Cystitis: self-care

Cystitis: self-care

Cystitis: self-care

Cystitis is an infection of the urinary tract which causes the bladder to become inflamed, commonly referred to as a urinary tract infection (UTI). Urinary tract infections commonly affect women more than men because it is easier for bacteria to travel up the female urinary tract to the bladder.

Cystitis is more common in sexually active women, pregnant women, and women with undiagnosed diabetes or after menopause.

Symptoms of cystitis can appear suddenly, but not all symptoms may be present. They commonly include:

  • smelly, dark or cloudy urine
  • burning or stinging while urinating, because bacteria make urine more acidic
  • the need to go to the toilet more often or at night, or you might urinate in small amounts
  • lower back pain, pain in the lower abdomen (belly), or pain when you finish urinating
  • signs of a UTI in children also include fever, being irritable, ‘wetting’ in a child that is normally ‘dry’ and feeding problems in babies

Cystitis is painful and annoying but is usually treated successfully. It can be more serious if the infection travels to the kidneys or pelvis and causes inflammation in those areas. In such cases you may experience fever, chills, nausea and vomiting.

See Your Pharmacist or Medical Professional

  • if your symptoms have lasted more than two or three days, or return soon after treatment
  • if you have symptoms of kidney infection (fever, chills, back pain, nausea or vomiting)
  • if you have not had cystitis before
  • if there is blood or pus in your urine
  • if you have a vaginal discharge
  • if you have fever, chills, nausea, vomiting or pain
  • if you suspect your child has cystitis
  • if you are a man, an older woman or a child
  • if you are pregnant
  • if you have had cystitis more than three times in one year
  • if you are taking medication for cystitis and it has not worked
  • if you do not empty your bladder properly when you go to the toilet
  • if you are taking medication for cystitis and you experience side effects
  • if you are taking supplements (e.g. potassium), other medications, or have another medical condition (e.g. diabetes)
  • if you are breastfeeding, as some medicines may not be suitable
  • if you have allergies to any medicines
  • if your immune system is compromised or suppressed for any reason

Treatment Tips

  • cystitis may resolve in a few days with simple treatments, but you may also require antibiotics to treat the infection
  • if you are prescribed antibiotics, make sure you finish taking the course, even if you feel better before you have taken them all
  • it is important to drink plenty of fluids to flush out your bladder
  • avoid drinks that can dehydrate, such as alcohol or caffeine, as these can concentrate the urine, making it easier for bacteria to multiply
  • some people are also affected by acidic drinks, such as juice and fizzy drinks, or spicy food
  • rest and a hot water bottle placed on your stomach, over clothing, may provide some relief
  • urinate when you feel the urge, rather than holding on
  • empty your bladder completely when urinating
  • treat vaginal infections quickly

Tips to prevent cystitis recurring:

  • always urinate when you feel the need; never ‘hold on’ and always empty your bladder fully
  • wipe from ‘front to back’ with toilet paper; it is best to blot with toilet paper and use each piece only once
  • wear loose-fitting cotton underpants and trousers. Avoid tight or synthetic underwear. Tight fitting clothing can make your genital area moist, which encourages bacterial growth
  • use a water-based lubricant during sex to prevent irritation if the vaginal area is dry; do not use spermicides as they can cause irritation
  • wash and dry yourself before and after sex, and go to the toilet (urinate) after sex
  • avoid using vaginal deodorants, soaps, bubble baths and other toiletries that could irritate your genital area
  • avoid vaginal douching
  • taking cranberry supplements has been proven to help prevent cystitis from recurring; it is thought that they stop bacteria from sticking to the urinary tract surface. They should be avoided in pregnancy and by people taking warfarin

Urinary alkalinisers (to relieve burning)

e.g. sodium bicarbonate, citric acid, tartaric acid, sodium citrate, sodium citrotartrate (Citralite, Citravescent Sachets, Uracol, Ural, Uricalm)

  • urinary alkalinisers make urine less acidic and relieve the ‘burning’ feeling when you go to the toilet
  • they are available as granules or powder, to be dissolved in a glass of water and drunk up to four times a day
  • people with kidney problems or those taking medicines for blood pressure or heart conditions should check with their pharmacist before taking urinary alkalinisers
  • do not use urinary alkalisers if using the prescription medication Lithium (e.g. Lithicarb, Quilonum) as it makes lithium less effective

