Preventing cystitis

Photo of women having a picnic (George Doyle / Photos.com)

There is no sure-fire way to prevent cystitis. Medication for the prevention of cystitis needs to be taken for a long time and often has side effects. Other medicines are ineffective or haven't been studied enough. But it can be worth paying attention to certain things in everyday life.

Although cystitis (a urinary tract infection, or UTI) isn't usually a big problem, the symptoms can be so unpleasant that they have a major impact on day-to-day life. Some women find their symptoms embarrassing too. People who have recurrent cystitis sometimes avoid activities such as swimming and may not feel like having sex. For these reasons, many women would like to try to prevent cystitis from arising in the first place.

Prevention with everyday strategies

Various everyday strategies are believed to help prevent cystitis. Because sexual intercourse can cause more bacteria to enter the urethra, people are often advised to urinate soon afterwards in order to flush bacteria out of the urethra. The type of contraception you use plays a role too. For instance, sperm-killing agents (spermicides) and diaphragms can increase the risk of cystitis. So it can be worth trying out a different type of contraception instead.

Good personal hygiene is also often mentioned too. Washing yourself with warm water and soap is enough, though – special products for genital hygiene aren't necessary. It is important to try to prevent intestinal bacteria entering the vagina and urethra. For example, women are advised to always wipe from front to back after going to the toilet.

Keeping your feet and lower abdomen warm is also recommended. Sometimes women are given more general advice about ways to strengthen their immune system, like getting enough sleep and avoiding stress.

Although these tips seem sensible enough and are generally easy to incorporate into everyday life, there is currently not enough scientific evidence to say whether they help or not. Many of them will most likely never be studied in good-quality studies.

Cranberry products

Cranberry products are sometimes recommended for the prevention of cystitis. They are available in pharmacies and drugstores in the form of juices, powder, capsules and tablets. But studies have shown that cranberries cannot prevent cystitis. Many women also find it difficult to take these products regularly for a long time.

Research summaries

Antibiotics

Women who keep getting cystitis can take low-dose antibiotics. They need to be taken over very long time periods, though, often for six to twelve months. The optimal length of time is still not clear.

Although low-dose antibiotics reduce the average number of cystitis episodes, they very often lead to side effects such as digestion problems, rashes and vaginal thrush. As a result, a lot of women stop taking them after a while. What’s more, the overuse of antibiotics increases the risk of bacteria getting used to (becoming "resistant to") the medication. If this happens, the antibiotics don't work.

Hormones

After menopause, women’s bodies start producing less of the female sex hormone estrogen. In some women this makes the membranes lining the vagina thinner and drier, which means that it is easier for bacteria to colonize them, making cystitis more likely. Estrogen products can be inserted into the vagina to try to prevent this from happening. They are available in the form of vaginal suppositories, cream or tablets.

Locally applied estrogen products can help lower the frequency of cystitis in some women. But they can also have side effects, like vaginal itching and burning. Also, not much is known about the effects of using these products for longer periods of time (longer than eight months).

Taking estrogen tablets orally, on the other hand, doesn’t prevent cystitis. And they can lead to side effects after a few months, such as breast tenderness, light vaginal bleeding and rashes.

Drugs with inactive strains of bacteria

A vaccine against cystitis has been on the market in Germany since 2004. The vaccine has several inactive strains of bacteria in it. According to the manufacturer, it helps the body learn how to fight the bacteria better. But there isn’t enough research in this area to be able to say whether the vaccine actually helps prevent cystitis. German statutory health insurers do not cover the costs.

Some women try to prevent cystitis by taking capsules containing extracts of non-living Eschericia coli bacteria (E. coli). Like the vaccine, these are meant to help the body respond to infections faster and more effectively. Studies have found weak evidence that this treatment can prevent recurrent urinary tract infections like cystitis. But the studies were quite small, so further research is needed to be more sure. In Germany, the costs of E. coli capsules aren’t covered by statutory health insurers.