Definition

Cystitis is a problem in which pain, pressure, or burning in the bladder is present. Most often, this problem is caused by germs such as bacteria. Cystitis is called noninfectious when there is no infection.

Alternative Names

Abacterial cystitis; Radiation cystitis; Chemical cystitis; Urethral syndrome - acute; Bladder pain syndrome; Painful bladder disease complex; Dysuria - noninfectious cystitis; Frequent urination - noninfectious cystitis; Painful urination - noninfectious; Interstitial cystitis

Causes

The exact cause of noninfectious cystitis is often not known. It is more common in women than men.

The problem has been linked to:

• Use of baths and feminine hygiene sprays
• Use of spermicide jellies, gels, foams, and sponges
• Radiation therapy to the pelvis area
• Certain types of chemotherapy drugs
• History of severe or repeated bladder infections

Certain foods, such as spicy or acidic foods, tomatoes, artificial sweeteners, caffeine, chocolate, and alcohol, can cause bladder symptoms.

Stress may also make symptoms worse, but stress does not cause symptoms.

Symptoms

Common symptoms include:

• Pressure or pain in the lower pelvis
• Painful urination
• Frequent need to urinate
• Urgent need to urinate
• Problems holding urine
• Need to urinate at night
• Abnormal urine color, cloudy urine
• Blood in the urine
• Foul or strong urine odor

Other symptoms may include:

• Pain during sexual intercourse
• Scrotum, penile, or vaginal pain
• Fatigue

Exams and Tests

A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs). Urine may be examined under a microscope to look for cancerous cells.

A urine culture (clean catch) is done to look for a bacterial infection.

A cystoscopy (use of lighted instrument to look inside the bladder) may be done if you have:

• Symptoms related to radiation therapy or chemotherapy
• Symptoms that do not get better with treatment
• Blood in the urine

Treatment

The goal of treatment is to manage your symptoms.

This may include:

• Medicines to help your bladder relax. They can reduce the strong urge to urinate or need to urinate frequently. These are called anticholinergic medicines. Possible side effects include increased heart rate, low blood pressure, dry mouth, and constipation. Another class of medicine is known as a beta 3 receptor blocker. A possible side effect can be an increase in blood pressure but this does not occur often.
• A medicine called phenazopyridine (Pyridium) to help relieve pain and burning with urination.
• Medicines to help reduce pain.
• Surgery is rarely done. It may be performed if a person has symptoms that do not go away with other treatments, trouble passing urine, or blood in the urine.

Other things that may help include:

• Avoiding foods and fluids that irritate the bladder. These include spicy and acidic foods as well as alcohol, citrus juices, and caffeine, and foods that contain them.
• Performing bladder training exercises to help you schedule times to try to urinate and to delay urination at all other times. One method is to force yourself to delay urinating despite the urge to urinate in between these times. As you become better at waiting this long, slowly increase the time intervals by 15 minutes. Try to reach a goal of urinating every 3 to 4 hours.
• Avoiding pelvic muscle strengthening exercises called Kegel exercises.
• Pelvic floor physical therapy to relieve pain in the abdominal and pelvic areas and to release tight and scarred tissues.

Outlook (Prognosis)

Most cases of cystitis are uncomfortable, but the symptoms most often get better over time. Symptoms can improve if you are able to identify and avoid food triggers.

Possible Complications

Complications may include:

• Ulceration of bladder wall
• Painful sex
• Sleep loss
• Depression

When to Contact a Medical Professional

Contact your health care provider if:

• You have symptoms of cystitis
• You have been diagnosed with cystitis and your symptoms get worse, or you have new symptoms, especially fever, blood in the urine, back or flank pain, and vomiting

Prevention

Avoid products that may irritate the bladder such as:

• Bubble baths
• Feminine hygiene sprays
• Tampons (especially scented products)
• Spermicidal jellies

If you need to use such products, try to find those that do not cause irritation for you.

References

American Urological Association website. Diagnosis and Treatment Interstitial Cystitis/Bladder Pain Syndrome (2022). www.auanet.org/guidelines/guidelines/diagnosis-and-treatment-interstitial-cystitis/bladder-pain-syndrome-(2022). Accessed June 25, 2024.

Clemens JQ, Erickson DR, Varela NP, Lai HH. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2022; 208(1):34-42. PMID: 35536143 pubmed.ncbi.nlm.nih.gov/35536143/.

Moldwin RM, Hanno PM. Interstitial cystitis/bladder pain syndrome and related disorders. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 57.

National Institute of Diabetes and Digestive and Kidney Diseases website. Interstitial cystitis (painful bladder syndrome). www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome. Updated July 2017. Accessed June 6, 2024.