A bladder infection, or cystitis, is the most common urinary tract infection. In the vast majority of cases, inflammation is caused by bacteria. These can move up through the urethra into the bladder. A burning sensation when urinating and a frequent urge to urinate are typical symptoms of a urinary tract infection. Healing bladder infections is usually straightforward and antibiotics are only necessary in complicated cases.
Bladder infection at a glance
Bladder infections or urinary tract infections are amongst the most common infections in humans. In the majority of cases, intestinal bacteria (E. coli) are the pathogens responsible for the illness. These rise via the urethra into the bladder. Women are affected much more often than men, because their urethra is shorter than in men and the exit of the urethra is closer to the anus.
Inflammation of the urethra or bladder is referred to as a lower urinary tract infection. If the inflammation continues to rise through the ureter into the renal pelvis, this is referred to as an upper urinary tract infection. Upper urinary tract infection is described in the section renal pelvic inflammation (pyelonephritis).
Causes and risk factors
In more than 80% of cases, cystitis is caused by intestinal bacteria (E. coli). These pass through the urethra into the bladder, where they lead to an infection. There are various risk factors that can facilitate cystitis, including:
Frequent sexual intercourse
Mechanical irritation and the spread of germs towards the urethra encourage bacteria to enter the bladder (also known as "honeymoon cystitis").
Certain methods of contraception such as diaphragm or spermicides
Diaphragms can alter the vaginal flora and increase the risk of cystitis. Spermicides disrupt the natural vaginal flora and thus encourage bacteria to settle.
Hormonal changes (e.g. during pregnancy or menopause)
During pregnancy, the increased progesterone level leads to a loosening of the muscles, including in the ureter and bladder, which makes it easier for germs to rise and enter the urinary tract. In addition, pregnant women's urine is often less antibacterial, which can lead to infection.
During menopause, oestrogen deficiency leads to blood thinning and poor blood circulation in the mucous membranes in the urogenital tract. The protective vaginal flora changes, the defence mechanisms against germs decline and the urinary tract becomes more susceptible to infections such as cystitis.
Bladder stones
Bladder stones can mechanically irritate the mucosa of the urinary tract and hinder the flow of urine. Both create conditions that encourage the development of cystitis.
Diabetes mellitus
A permanently elevated blood sugar level may lead to increased excretion of sugar in the urine. This sugar serves as a nutrient for bacteria and thus aids their multiplication in the bladder.
Excessive intimate hygiene
Frequent washing with soap or disinfectant destroys the natural protective flora in the intimate area and makes it easier for pathogens to penetrate.
Cold and wet swimwear
Cold and wet swimwear can lead to hypothermia in the pelvic and genital area. This reduces blood circulation in the mucous membranes, which weakens the local immune system. In this condition, pathogenic germs find it easier to settle and multiply in the bladder or urethra.
After passing stools, wiping from back to front
If you wipe forwards after passing a stool, intestinal bacteria can spread to the urethra area, which can increase the risk of cystitis.
Pushing urine out despite the urge to urinate
If you suppress the urge to urinate over a long period of time, you risk accumulating urine in the bladder. This stationary urine provides the ideal conditions for bacteria to multiply, while regular urination helps to flush out germs at an early stage.
Symptoms of bladder infections
To defend against the invading pathogens, the body reacts through increased urine production. The inflammation causes the bladder and urethra to cramp up. Typical signs of an uncomplicated bladder infection are therefore:
- burning sensation when urinating
- increased and frequent urge to urinate
- lower abdominal pain
- cloudy or foul-smelling urine
- blood in urine
If the inflammation spreads to the upper urinary tract, particularly to the renal pelvis, this is a complicated cystitis involving the kidneys (infection of the renal pelvis). In such cases, the following symptoms may occur in addition to the typical bladder complaints:
- fever
- chills
- severe pain in lower abdomen
- flank pain
Diagnosing cystitis
Various examination methods are available to clarify cystitis. The most important basis is first a clinical assessment based on the typical complaints such as burning sensation when urinating and frequent urination. To determine the cause and severity of the urinary tract infection more accurately, the following methods are used:
Urine rapid test (test strip)
A simple test with a strip held in the urine can provide indications of inflammation. The leucocytes (white blood cells) indicate inflammation and nitrite (a bacterial breakdown product) indicate the presence of bacteria.