Urinary antiseptic


methenamine (hexamine) hippurate (Hiprex Tablets)

  • methenamine (hexamine) hippurate is an antibacterial antiseptic used to treat and prevent urinary tract infections. It only works when your urine is acidic, which generally occurs in bladder infections
  • avoid taking medications sodium bicarbonate (Ural, Citralite or Citravescent) as they make methenamine less effective

Pain relief


Packets of 20 or fewer, e.g. paracetamol (Panadol)


larger pack sizes, e.g. paracetamol (Panadol, Parapane, Panamax, Febridol)

  • paracetamol can be taken to provide pain relief (if needed). It is a safe choice for most people but it is important not to take more than the recommended dose. Paracetamol is an ingredient in many cold and flu remedies so be careful not to double dose. The maximum daily dose for an adult is 4 g (4000 mg), and no more than 1 g (1000 mg) every four hours
  • avoid using aspirin for cystitis
  • if you are taking other medications or you have other medical conditions, check with your pharmacist for individualised advice on pain relief



  • sometimes a short course of antibiotics is needed to treat the bacterial infection. If the doctor prescribes antibiotics for your cystitis, make sure you finish taking the full course.
  • some antibiotics can interact with food or other drugs, so talk to your pharmacist if you are taking any other medicines. Some antibiotics used for the treatment of cystitis should not be used with urinary alkalinisers; check with the pharmacist. Not all antibiotics are suitable to take during pregnancy.
  • although many antibiotics are well tolerated, some can have side effects such as nausea, vomiting, headache, fever, itch, rash, heartburn, abdominal pain, dizziness and sensitivity to the sun.
  • if you are prescribed antibiotics to be taken once daily, they will work better if you take them after emptying your bladder, just before going to bed.

More Information

Availability of medicines

  • GENERAL SALE available through pharmacies and possibly other retail outlets.
  • PHARMACY ONLY available for sale through pharmacies only.
  • PHARMACIST ONLY may only be sold by a pharmacist.
  • PRESCRIPTION ONLY available only with a prescription from your doctor or other health professional.

Search myDr for Consumer Medicine Information


1. Pharmaceutical Society of Australia. Urinary tract infection (cystitis): Pharmaceutical Society of Australia; 2019. Available from: 2.

Australian Medicines Handbook. Lithium 2019. Available from:

3. Australian Medicines Handbook. 2019.

Methenamine hippurate


Cystitis – Treatment

Cystitis: self-care

Mild cystitis will usually clear up on its own within a few days, although sometimes you may need to take antibiotics.

See a GP for advice and treatment if:

  • you're not sure whether you have cystitis
  • your symptoms don't start to improve within 3 days
  • you get cystitis frequently
  • you have severe symptoms, such as blood in your urine
  • you're pregnant and have symptoms of cystitis
  • you're a man and have symptoms of cystitis
  • your child has symptoms of cystitis

Women who have had cystitis before or who have had mild symptoms for less than 3 days don't necessarily need to see a GP, as mild cases often get better without antibiotics.

You can try some self-help measures or ask a pharmacist for advice.

If you have had cystitis before and don't feel you need to see a GP, or had mild symptoms for less than 3 days, the following advice may help to relieve your symptoms until the condition clears up:

  • take over-the-counter painkillers, such as paracetamol or ibuprofen (always read the medicine information leaflet beforehand to check whether you can take it, and check with a pharmacist if you're not sure)
  • drink plenty of water (this may help flush the infection your bladder and some people find it helpful, although it's not clear how effective it actually is)
  • don't have sex until you're feeling better as it may make the condition worse

Some people believe drinking cranberry juice or using products that lowers the acidity of their urine (such as sodium bicarbonate or potassium citrate) reduces their symptoms, but there's a lack of evidence to suggest they're effective.

These products also aren't suitable for everyone. Check with a GP or pharmacist before trying them if you're taking any other medication.

In some cases, a GP may prescribe a course of antibiotics. This will usually involve taking a tablet or capsule 2 to 4 times a day for 3 days.

For some women, they'll be prescribed for 5 to 10 days.

Antibiotics should start to have an effect quite quickly. Go back to your GP if your symptoms haven't started to improve within a few days.

