Cystitis in women

Cystitis is inflammation of the bladder. There are two main types.

Bacterial cystitis is caused by bacteria (germs), and is also referred to as a urinary tract infection or a UTI. These bacteria, mainly Escherichia coli (E. coli for short), normally live in and around the anus (back passage). In men, the urethra goes along the length of the penis and is about 24–30 cm long, but in women it is only about 6 cm long. So in women, bacteria on the skin can easily get into the bladder, as with a shorter urethra there is a shorter distance for the bacteria to travel. This probably explains why cystitis is much more common in women than in men.

Some women find that bacterial cystitis is related to boisterous sex, which can bruise the urethra and may push or squeeze bacteria up into the bladder.

Bladder pain syndrome (also called painful bladder syndrome, interstitial cystitis, non-bacterial cystitis, urgency and frequency syndrome) is inflammation of the bladder without any bacteria being present. Most sufferers (90%) are women. Bladder pain syndrome can occur at any age, but is most common in women in their early 40s. It is a bit of a mystery, and no one really knows what causes it. Theories include:

• lack of a substance called glycosaminoglycan, which is part of the slimy layer that covers and protects the lining of the bladder
• activity of special types of cells (called mast cells) commonly found in the bladder wall of people with bladder pain syndrome. These cells respond to allergy by releasing chemicals such as histamine, which cause swelling and pain. 

Symptoms of cystitis

The symptoms of cystitis are:

• a burning, stinging or aching pain when you pass urine
• a need to pass water very frequently, often only a small amount each time
• bloody or cloudy urine (severe cystitis).

Bacterial cystitis. With bacterial cystitis, you usually experience only the burning pain and frequent urination. It is possible for the infection to travels upwards to the kidneys, but this is unusual. Infection in a kidney needs proper medical treatment, so see your doctor straight away if you also have:

• blood (or a smoky appearance) in the urine
• backache or stomach ache
• fever and weakness.

Painful pain syndrome. With bladder pain syndrome (interstitial cystitis) the symptoms are diverse. You have to pass urine frequently (including at night), and maybe urgently. You may have discomfort in the lower abdomen when the bladder is filling (pelvic pain), but once you urinate the pain or discomfort is relieved. Sex may be painful. Often, symptoms are worse in the week before a period.

What else could I have?

Not all urine problems are cystitis. For example:

• if you have soreness or itching around the opening of the urethra (pee hole) you might have a herpes infection, yeast infection or a chlamydia infection
• if your only problem is having to pass urine frequently, you might have diabetes (especially if you are thirsty all the time), so see your doctor
• if your main problem is having to rush to the toilet, you may have a continence problem.