Urine culture in the laboratory
A urine sample is grown in the laboratory for more precise clarification, primarily in the case of recurring infections or during pregnancy. This makes it possible not only to identify the exact type of bacteria, but also to determine which antibiotic is most effective (antibiogram).
Ultrasound (ultrasonography)
An ultrasound of the urinary tract can help to uncover structural causes such as bladder stones, urinary blockage or anatomical changes. The examination provides important indications of potential complications or concomitant diseases.
Cystoscopy
In rare cases, such as very frequent or unclear complaints, a cystoscopy may be useful. A thin instrument with a camera is inserted into the bladder via the urethra in order to assess the mucous membrane directly. For example, chronic inflammation, foreign bodies or even tumours can be ruled out.
Treatment
In most cases, simple bladder infections will heal without antibiotics. Treatment aims to alleviate the symptoms and flush out the pathogens:
- Drink plenty of fluids (e.g. bladder and kidney tea)
- Heat (hot water bottle, hip bath)
- Anti-inflammatory medication
- Bladder infection treatment using antibiotics is mainly chosen for complicated cases or chronic cystitis. It is important to act quickly at the first signs of cystitis so that further complications can be avoided.
Important: Antibiotics should always be prescribed by a doctor and taken exactly as directed to avoid resistance.
Prevention: How to prevent bladder infections
If you want to prevent cystitis, you can do a lot through simple but effective habits. Here are a few tips on how to minimise the risk of cystitis:
- Sufficient hydration: To prevent cystitis, it is recommended to drink at least 1.5 to 2 litres of water or unsweetened tea a day. The bladder is flushed regularly and possible germs are washed out early before they can trigger inflammation.
- Avoid cold in the lower abdomen and foot area: Warm clothing and quickly changing out of wet swimwear protect the local immune function of the mucous membranes.
- Regular emptying of the bladder: If you suppress the urge to urinate for too long, there is a risk that bacteria will multiply. Particularly after sexual intercourse, it is recommended to go to the toilet quickly to directly flush out any invading pathogens.
- Proper toilet hygiene: After passing stools, always wipe from front to back to avoid contact between intestinal bacteria and the urethra.
- Careful care of intimate area: Do not use perfumed washing lotions or intimate area sprays, as these can aggravate the natural protective flora. Hot water is usually sufficient.
FAQ – Frequently asked questions about cystitis
How do you know if you have cystitis?
Cystitis usually manifests itself through the sudden onset of typical symptoms, such as a burning or stabbing sensation when urinating, frequent urination in small amounts and unpleasant pressure or pain in the lower abdomen.
What can you do to alleviate cystitis quickly?
In the case of acute cystitis, it helps to drink plenty of fluids – ideally 2 to 3 litres per day to “rinse” the bladder. In addition, anti-inflammatory agents and heat (e.g. hot water bottle) can be used to alleviate the symptoms. If the symptoms do not improve after two to three days or fever occurs, a medical clarification and, if necessary, targeted antibiotic treatment is necessary.
Can cystitis heal on its own?
Yes, in many cases, simple cystitis heals within a few days without antibiotics. It is important to take the symptoms seriously and to take supportive measures, such as drinking a lot or warmth, at an early stage.
What causes sudden cystitis?
Cystitis usually occurs when intestinal bacteria (especially Escherichia coli) ascend through the urethra into the bladder. This can be triggered by: cold (e.g. sitting on a cold surface), too little drinking, suppressing the urge to urinate, sexual intercourse (honeymoon cystitis), hormonal changes or excessive hygiene habits relating to the intimate area. A weakened immune system or certain illnesses such as diabetes mellitus also increase the risk.
What happens if you do nothing about cystitis?
If cystitis remains untreated, there is a risk that the infection will spread through the ureter into the renal pelvis. This is referred to as inflammation of the renal pelvis (pyelonephritis), which manifests itself in symptoms such as high fever, chills and flank pain. In this case, immediate medical clarification is required.
When do you need to see a doctor with cystitis?
A visit to the doctor is necessary if:
- fever, chills or flank pain occur
- blood is visible in urine
- the symptoms persist for more than three days
- cystitis recurs frequently
- you are pregnant, diabetic or have a weakened immune system