Most people won't have any side effects from antibiotic treatment, but possible side effects can include feeling or being sick, itching, a rash and diarrhoea.

If you keep getting cystitis (recurrent cystitis), a doctor may prescribe stand-by antibiotics or continuous antibiotics.

A stand-by antibiotic is a prescription you can take to a pharmacy the next time you have symptoms of cystitis without needing to visit a GP first.

Continuous antibiotics are taken for several months to prevent further episodes of cystitis.

These may be prescribed:

  • if cystitis usually occurs after having sex (you may be given a prescription for antibiotics to take within 2 hours of having sex)
  • if cystitis isn't related to having sex (you may be given a low-dose antibiotic to take for a trial period of 6 months)

Your doctor may also recommend some, although it's not clear how effective these are.


Interstitial Cystitis – Painful Bladder Syndrome | Cooper University Health Care

Cystitis: self-care

Interstitial cystitis (IC), also called painful bladder syndrome, is a chronic condition in which the walls of the bladder are irritated and inflamed. It can be extremely painful and is one of the most common underlying causes of chronic pelvic pain.

While IC affects an estimated 4 to 12 million people in the U.S. regardless of age, gender or ethnicity, about 90% of those diagnosed with IC are women. It is most frequently diagnosed during a woman’s reproductive years.

The exact cause of IC isn’t known, but some possible causes include bladder trauma, pelvic floor muscle dysfunction, bacterial bladder infection (cystitis), or autoimmune disorder.

The symptoms of IC can vary from person to person, but generally include the need to urinate frequently (up to 60 times a day in severe cases), having to urinate urgently (which may be accompanied by pain, pressure or spasms), and pain in the lower abdomen, urethra, vagina, lower back or thighs. Pain and urinary symptoms often worsen before a woman’s period. Sexual intercourse can also be painful with IC.

Treatment for interstitial cystitis is complex and can include self-help measures and lifestyle changes, medications, specialized physical therapy, complementary therapies such as acupuncture, neuromodulation, Botox injections or surgery.

Diagnosing IC in women can be difficult because its symptoms can mimic or overlap with more common conditions such as urinary tract infections (UTIs), overactive bladder (OAB), pelvic floor disorders, pelvic congestion syndrome or endometriosis.

This is why it’s important to see a urogynecologist – a specialist in female pelvic medicine and reconstructive surgery – who deals specifically with issues such as IC. These specialists can provide an accurate, timely diagnosis and appropriate treatment.

Why Choose Cooper to Diagnose and Treat Interstitial Cystitis

Cooper University Health Care has a comprehensive urogynecology program that is on the forefront of care for interstitial cystitis in women. Our team of fellowship-trained urogynecologists offers a full range of today’s most advanced diagnostic and treatment services, provided in a caring, sensitive manner.

  • We teach the next generation of urogynecologists through a respected fellowship program—testament to the high level of clinical expertise available here
  • Our urogynecologists conduct leading-edge research, giving you access to the latest knowledge and advances in treating IC in women

The specific cause of IC is still not clearly known, but scientists have pinpointed several factors that may contribute to developing this condition:

  • Trauma to the bladder, such as from pelvic surgery
  • Pelvic floor muscle dysfunction
  • Bladder overdistention (stretching) if you repeatedly go long periods without urinating
  • Autoimmune disorder(s)
  • Bacterial bladder infection (cystitis)
  • Inflammation or hypersensitivity of the pelvic nerves (neurogenic inflammation)
  • Damage to the spinal cord

Many scientists believe that a trigger, such as one or more of these factors, may damage the bladder or its lining. This damage allows particles in the urine to leak into the lining, leading to further damage to the bladder and causing chronic pain.

Normally, the bladder repairs itself, but in people with IC it doesn’t. Research shows that this might be because of a protein called APF (antiproliferative factor) that is produced by the cells of people with IC (but not in healthy people).

