Cystitis (bladder infection)
Acute cystitis manifests itself through burning or pain when urinating, frequent urination and occasionally blood in the urine. It is a urinary tract infection caused by bacteria, which, in addition to pain relief, often has to be treated with antibiotics. In principle, increasing fluid intake is recommended in order to flush out the bacteria. In the case of frequently recurring cystitis, contributing factors should be ruled out by a urological examination.
Questions about the diagnosis and treatment of cystitis
Typical symptoms are frequent and painful urination. In addition, the urine may be bloody and there may be pain in the lower abdomen. Fever usually does not occur. In case of doubt, a doctor should always be consulted, as these symptoms can also be signs of other serious conditions such as ureteral stones. At the latest when fever also occurs, a visit to a urologist is essential, as other organs of the urinary tract are then often involved.
Acute cystitis is a bacterial infection. Contrary to popular belief, you do not catch it from toilets; rather, the bacteria are usually part of your own skin or intestinal flora. These are not particularly dangerous or malignant, but they do not belong in the bladder. Exceptions are sexually transmitted infections, which can be transmitted during unprotected sexual intercourse.
Due to their particular anatomy, women often suffer from cystitis even at a young age, as germs can easily enter the bladder via the short urethra. The disease can usually heal without treatment, but there is a risk of an ascending infection involving the kidneys. With increasing age, men are also affected more and more frequently, as the enlarging prostate causes so-called residual urine, in which bacteria can multiply well. In this case, antibiotic therapy should always be given, as complications such as prostatitis or epididymitis often occur.
In women, mild cystitis can be left to heal on its own; plenty of fluids are definitely recommended. Painkillers are helpful. There are exceptions: for example, any cystitis during pregnancy should be treated with antibiotics. An antibiotic should also be given if the symptoms are more severe.
In addition to a detailed consultation and a physical examination, a urine test is carried out. If there are typical signs of cystitis, a urine culture is also prepared in which the bacteria are cultivated. Although the result takes a few days, you then know exactly which antibiotic is effective against the infection. An ultrasound examination serves to rule out other causes of the symptoms.
Almost a third of all adult women have symptoms of cystitis at least once a year. General recommendations for preventing recurrent infections include, for example, sufficient fluid intake and urinating after sex. Whether drinking cranberry juice or concentrate helps is still the subject of contradictory scientific debate.
If infections occur several times a year, extended urological diagnostics should be carried out; this includes, among other things, a cystoscopy and, if necessary, X-ray diagnostics.
If no abnormalities requiring treatment are found, there are various options for prophylaxis. Vaccinations are available both as capsules and as injections. D-mannose is a sugar available in powder form that is excreted largely unchanged in the urine and thus reaches the bladder. Here it binds to the bacteria and inhibits their "docking" to the bladder mucosa. In the case of pronounced problems, low-dose long-term antibiotic therapy is also possible.
The prognosis is good. In most cases, symptoms occur in episodes; very few women have severe problems throughout their lives.
Further information in the videos:
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Cystitis in women
Diagnosis & treatment
In this video, you will learn more about cystitis in women – a painful condition with a frequent urge to urinate and burning when urinating.
- Diagnosis: First, a urine test is carried out in which white blood cells are detected as a sign of inflammation. A urine culture can then be carried out to precisely identify the causative bacterium. Finally, an antibiogram can be used to determine the most effective antibiotic for targeted treatment.
- Special features in women: Cystitis occurs more frequently in women than in men, as the urethra is shorter and the natural barrier to infection is therefore less pronounced. A distinction is made between sporadic, one-off cystitis and recurrent infections that frequently occur again.
- Causes of recurrent cystitis: Frequently incomplete bladder emptying with residual urine, anatomical changes such as pelvic floor prolapse or bladder diverticula, nerve disorders (e.g. due to slipped discs) and the consequences of operations such as vaginal tapes. Less frequently, there is a scarred narrowing of the urethra (meatal stenosis).
- Treatment:
- Uncomplicated cystitis: antibiotics are usually sufficient
- Recurrent cystitis: urological investigation necessary, above all to treat the cause and ensure complete bladder emptying
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Cystitis in men
Symptoms, causes & treatment
In this video:
- Special features of the male urinary tract
- Symptoms of cystitis
- Why urinary tract infections are rare in men
- Prostate & residual urine as the main cause
- Diagnostics & therapy
- Risks & other causes
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Urinary tract infection in men
What you should know
In this video:
- What is a urinary tract infection?
- Anatomical features in men
- The difference from cystitis
- Spread to the kidneys, prostate & epididymis
- Treatment & elimination of the cause
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Blood in the urine
Why see a urologist immediately?
Blood in the urine is a warning sign and should always be investigated by a urologist. Prof. Lahme explains the most common causes of blood in the urine, including cystitis, kidney stones, bladder cancer, tumours of the urinary tract and changes in the renal pelvis or ureter.
- Blood in the urine: why have it investigated immediately?
- Where can blood in the urine come from?
- How is urine produced in the kidneys?
- Pain vs. painless bleeding
- Common causes: inflammation, stones, tumours
- Examination by the urologist
- Cystoscopy explained
- CT, MRI and further diagnostics
- When no cause is found
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Cystoscopy
How it works
In this video, you will learn everything important about cystoscopy – an endoscopic examination of the urinary bladder in men and women.
- Purpose: Clarification of subtle changes in the bladder wall, e.g. in the case of blood in the urine, suspected tumours, bladder stones or emptying disorders.
- Procedure: Examination under sterile conditions with lubricating gel and local anaesthesia.
- In women: Use of a rigid endoscope – the short, straight urethra allows a simple examination.
- In men: Use of a flexible endoscope that adapts to the natural curves of the urethra – making it low-pain and gentle.
- Technology: Modern video optics ("chip-on-the-tip") provide clear images; if necessary, minor procedures or tissue sampling can be carried out directly.
- Advantages: Reliable diagnostics, precise assessment of the bladder wall, practically painless today.
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Constant bladder infections?
It could be a fistula
Prof. Lahme explains how a fistula forms and how a reliable diagnosis is made with the help of a cystoscopy and a CT examination.
In this video you will learn:
- What a fistula between the bowel and the bladder is
- Why sigmoid diverticulitis or Crohn's disease can lead to fistula formation
- Warning sign: air in the urine (pneumaturia)
- Diagnostic certainty: the value of cystoscopy, CT and the simple poppy seed test
- Why antibiotics fail and the inflammation keeps coming back
- Why only surgical removal of the fistula using a peritoneal flap enables a permanent cure
About this page:
Author
Medical director of the Goldstadt-Privatklinik.
Specialist for Urology, Mini-PCNL and robot-assisted da Vinci procedures.
Member in Scientific Societies and Reviewer of scientific journals.
