Checking Your Urine for Bacteria
Your doctor or nurse can check your urine for bacteria with a simple dipstick test, although they may not do this for a single episode of cystitis. If you keep getting cystitis, and a dipstick test indicates a bacterial infection, then a fresh urine sample can be sent to the laboratory to find out what type of bacteria is present and which antibiotics are best for treating the infection.
Your doctor may prescribe a short course of antibiotics (such as nitrofurantoin or trimethoprim) if bacterial cystitis and a true urinary tract infection (UTI) seems likely. Cure rates with antibiotics are about 85–95%. Most women are not keen on taking too many antibiotics, so one possibility is to wait for 48 hours and see if the symptoms clear up; if not, take the antibiotics. This may mean that you have the discomfort for longer (see what you can do to relieve the symptoms of cystitis), but on the other hand you may be able to avoid taking an antibiotic (British Medical Journal 2010;340:b5633).
If your symptoms are severe, your doctor may prescribe a short course of antibiotics. If the cystitis keeps returning you may be prescribed stand-by antibiotics to take the next time you have cystitis, or continuous lower-dose antibiotics to take for several months to prevent further episodes.
Bladder Pain Syndrome
If no bacteria are present and your doctor thinks you have bladder pain syndrome (interstitial cystitis), there are several possible treatments (British Medical Journal 2009;339:b2707). They do not cure the condition, but can keep symptoms under control. There is a lot of interest in this condition, and many new treatments are being investigated, so the future is hopeful.
- Stopping smoking is important as the chemicals can irritate the bladder.
- Reducing stress is important – regular physical exercise, yoga or a course of cognitive behavioural therapy may help.
- Bladder training, physiotherapy, and transcutaneous electrical nerve stimulation (TENS) can help some patients.
- Amitriptyline and similar drugs are often used (Journal of Urology 2005;174:1837–1840). These drugs are commonly used antidepressants, but they also have a pain-blocking effect. In interstitial cystitis, they are used as a pain blocker, not because your doctor thinks you are depressed or imagining your symptoms.
- Antihistamine medications (similar to hayfever treatments) have been tried, on the basis that interstitial cystitis might be a type of allergy.
- Pentosan polysulfate is used in the USA and in some other countries, but is not available in the UK. It contains the glucosaminoglycans chemicals that some researchers think are deficient in the bladders of women with interstitial cystitis. It may take up to 6 months before it has any effect. Some scientific studies that have assessed whether Pentosan polysulfate works have been encouraging; others have given contradictory results.
- ‘Hydrodistension’ is the stretching of the bladder with water. This is a specialist treatment and you would need an anaesthetic. No one knows how it works, but it helps 60% of people. The improvement lasts for several months.
- DMSO (dimethyl sulfoxide) and other medications can be squirted into the bladder to reduce pain and inflammation. Some studies suggest that it works in about 50% of people, but these studies may not be reliable because they involved only small numbers of people (British Medical Journal 2008;337:a2325). For this treatment, you will need to be referred to a specialist. There have been worries that DMSO could affect the eyes and liver.
- Low doses of prednisolone (a steroid) or ciclosporin have been used to reduce bladder inflammation if other treatments have not worked (British Medical Journal 2009;339:b2707). More research needs to be done on these medications.
First published on: embarrassingproblems.com
Reviewed and edited by: Dr Kevin Barrett
Last updated: May 2021