Symptoms of Interstitial Cystitis

IC symptoms are different from person to person and can even vary in the same person at different times. With IC, you may have some or all of these symptoms, and they may worsen around the time of your period:

  • Urinary frequency: The urge to go a lot – as many as 60 times a day in severe cases
  • Urinary urgency: The need to go immediately; pain, spasms or pressure may also accompany this urge
  • Pain: You may feel ongoing pain in the lower abdomen or back, urethra, vagina or thighs, and frequently during sexual intercourse

Treating Interstitial Cystitis

While there currently is no cure for IC, there are many treatment options available to help relieve its symptoms. These include:

  • Dietary changes such as avoiding alcohol, caffeine, citrus fruits, potassium-rich foods or other foods that can trigger symptoms
  • Bladder retraining to learn to control the urge to urinate
  • Specialized physical therapy techniques to help relax and lengthen tight muscles and release trigger points in the pelvic floor
  • Alternative/complementary therapies such as acupuncture, Reiki, guided imagery or therapeutic massage
  • Bladder instillations, in which medications to help ease IC symptoms are given via a small catheter inserted into the bladder
  • Oral medications such as pain relievers, antidepressants, immunosuppressants, and antispasmodics
  • Botox injections to relax the bladder muscles
  • Neuromodulation, including the use of electrical nerve stimulators to alter pain signals
  • Laser surgery to repair Hunner’s lesions (also called Hunner’s ulcers), which are areas of inflammation on the bladder wall found in 5% to 10% of people with IC

For most women with IC, a combination of various treatments is best. You may need to try a few different options before you find the optimal regimen to address your symptoms. Working with a specialist who understands the complex nature of IC can aid in this process.

Make an Appointment With an Interstitial Cystitis Expert at Cooper

To learn more about the resources available for diagnosing and treating interstitial cystitis in women at Cooper or to request an appointment, please call 800.8.COOPER (800.826.6737).


Cystitis symptoms and treatments

Cystitis: self-care

Cystitis is inflammation of the bladder, usually caused by a bladder infection.

It's a common type of urinary tract infection (UTI), particularly in women, and is usually more of a nuisance than a cause for serious concern. Mild cases will often get better by themselves within a few days.

However, some people experience episodes of cystitis frequently and may need regular or long-term treatment.

There's also a chance that cystitis could lead to a more serious kidney infection in some cases, so it's important to seek medical advice if your symptoms don't improve.

Signs and symptoms of cystitis

The main symptoms of cystitis include:

  • pain, burning or stinging when you pee
  • needing to pee more often and urgently than normal
  • urine that's dark, cloudy or strong smelling
  • pain low down in your tummy
  • feeling generally unwell, achy, sick and tired

Possible symptoms in young children include a high temperature (fever) of 38C (100.4F) or above, weakness, irritability, reduced appetite and vomiting.

Read more about the symptoms of cystitis

When to see your GP

Women who have had cystitis before don't necessarily need to see their GP if the condition returns, as mild cases often get better without treatment. You can try the self-help measures listed below, or ask your pharmacist for advice.

You should see your GP if:

  • you have symptoms of cystitis for the first time
  • your symptoms don't start to improve within a few days
  • you get cystitis frequently
  • you have severe symptoms, such as blood in your urine
  • you're pregnant and have symptoms of cystitis
  • you're a man and have symptoms of cystitis
  • your child has symptoms of cystitis

Your GP should be able to diagnose cystitis by asking about your symptoms. They may test a sample of your urine for bacteria to help confirm the diagnosis.

What causes cystitis?

Most cases are thought to occur when bacteria that live harmlessly in the bowel or on the skin get into the bladder through the urethra (tube that carries urine your body).

It's not always clear how this happens, but it can be caused by:

  • having sex
  • wiping your bottom after going to the toilet – particularly if you wipe from back to front
  • inserting a tampon or urinary catheter (a thin tube inserted into the urethra to drain the bladder)
  • using a diaphragm for contraception

Women may get cystitis more often than men because their anus (back passage) is closer to their urethra, and their urethra is much shorter, which means bacteria may be able to get into the bladder more easily.

Read more about the causes of cystitis

Treatments for cystitis

If you see your GP with cystitis, you'll usually be prescribed antibiotics to treat the infection. These should start to have an effect within a day or two.

If you've had cystitis before and don't feel you need to see your GP, you may want to treat your symptoms at home.

Until you're feeling better, it may help to:

  • take paracetamol or ibuprofen
  • drink plenty of water
  • hold a hot water bottle on your tummy or between your thighs
  • avoid having sex

Some people find it helpful to try over-the-counter products that reduce the acidity of their urine (such as sodium bicarbonate or potassium citrate), but there's a lack of evidence to suggest they're effective.

