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Bacterial cystitis (BC)

Bacterial cystitis (BC) occurs when bacteria outside the body enter the urinary tract through the urethra and begin to multiply causing UTIs. Most cases of cystitis are caused by a type of Escherichia coli (E. coli) bacteria. BC is much more common in women than men.19,20

BC can occur in women for the following reasons:

  • Women have a shorter urethra than men, which is situated close to their anus17,19,21,22
  • Movements during intercourse push bacteria up into the bladder or there is slight damage to the urethra, which encourages bacteria to thrive (this is more likely if the vagina is dry)21–25
  • Diaphragms are used with spermicides which can kill off the protective bacteria in the vagina, as well as change the pH balance of the vagina22,23,25,26
  • There’s pressure from the uterus due to pregnancy, resulting in incomplete emptying of the bladder21–23
  • Hormonal changes occur during menopause, resulting in changes to normal vaginal flora21–23

BC can occur in both women and men for the following reasons:

  • Catheters infect or damage the urethra or bladder21,25,27
  • Poor bladder emptying results in residual urine that leads to increased amounts of bacteria21,27
  • The urine of diabetics that contains a lot of sugar encourages bacteria to grow21,23
  • Kidney stones block the ureter or urethra causing severe pain or a UTI25,28
  • There are abnormalities in the urinary system25,29
  • A parasite (such as Schistosoma mansoni or Schistosoma haematobium) is present in people who have spent time in North Africa or the Middle East)21,30
  • Sexually transmitted diseases (STDs) such as chlamydia and gonorrhoea21

There are also some conditions that can cause ‘cystitis-like’ symptoms in men (usually in men over 50), such as prostate infection or other issues with the urinary tract.27,31,32

Recurrent bacterial cystitis (RBC)

Recurrent bacterial cystitis (RBC) is characterised by repeated episodes of UTIs. If a patient has two proven infections in six months or three in a year it can be considered RBC.19,22

RBC occurs as a consequence of reinfection by a different bacteria, or more commonly, persistence of the same bacteria.33,34 Some women are more prone to recurrent infection than others, however the reason for this remains ambiguous as it occurs when there seems to be no problem with the bladder or immune system. It may be linked to a damaged bladder lining or a slight variation in the body's defence that may tip the balance in favour of bacteria, causing infection more often (in the same way some people are more prone to colds). It has been suggested that patients who get more UTIs can suffer from greater damage to the bladder lining.22,35


  • 17.Medline Plus. Cystitis - acute. medlineplus.gov/ency/article/000526.htm. Published 2016. Accessed September 1, 2017.
  • 19.Barber AE, Norton JP, Spivak AM, Mulvey MA. Urinary Tract Infections: Current and Emerging Management Strategies. Clin Infect Dis. 2013;57:719-724. doi:10.1093/cid/cit284.
  • 20.European Association of Urology. European Association of Urology Guidelines.; 2016.
  • 21.Bladder Health UK. Bacterial Cystitis. www.bladderhealthuk.org/bladder-conditions/cystitis/bacterial-cystitis. Published 2017. Accessed September 1, 2017.
  • 22.Kenny T, Harding M, Knott L. Recurrent cystitis in women. Patient. patient.info/health/recurrent-cystitis-in-women Discuss. Published 2016. Accessed September 1, 2017.
  • 23.Fihn SD. Acute Uncomplicated Urinary Tract Infection in Women. N Engl J Med. 2003;349:259-266. doi:10.1056/NEJMcp030027.
  • 24.Kehinde EO, Anim JT, Hira PR. Parasites of Urological Importance. Urol Int. 2008;81:1-13. doi:10.1159/000137633.
  • 25.Colgan R, Williams M. Diagnosis and Treatment of Acute Uncomplicated Cystitis. Am Fam Physician. 2011;84(7):771-776. doi:d9030 [pii].
  • 26.Davis S. Do Diaphragms Cause Urinary Tract Infections? WebMD. www.webmd.com/urinary-incontinence-oab/features/do-diaphragms-cause-urinary-tract-infections. Published 2011. Accessed September 1, 2017.
  • 27.Grabe M, Bartoletti R, Bjerklund-Johansen T, et al. Guidelines on Urological Infections.; 2015. doi:10.3201/eid0702.010240.
  • 28.Preminger GM, Glenn JF. Urinary Calculi. MSD Manual. www.msdmanuals.com/en-gb/professional/genitourinary-disorders/urinary-calculi/urinary-calculi. Published 2016. Accessed September 1, 2017.
  • 29.Gupta K, Hooton TM, Stamm WE. Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Aquired Urinary Tract Infections. Ann Intern Med. 2001;135:41-50. doi:10.7326/0003-4819-135-1-200107030-00012.
  • 30.Mostafa M, Sheweita S, O’Connor P. Relationship between Schistosomiasis and Bladder Cancer. Clin Microbiol Rev. 1999;12(1):97-111. http://www.ncbi.nlm.nih.gov/pubmed/9880476. Accessed October 19, 2017.
  • 31.Brusch JL. Urinary Tract Infection in Males. Medscape. emedicine.medscape.com/article/231574-overview. Published 2016. Accessed September 1, 2017.
  • 32.Lipsky BA. Prostatitis and Urinary Tract Infection in Men: What’s new; What’s True? Am J Med. 1999;106:327-334.
  • 33.Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 2011;5(5):316-3122. doi:10.5489/cuaj.11214.
  • 34.Hickling DR, Nitti VW. Management of Recurrent Urinary Tract Infections in Healthy Adult Women. Rev Urol. 2013;15(2):41-48. doi:10.3909/riu0566.
  • 35.Taylor D. Recurrent Cystitis in Women. 2003.