditional treatment," Dr. Cremona says.

Symptoms: how to distinguish cystitis from other disorders?

There is much confusion on the part of women, in recognizing cystitis; therefore, the presence of urinary problems is essential in arriving at this diagnosis.

"Other types of symptoms, such as discomfort with an empty bladder or difficulty maintaining a sitting position, can be traced to other conditions such as, for example, hemorrhoids and chronic colitis or irritable bowel syndrome. IBS is easily and frequently confused with cystitis because in addition to abdominal pain near the bladder, it is also accompanied by frequent urination.

Vulvo-vaginitis can also mimic cystitis because it causes urinary burning and frequent urination. In this case, urine passes over the inflamed vaginal mucosa and causes burning. Of all of them, however, IBS remains the disorder most easily confused with cystitis," Dr. Cremona asserts

Urinoculture: the first step to correct diagnosis

The most appropriate test is, in the first instance, urinoculture. It is important to perform it correctly if you do not want to risk altered results.

How to collect urine

In a sterile jar, which can be easily found in pharmacies, the patient should collect the second stream of the first morning urine; this is because the first one performs the function of “cleaning” the way of any bacteria that might contaminate the liquid.

Other examinations

"In more important forms of cystitis," the doctor explains, "such as hemorrhagic cystitis, one can investigate further with additional examinations, such as outpatient cystoscopy; this allows one to observe whether there are wall changes, whether the bladder is dilated, and whether it does not empty completely.

Bladder ultrasonography, a very simple examination, also allows for the detection of any bladder problems that may facilitate the onset of cystitis. Interstitial cystitis, on the other hand, to be investigated, requires cystoscopies with biopsies to detect certain changes typical of this form of cystitis."


If the test results give a value ranging from 100,000 CFU/ml and up, it can be called an infection.

"Usually, broad-spectrum antibiotics are prescribed, but if the cystitis does not heal, at that point, an antibiogram (ABG) is used. In this case, the bacteria are compared with the various antibiotics. The bacterium may in fact be resistant or sensitive to that type of antibiotic, and so the most suitable drug can be chosen," Dr. Cremona concludes.

Remedies and useful tips for good bladder control

The following remedies can be taken to limit cystitis:

  • drink at least 1.5-2 liters of fluids daily (water, herbal tea, chamomile tea). If you drink a lot, your urine will become very light in color, almost transparent;
  • eat lots of fruits and vegetables because they increase urine production;
  • observe proper hygiene that avoids overly aggressive intimate cleansers that can alter natural defenses. Better to use mild soap, such as that used for children, rinsing with plenty of water;
  • use undergarments made from natural fabrics (e.g., cotton), avoiding synthetic materials that could create irritation;
  • also useful are dietary supplements, such as those with blueberry, which are true natural anti-inflammatories that can help keep the urinary tract clean;
  • maintain healthy and safe sexual activity.

Read others


Urinary incontinence: what are the most effective treatments?


Symptoms and causes of cryptorchidism


Bladder cancer: symptoms, diagnosis and treatment