If you keep getting cystitis, your GP may give you an antibiotic prescription to take to a pharmacy whenever you develop symptoms, without needing to see your doctor first. Your GP can also prescribe a low dose of antibiotics for you to take continuously over several months.

Read more about treating cystitis

Preventing cystitis

If you get cystitis frequently, there are some things you can try that may stop it coming back. However, it's not clear how effective most of these measures are.

These measures include:

  • not using perfumed bubble bath, soap or talcum powder around your genitals – use plain, unperfumed varieties
  • having a shower, rather than a bath – this avoids exposing your genitals to the chemicals in your cleaning products for too long
  • going to the toilet as soon as you need to pee and always emptying your bladder fully
  • staying well hydrated – drinking plenty of fluids may help to stop bacteria multiplying in your bladder 
  • always wiping your bottom from front to back when you go to the toilet
  • emptying your bladder as soon as possible after having sex
  • contraception instead
  • wearing underwear made from cotton,rather than synthetic material such as nylon, and not wearing tight jeans and trousers

Drinking cranberry juice has traditionally been recommended as a way of reducing your chances of getting cystitis. However, large studies have suggested it doesn't make a significant difference.


Learning to Take Time for Self-Care After My Interstitial Cystitis Diagnosis

Cystitis: self-care

By Lisa King

The word rest was always a four-letter word to me. Ever since I was a teen, I was always studying, working, organizing or doing.  And looking back, I realized that in all those busy years, I had always had bladder issues. I was always asking to go to the bathroom while on family road trips or when I was running errands with my mom.

As I headed off to college for pharmacy school, my bladder issues definitely seemed to worsen. I was told that I had urinary tract infections, but there were never any bacteria in my urine. I started experiencing more and more pain and I was going from doctor to doctor searching for answers.

It wasn't until about 8 years later that I finally received an interstitial cystitis diagnosis. For those who are not familiar with interstitial cystitis (IC), it is now known as painful bladder syndrome.

The symptoms can range from mild to severe pain, constant pressure, and also urinary frequency that can be up to 40-60 times per day in severe cases. Often times emptying the bladder does not lead to relief.


At the time of my diagnosis, my children were one and four years old. I was experiencing knife- pain every time I urinated. I was experiencing extreme frequency as well.

Urinating every 15 minutes while taking care of my home and two young boys was no easy task. Still, I continued to push myself despite my symptoms. I was working, cleaning my home, and trying to provide a somewhat normal daily routine for my two boys.

I would wake up all night long to use the bathroom and I was simply exhausted. 

I was able to achieve some control of my symptoms over time through dietary changes. Sticking to the IC diet was now a part of my daily routine. Taking medication and doctor visits were the norm. I would often visit the doctor on my lunch hour at the pharmacy.

This new norm went on for about five years before I knew that something had to change. I was feeling exhausted from frequent bathroom trips. I was feeling guilty for not being there emotionally for my family. I was basically sick and tired of feeling sick and tired.

At this time, I met a woman who introduced me to meditation and taught me to picture my bladder healing. I began to take time every day for at least a half an hour or more before I picked my children up from school to meditate and rest. 

Many women with interstitial cystitis experience flares that are caused by stress. Many women with IC carry stress and tension in their bladders just as someone would carry stress in their back.

I can attest that I definitely experienced more symptoms when I was under stress. As I began to learn to relax and reduce that stress, my bladder symptoms began to subside. Eventually, I was able to go off of all of my medication. I was even able to have another baby without increasing my bladder symptoms. 

During this time, I began to learn to take care of me. If I was tired, I rested. If I needed a nap, I took a nap. I know it can be so hard for women to let themselves make time for self-care. However, some days, resting on the couch verses cleaning the kitchen is just what the doctor ordered—so to speak.  This is especially crucial when on a healing journey.

Taking time for self-care can look many things to different people. It is an important part of allowing your body to heal by giving your body the energy to heal, releasing healing hormones, and allowing your immune system to work properly.

Here are some small ideas for self-care:

  • Take a bath
  • Meditate
  • Practice yoga or gentle stretches
  • Call a friend
  • Read a book
  • Have a cup of tea
  • Write in a gratitude journal
  • Just do nothing

Even now that my bladder symptoms have subsided, I still remind myself that self-care is an important part of a healthy living journey. I am in tune with what my body is telling me to do and I know that when it says to rest, then I will do just that.  Rest is no longer just a four-letter word to me!

