Bladder Infection (Cystitis)

Chronic bladder pain and changes in urine aren’t normal. Bladder infections, commonly referred to as cystitis, can cause significant discomfort and disrupt daily life. When left untreated, this condition can spread to the kidneys, leading to serious complications. This makes addressing cystitis early is crucial in preventing further damage.

What is bladder infection (cystitis)?

Bladder infection, medically termed cystitis, is a condition in which the bladder becomes inflamed due to a bacterial infection. It is the most common type of urinary tract infection (UTI), typically caused by bacteria, primarily Escherichia coli (E. coli), which enters the bladder through the urethra. Once in the bladder, the bacteria multiply, leading to symptoms such as frequent urination, pain or burning during urination, and cloudy or strong-smelling urine.

In most cases, bladder infections are acute and occur suddenly. However, in some individuals, particularly those with underlying conditions or recurrent UTIs, cystitis can become chronic, which may result in prolonged discomfort. While cystitis is far more common in women due to anatomical factors (such as the shorter urethra), men, especially older men with prostate issues, can also develop bladder infections.

What causes bladder infection (cystitis)?

Bladder infections, primarily caused by bacterial pathogens, occur when bacteria enter the bladder through the urethra. The most common culprit is Escherichia coli (E. coli), which is normally found in the intestines. Cystitis happens when these bacteria, introduced into the urinary tract (typically from the bowel), adhere to the urethral lining and move upward into the bladder.

Once inside the bladder, the bacteria rapidly multiply. E. coli possess specialised surface structures called fimbriae (or pili), which allow them to attach to the cells lining the bladder wall. This adhesion helps the bacteria evade the body’s natural flushing mechanism during urination. Normally, urine flow helps wash away bacteria, but with strong adhesion, E. coli can colonise the bladder.

Once they establish themselves on the bladder’s epithelial cells, the bacteria form biofilms — protective layers that shield them from the body’s immune responses and even some antibiotics. These biofilms make the infection more persistent, enabling the bacteria to resist removal during urination.

The immune system reacts by sending white blood cells to the site of infection, leading to inflammation. If untreated, the bacteria can migrate further into the urinary tract, potentially reaching the kidneys and causing a more severe infection, known as pyelonephritis.

What are the symptoms of bladder infection (cystitis)?

Bladder infection (cystitis) presents with a range of symptoms, primarily affecting urination and causing discomfort. Common symptoms include:

A persistent urge to urinate, often with little urine output.
Pain or burning sensation during urination (dysuria).
Cloudy or strong-smelling urine.
Blood in the urine (hematuria), which may appear pink, red, or brown.
Lower abdominal or pelvic pain.
Pressure or discomfort in the bladder area.
Low-grade fever, though this is less common.

These symptoms may vary in severity and can worsen if the infection spreads to the kidneys.

Who is at risk of bladder infection (cystitis) in Singapore?

In Singapore, the following groups are at higher risk of developing bladder infections (cystitis) due to specific factors related to anatomy, lifestyle, and underlying health conditions:

Women

Due to the shorter length of the female urethra, bacteria can more easily enter the bladder. Women are more prone to bladder infections, particularly after sexual activity or post-menopause due to hormonal changes.

Sexually active individuals

Sexual intercourse increases the chances of bacteria entering the urethra, especially for women. The use of certain birth control methods like diaphragms and spermicides also raises the risk.

Postmenopausal women

Hormonal changes after menopause can lead to changes in the urinary tract, such as thinning of the bladder lining and a decrease in protective vaginal flora, which increases the chances of infections.

People with urinary tract abnormalities

Individuals with structural abnormalities of the urinary tract or blockages (e.g., from kidney stones or enlarged prostates are at a greater risk due to impaired urine flow.

People with weakened immune systems

Conditions like diabetes, HIV, or cancer can weaken the immune system, which makes it harder for the body to fight off bacterial infections.

Individuals using catheters

Prolonged use of urinary catheters increases the risk of bladder infections as they provide a direct pathway for bacteria to enter the bladder.

How is bladder infection (cystitis) diagnosed?

