Cystitis, Recurrent Urinary Tract Infections

Overview of Cystitis


Urinary tract infections (UTIs), also commonly referred to as cystitis, are the most common form of infection in females aged 18 to 65.  More than three infections in a year or more than two in six months is then termed as recurrent UTIs and is an increasing problem worldwide, both in men and women.


Most UTIs are caused by bacteria ascending from the vaginal wall and entering the urethra (water pipe) to pass into the bladder.

Although bladder infections, cystitis, UTIs etc are common, please remember that symptoms of cystitis can be caused by sinister underlying diseases of the bladder such as cancer. Please consult your doctor if your symptoms persist, as further diagnostic reassurance is warranted.



Lifestyle Advice


There are a few simple steps you can take to avoid UTIs.

Always wipe from the front to the back after using the bathroom. After bowel movements, clean the area around the anus gently, wiping from front to back. Never wipe twice with the same tissue.  Take showers and avoid prolonged baths. Bath water may quickly become contaminated by the bather’s own natural bacteria. Douches have no proven benefit in preventing bladder infections.


Avoid long intervals between urinating. Try to empty the bladder at least every 4 hours during the day while awake.  Do not wear tight-fitting undergarments made of non-breathing materials as moisture can build up leading to bacterial over growth near the opening of the bladder. Cotton underwear for general use is suggested.


Drink more water if the urine appears any darker than a very pale yellow, this means not enough liquid is being ingested; increase the fluid intake. Cranberry juice and cranberry pills have unproven benefit in reducing UTIs but may give some benefit, particularly in younger women.

Take special precautions after sexual activity. The bladder should be emptied after intercourse;. Avoid the use of spermicidal jelly as this kills the normal vaginal bacteria which are extremely important in suppressing infection causing bacteria.


Treatments for Cystitis




The standard treatment is with antibiotics, this works well in those with a single infection.   

Mr Zakikhani takes antimicrobial stewardship responsibly and his selection of antibiotics is tailored to the individual patient.

Once the infections become more chronic, antibiotic treatments range from keeping antibiotics at home, to going onto a low dose antibiotic where you take one every night or just one antibiotic after sexual intercourse.

There is currently a lot of concern about long-term use of antibiotics and although they are well recognised and well established, alternative treatments are becoming more popular.



Intra-Vesical Treatments


This is a well established treatment, and involves a course of bladder installations once a week for six weeks, followed by a monthly course for six months.   The goal here is to replenish the natural lining of the bladder which may have become deficient.

Seventy percent of patients with recurrent infections respond well to intra-vesical treatments with both an increase in bladder comfort and a reduction in infection rates.



UTI Vaccine


Recently the use of vaccine / immunostimulation in patients with recurrent infections has become more popular.  The science behind this won a Nobel Prize for medicine in 2010 and has been very popular on the continent although very few trials have been performed to date.



Oestrogen creams


Many ladies develop their urinary tract infections after the menopause due to the change in vaginal health.  Routine treatments with hormone replacement therapies and local oestrogen cream can reverse some of these effects.