Lisa King has been a practicing pharmacist for 30 plus years. She has always been passionate about health, but not until she started her own healthy living journey did she realize how actually important health and wellness was for disease prevention and ageless living. You can connect and find her at her blog, The Fulfilled Pharmacist and on Instagram @thefulfililedpharmacist.


Interstitial Cystitis (Painful Bladder Syndrome) Management and Treatment

Cystitis: self-care

Although IC/PBS cannot be cured, there are many ways to treat it. There is no way to predict who will respond best to certain treatments. Symptoms of IC/PBS may become more severe, or may disappear. Even if symptoms disappear, they may return after days, weeks, months or years.

Treatments for IC/PBS are aimed at relieving symptoms. Doctors will help decide the appropriate treatment for the patient. For some patients, treatments are combined.

Interstitial cystitis/painful bladder treatments can include:

  • Diet: Some people with IC/PBS find that certain foods or drinks make their symptoms worse. You may find it helpful to keep a diary of what you eat and drink to see if any foods or drinks cause symptoms and/or flare-ups. For patients who have IC/PBS, acidic foods may irritate the bladder. If this is the case, your doctor may recommend taking an antacid with meals to reduce the amount of acid that gets into the urine. You may also want to remove certain foods from your diet, such as:
    • Alcohol
    • Caffeine
    • Carbonated beverages
    • Chocolate
    • Tomatoes
    • Artificial sweeteners
  • Physical activity: Exercise and physical activity may help relieve the symptoms of IC/PBS. Exercises can include:
    • Walking
    • Biking
    • Gentle stretching
  • Reducing stress: Stress can trigger flare-ups and symptoms in someone who has IC/PBS. Learning stress reduction methods and setting aside time for relaxation may make living with IC/PBS easier.
  • Physical therapy: The pelvic muscles hold the bladder in place and help control urination. Exercising these muscles may help reduce the symptoms of IC/PBS. Your doctor or physical therapist can help you perform this exercises correctly.
  • Bladder retraining: A person who has bladder pain can get in the habit of using the bathroom as soon as he or she feels pain or urgency, even if the bladder is not full. As a result, his or her body may get used to going to the bathroom often. Bladder retraining is a treatment to try to overcome this habit by helping you hold urine for a longer period of time. To use bladder retraining, keep a diary of how often you urinate, and how often you have the urge to urinate. Use the diary to gradually increase the length of time between bathroom breaks.
  • Oral medications: Pentosan polysulfate sodium (Elmiron®) is a medication approved for treating the pain of IC. This medication may have to be taken for up to six months before any improvement is noticed. Medicines that treat heartburn may help the symptoms of IC by reducing the amount of acid made by the body. Muscle relaxants can help relieve the symptoms by keeping the bladder from squeezing at the wrong time. Antidepressants can be used to relieve pain in patients with IC. Tricyclic antidepressants such as amitriptyline (Elavil) have been shown to improve pain and reduce frequent urination in patients with IC. Narcotic pain medications are not routinely used to treat pain in IC patients.
  • Bladder instillations: Another treatment is to fill the bladder with a liquid medicine. You place a small catheter or tube in the urethra and fill the bladder with medicine.
  • Bladder stretching/hydrodistension: Bladder stretching or hydrodistension is a procedure that is performed in the operating room under anesthesia. The bladder is filled with sterile water in order to distend the bladder and increase the amount of urine you can hold.
  • Nerve stimulation: Nerve stimulation is a treatment that helps regulate the bladder. These treatments are more helpful in reducing urgency and urinary frequency but sometimes can help with the bladder/suprapubic pain.
  • Surgery: Surgery to treat IC/PBS is used as a last resort. The surgery may remove parts of the bladder or even the entire bladder. If the patient has tried every other treatment option and pain is unbearable, surgery may be considered.

Last reviewed by a Cleveland Clinic medical professional on 09/16/2019.



Self Care Archives – Interstitial Cystitis Network

Cystitis: self-care

Articles that share self-help and self-care strategies for patients with bladder and pelvic pain.

