How to Deal with Chronic Cystitis

Chronic cystitis is a long term or repeated bladder infection

  • Not to be confused with interstitial cystitis, which is a more complex bladder infection.
  • Less likely to occur in men than in women, especially those over 30 years of age.
  • Untreated chronic cystitis could develop into a severe infection or escalate to a kidney infection, becoming more difficult to treat.

What is chronic cystitis?

Cystitis is a bladder infection where bacteria, most commonly E. coli, usually present in our bowels and around our anus, enters the opening of the urethra, and travels to the bladder and multiply. Women are eight times more likely to be affected than men because women have a shorter urethra, making it easier for the bacteria to reach the bladder.

The most common symptoms of chronic cystitis are similar to those of acute cystitis, including a burning sensation while urinating, a sudden and strong urge to urinate, pain in the lower abdominal, foul-smelling urine, high temperature or feeling unwell, and/or occasionally blood in the urine. In the elderly, a bladder infection could also cause mental changes or confusion.

Risk factors of cystitis?

  • Wiping your bottom from back to front after going to the toilet
  • Sexual intercourse
  • Using a female diaphragm for contraception
  • Having a urinary catheter
  • Presence of bladder/kidney stones
  • Prostatitis (in men)
  • Chlamydia (more common to cause cystitis in men)
  • Pregnancy
  • Menopause
  • Diabetes
  • Chemical irritants from perfumed soaps or bath products
  • Structural abnormalities such as abnormal shape of the tract, or female genital mutilation (FGM)

Knowing the risk factor is important as it may affect the treatment option and outlook, for example, certain antibiotics may not be suitable for pregnant women. For diabetics, chronic cystitis could be an indication of an uncontrolled blood sugar level.

How to deal with chronic cystitis?

Mild acute cystitis usually resolves on its own within a few days, alongside over-the-counter painkillers such as paracetamol. In cases where antibiotics are necessary, it is usually a three to five-day course for women and a seven-day course for men. Symptoms usually start to improve within 2 days of starting treatment.

Chronic cystitis happens when the initial treatments for cystitis had failed, or if the episode of infection lasted longer than two weeks. Persistent or recurrent cystitis – getting two proven separate bladder infection in the space of six months – is also considered chronic cystitis. In these cases, antibiotics are necessary to prevent the infection from spreading to the kidneys.

Treatment is directed at the underlying cause. In the absence of an apparent underlying cause, your GP may choose antibiotics as treatment and prevention of further episodes.

Choice of antibiotics depends on the patient’s age, gender and medical condition. The commonly used antibiotics include trimethoprim, nitrofurantoin, amoxicillin and doxycycline.

  1. Low dose antibiotics for six months up to two years.
  2. Advance antibiotics are given by your GP, to take as soon as you notice signs of cystitis.
  3. Advance antibiotics are given by your GP, to take after intercourse if your recurrent cystitis is believed to be triggered by sex.

Other options include oestrogen therapy – oral or vaginal – for menopausal women whose fall of oestrogen levels is causing repeated cystitis.

Self-help measures encouraged by the NHS include taking painkillers to ease the pain, drinking plenty of fluids, and avoid sexual intercourse until you feel better. If there are known and avoidable risk factors, they should be avoided as well. For example, wiping your bottom from front to back instead, avoid scented feminine products, empty your bladder when you need to and after intercourse, opt for other birth control options instead of a diaphragm, etc.

Some products to lower the acidity (potassium citrate or sodium bicarbonate) of the urine to reduce the stinging pain when urinating has limited evidence to suggest its effectiveness. As for cranberry juice, research finds that the evidence to suggest its benefit as a preventative measure is small. It may be of some value for women who get repeated episodes of cystitis if drank consistently. But you should discuss with your pharmacist or GP about the suitability of these products beforehand, especially if you take any regular medication, as it could interact with some medication, such as blood thinning medication.


  1. (2018). Cystitis. [online] Available at: [Accessed 30 Mar. 2019].
  2. (2008). Chronic Cystitis. [online] Available at: [Accessed 30 Mar. 2019].
  3. Castle M.D., E. (2016). Chronic bladder infection: Is there a cure?. [online] Mayo Clinic. Available at: [Accessed 30 Mar. 2019].
  4. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD001321. DOI: 10.1002/14651858.CD001321.pub5.
  5. Hammond, C. (2013). Does cranberry juice stop cystitis?. BBC Future. [online] Available at: [Accessed 30 Mar. 2019].
  6. (2018). Interstitial cystitis. [online] Available at: [Accessed 30 Mar. 2019].
  7. (2017). Prostatitis. [online] Available at: [Accessed 30 Mar. 2019].