At Allen Sim Urology, we use the following methods to diagnose bladder infections (cystitis), as they help us ensure an accurate and effective treatment plan:

01. Medical history and symptom analysis

Our Urologist begins by understanding your symptoms and medical history to guide the diagnostic process.

02. Urinalysis

The doctor will analyse your urine sample to check for signs of infection, including bacteria, white blood cells, and blood.

03. Urine Culture

This test identifies the specific bacteria causing the infection, which helps us tailor the antibiotic treatment according to your condition.

04. Ultrasound

In some cases, we may use this non-invasive imaging to examine the urinary tract and bladder for any abnormalities.

05. Cystoscopy

During this procedure, we use a camera-equipped tube to view the inside of your bladder. This method is particularly helpful in recurring or severe cases.

06. CT Scan

In some cases, we may use detailed 3D imaging to detect any structural issues or blockages in the urinary tract.

What are the treatment options for bladder infection (cystitis) in Singapore?

At Allen Sim Urology, we offer a range of effective treatment options for bladder infections (cystitis) tailored to your individual needs. Once your diagnosis is confirmed, we focus on providing the best course of action to ensure a swift recovery and prevent future infections.

The primary treatment for bacterial bladder infections is antibiotic therapy. Based on the results of your urine culture, we prescribe antibiotics that specifically target the bacteria causing the infection. Commonly prescribed antibiotics include nitrofurantoin, trimethoprim-sulfamethoxazole (Bactrim®), and ciprofloxacin (Cipro®). It’s crucial to complete the entire course of antibiotics, even if symptoms improve, to prevent recurrence or antibiotic resistance. For patients with frequent infections or underlying conditions, we may explore additional treatment strategies, such as:

Pain management

To relieve discomfort, we can recommend over-the-counter pain relievers or prescription medications that help alleviate bladder pain and burning.

Intravesical therapyIncreased fluid intake

Staying hydrated by drinking plenty of water helps flush out bacteria from the bladder, which speeds up the recovery process.

Guidance on preventive measures

For recurring bladder infections, we provide guidance on preventive measures, including proper hygiene, urination habits, and in some cases, recommendations for topical oestrogen for postmenopausal women.

If you experience more complex cases, such as chronic or interstitial cystitis, we may discuss longer-term management strategies, which could involve lifestyle adjustments or specialised therapies like bladder instillations.

At Allen Sim Urology, our goal is to ensure that every patient receives personalised and effective care for their bladder infection. If you are experiencing symptoms of a bladder infection, don’t wait — schedule an appointment with us today to receive expert care and personalised treatment.

Frequently Asked Questions (FAQs)

01. How long does a bladder infection last?

A bladder infection typically improves within a few days of starting antibiotic treatment. However, it's essential to complete the full course of medication to prevent recurrence. Without treatment, the infection may persist and even lead to more severe complications.

02. Can bladder infections go away on their own?

In some mild cases, bladder infections may resolve without antibiotics, particularly if symptoms are minimal and hydration is increased. However, this is not recommended, as untreated infections can worsen and spread to the kidneys, which may later require more extensive treatment.

03. What should I avoid during a bladder infection?

During a bladder infection, avoid irritants like caffeinated drinks, alcohol, spicy foods, and acidic fruits, as they can worsen bladder symptoms. It’s also a good idea to avoid using harsh feminine hygiene products that might irritate the urinary tract.

04. Is cranberry juice effective for preventing bladder infections?

Cranberry juice is commonly believed to help prevent bladder infections by preventing bacteria from adhering to the bladder wall. While there is some supporting evidence, it’s not a guaranteed solution, and its effectiveness varies from person to person. It’s best used alongside other preventive measures.

05. What is the difference between a UTI and cystitis?

Cystitis refers specifically to inflammation of the bladder, which is often caused by a bacterial urinary tract infection (UTI). However, a UTI can affect any part of the urinary system, including the urethra, bladder, ureters, and kidneys. Cystitis is typically localised to the bladder.

06. How can I prevent recurring bladder infections?

To prevent recurring bladder infections, stay hydrated, practise good hygiene (such as wiping front to back), urinate after sexual activity, and avoid using products that may irritate the urinary tract. If you are prone to frequent infections, your doctor may recommend a low-dose antibiotic as a preventive measure.