Though my IC (i.e. bladder pain) officially began when I was 32, I spent much of my 20's struggling with many of the conditions we now know are related to IC. I had vulvodynia in high school and college that felt a painful yeast infection. Despite many trips to the doctor, they rarely found […]

While IC patients are frequently in the bathroom to urinate, sometimes the very medicines recommended to help the condition cause another bathroom-related problem: constipation. And constipation causes increased discomfort in the pelvis, which is the last thing ICers need. According to the Harvard Medical School, some of the medicines that can cause constipation, especially in […]

Talking about IC with friends and family who don’t know anything about it can be hard. I struggle to find the right words to say to best describe how I feel without sounding I’m whining or looking for pity yet also not downplaying how I feel and the impact it has on my life. […]

The ICN Food List Application for Android Devices (Santa Rosa, CA) If you’re scared to drink a cup of coffee fear that you’ll spend the day in the restroom, you’re not alone. Mild urinary frequency and urgency are common but for patients with urinary disorders, these same foods can provoke days of pain and […]

If a picture speaks a thousand words, then the art of Atara Schimmel speaks volumes about pelvic pain and pudendal neuralgia. She's just won the ADA poster contest sponsored by the city of Boston for her entry “We Will Be Heard,” one of her Project Angel series which is dedicated to raising awareness for pelvic […]

(Here's part of an email I sent to an IC patient last night who was struggling with severe night time symptoms and bladder pain that describes the many factors that can be contributing to nighttime IC symptoms and pain. – Jill Osborne, ICN President) #1 – To treat the pain effectively, we have to know […]

If this is your first holiday season with a diagnosis of IC, we've assembled some resources that we hope will help you enjoy the season, including new videos, articles, meal tips and many IC friendly recipes to play with. Surviving a holiday Thanksgiving is all about pacing yourself, communicating clearly with your family and, […]

Why I Said No To Thanksgiving – An IC Holiday Survival Story Here's one of the most frustrating questions that IC patients often struggle with. “Should or shouldn't we go to Grandma's House for a holiday celebration if IC is flaring?” In my first year of IC, my family really didn't understand what I was […]

One of the easiest ways for patients to try to reduce their bladder and prostate discomfort is by removing foods which are high in acid, alcohol or hot spices. Even one cup of coffee day, one green tea or one soda can trigger severe bladder irritation and discomfort. Worse, that daily acid wash may prevent […]

 Blogs, News & Announcements Feature Article – Anxiety & Interstitial Cystitis It might surprise you to learn that anxiety is a strongly related condition to IC and pelvic pain. It was the human genome project which made the connection. Researchers trying to determine which section of the human genome correlated with anxiety discovered that a […]


Urinary tract infection (recurrent): antimicrobial prescribing

Cystitis: self-care

1.1.5 Consider the lowest effective dose of vaginal oestrogen[1] (for example, estriol cream) for postmenopausal women with recurrent UTI if behavioural and personal hygiene measures alone are not effective or not appropriate. Discuss the following with the woman to ensure shared decision-making:

  • the severity and frequency of previous symptoms
  • the risk of developing complications from recurrent UTIs
  • the possible benefits of treatment, including for other related symptoms, such as vaginal dryness
  • the possible adverse effects such as breast tenderness and vaginal bleeding (which should be reported because it may require investigation)
  • the uncertainty of endometrial safety with long-term or repeated use
  • preferences of the woman for treatment with vaginal oestrogen.Review treatment within 12 months, or earlier if agreed with the woman.

1.1.6 Do not offer oral oestrogens (hormone replacement therapy) specifically to reduce the risk of recurrent UTI in postmenopausal women.

See the evidence and committee discussion on oestrogens.

1.1.7 For women with recurrent UTI who are not pregnant, consider a trial of antibiotic prophylaxis only if behavioural and personal hygiene measures, and vaginal oestrogen (in postmenopausal women) are not effective or not appropriate.

1.1.8 For women with recurrent UTI who are not pregnant, ensure that any current UTI has been adequately treated then consider single-dose antibiotic prophylaxis for use when exposed to an identifiable trigger (see the recommendations on choice of antibiotic prophylaxis). Take account of:

  • the severity and frequency of previous symptoms
  • the risk of developing complications
  • previous urine culture and susceptibility results
  • previous antibiotic use, which may have led to resistant bacteria
  • the woman's preferences for antibiotic use.

