Preventing cystitis

Photo of two women using a laptop outdoors (PantherMedia / Renaud Philippe)

There is no sure-fire way to prevent cystitis. But it can be worth paying closer attention to certain things in everyday life. Medications that prevent cystitis need to be taken for a long time and usually have side effects. Other medicines are ineffective or haven't been studied enough.

Even though cystitis usually doesn't cause any major problems, the symptoms can be very unpleasant. Some women are also embarrassed to have cystitis. If they keep getting it, they may be reluctant to do fun activities like swimming or to have sex. Because of this, many women would like to do all they can to prevent cystitis.

Prevention with everyday strategies

Various things are said to help prevent cystitis. Because more bacteria enter the urethra during sexual intercourse, women are often advised to urinate (pee) afterwards in order to flush the bacteria out of the urethra. The type of contraception you use plays a role too: Sperm-killing agents (spermicides) and diaphragms can slightly increase the risk of cystitis. So it may be worth trying out other methods of contraception, like condoms.

Maintaining good genital hygiene is also commonly recommended – washing with water and soap is enough. Special female intimate hygiene products aren't needed. It's important to try to prevent intestinal bacteria from entering the vagina and urethra. For example, women are advised to always wipe from front to back after going to the toilet.

Other common tips include keeping your feet and lower abdomen warm, and drinking a lot of fluids. Sometimes women are also advised to do things to generally strengthen their immune system, like getting enough sleep and avoiding stress.

Although these tips seem sensible enough and can be incorporated into an everyday routine, there is no scientific evidence that they work.

Cranberry products and probiotics

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. So far it's not clear whether cranberries can actually prevent cystitis. Studies have shown inconsistent results. If cranberries do help, the effect is only small. And many women find it difficult to take cranberry products regularly for a long time.

Probiotics are also said to have a preventive effect. They are available in the form of suppositories, syrups or tablets. But none of these products have been proven to prevent cystitis.

Antibiotics

Antibiotics can also be used at a low dose to prevent recurrent cystitis, but they need to be taken over long periods of time, often for 3 to 6 months.

Women then have cystitis less often, but they frequently have side effects like digestive problems, rashes and vaginal yeast infections. So quite a lot of women stop taking them after a while. Using antibiotics too often also increases the risk of bacteria becoming resistant to the antibiotics, which means that these drugs may no longer work.

Hormones

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

Topical (locally applied) estrogen products can reduce the number of cystitis recurrences in some women. But they can have side effects, like vaginal itching and burning. Also, not much is known about the effects of using estrogen products for longer periods of time (longer than eight months).

Taking estrogen tablets orally, on the other hand, doesn't prevent cystitis. They may also lead to side effects after a few months, such as breast tenderness, light vaginal bleeding and rashes.

Other treatments

A vaccine against cystitis (StroVac) 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 to fight bacteria better. But it's not clear whether the vaccine is a good idea. German statutory health insurers don't cover its costs.

It's also not clear whether taking capsules that contain an extract of dead Escherichia coli bacteria has any advantages. Like the vaccine, these capsules are supposed to help the body respond to the infection faster and more effectively. But there have been too few people in the studies so far, so the results are not conclusive. Statutory health insurers in Germany generally don’t cover the costs of these capsules.