1.1.9 When single-dose antibiotic prophylaxis is given, give advice about:

  • how to use the antibiotic
  • possible adverse effects of antibiotics, particularly diarrhoea and nausea
  • returning for review within 6 months
  • seeking medical help if there are symptoms of an acute UTI.

See the evidence and committee discussion on antibiotic prophylaxis and antibiotic dosing and course length.

1.1.10 For women with recurrent UTI who are not pregnant and have had no improvement after single-dose antibiotic prophylaxis or have no identifiable triggers, ensure that any current UTI has been adequately treated then consider a trial of daily antibiotic prophylaxis (see the recommendations on choice of antibiotic prophylaxis). Take account of:

  • any further investigations (for example, ultrasound) that may be needed to identify an underlying cause
  • the severity and frequency of previous symptoms
  • the risks of long‑term antibiotic use
  • the risk of developing complications
  • previous urine culture and susceptibility results
  • previous antibiotic use, which may have led to resistant bacteria
  • the woman's preferences for antibiotic use.

1.1.11 When a trial of daily antibiotic prophylaxis is given, give advice about:

  • the risk of resistance with long-term antibiotics, which means they may be less effective in the future
  • possible adverse effects of long-term antibiotics
  • returning for review within 6 months
  • seeking medical help if there are symptoms of an acute UTI.

See the evidence and committee discussion on antibiotic prophylaxis.


Urinary Tract Infections and Self-Care Options

Cystitis: self-care

US Pharm. 2017;9(42):4-7.

Urinary tract infections (UTIs) are the most commonly occurring infections, affecting approximately 150 million people worldwide each year.1 In the United States alone, the societal costs of UTIs are estimated to be $3.5 billion annually.

1 UTIs can affect both men and women, but they are especially common in women of childbearing age.2 Most women will experience at least one episode during their lifetime; by 32 years of age, more than half of all women will have reported having at least one urinary tract infection.

2,3 Almost 25% of women will have a recurrent infection within a year.2

A UTI is an infection of the urinary system. UTIs are classified as uncomplicated and complicated.4 Uncomplicated UTIs are those occurring in healthy, premenopausal women with no urinary tract abnormalities.

3 Complicated UTIs are caused by abnormalities that compromise the urinary tract, such as urinary obstruction, urinary retention, immunosuppression, renal failure, renal transplantation, and presence of foreign objects; pregnancy is another cause.

1 Indwelling catheters account for one million cases, or 70% to 80%, of complicated UTIs in the U.S. per year.1 Complicated UTIs occur in both sexes and often affect the upper and lower urinary tracts. UTIs are further categorized location: lower UTIs (cystitis) and upper UTIs (pyelonephritis).

Pharmacists will frequently encounter patients inquiring about relief from UTI-related symptoms, so it is important that they understand the various OTC products marketed for the management of UTIs.

Etiology and Risk Factors

Urine is generally sterile, and the causative agents for most UTIs originate in bowel flora that enter the periurethral area. Most UTIs are caused by one organism; UTIs caused by multiple organisms may indicate contamination. The causative agents are gram-positive and gram-negative organisms, as well as some fungi.

1 The gram-negative bacterium Escherichia coli accounts for almost 90% of all episodes.

3,5 Other common causative agents include Staphylococcus saprophyticus, Klebsiella pneumoniae, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida species.

Women are more ly to develop a UTI because their urethras are shorter than men’s.

5 Other risk factors include previous episodes of UTI, sexual intercourse, spermicide use, new sexual partner, reduced mobility, changes in vaginal flora, pregnancy, menopause, diabetes, urinary incontinence, kidney stones, prostate enlargement, and history of UTI in a first-degree relative.

2,4,5 In the elderly population, other risk factors to consider are age-related changes in immune function, increased exposure to nosocomial pathogens, and an increased number of comorbidities.

6 Certain behaviors are thought to contribute to the development of UTIs, such as frequency of urination and delayed voiding, not voiding pre- and postcoitally, consumption of certain beverages, hot tub usage, douching, wiping patterns, and choice of clothing; BMI may also be a factor. A case-control study found no increased risk of UTI development with these practices.7

Clinical Presentation and Diagnosis

Patients with cystitis often present with a frequent, persistent urge to urinate despite passing a small amount, dysuria or a burning sensation during urination, or suprapubic heaviness.7 Patients with pyelonephritis often experience flank pain or tenderness, a low fever (