Preventing cystitis

Various things are said to help prevent cystitis. Because more bacteria enter the urethra (the tube leading to the bladder) during sexual intercourse, women are often advised to 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 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 warm water is enough. Special female intimate hygiene products aren't needed. It is 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 drinking a lot of fluids and keeping your feet and lower belly warm. 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 and can be incorporated into an everyday routine, there is no scientific evidence that they work.

Cranberry products are sometimes recommended for the prevention of cystitis. They are available in pharmacies and drugstores in the form of capsules, tablets, powder, tea and juices. Studies have shown that women who take a cranberry product are somewhat less likely to develop uncomplicated cystitis: The number of women who had cystitis at least once within three months was

• about 8 out of 100 if they took a placebo, and
• about 5 out of 100 if they took a cranberry product.

But these cranberry products only work for as long as you take them. Hardly any side effects were recorded in the studies. A few women said they had digestive problems like flatulence or diarrhea, though.

There are also other herbal products for the prevention of cystitis. But none of them have any clearly proven advantages.

Women who keep getting cystitis can take antibiotics at a low dose to prevent it. But the antibiotics 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 stomach and bowel trouble, rashes and vaginal yeast infections (thrush). A lot of women stop taking the antibiotics after a while because of these side effects. Using antibiotics too often also increases the risk of bacteria becoming resistant to the antibiotics, which means that these drugs then no longer work.

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. That makes it easier for bacteria to grow there, so cystitis is 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. The tablets may also lead to side effects after a few months, such as breast tenderness, light vaginal bleeding and rashes.

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 that cause urinary tract infections (UTIs) like cystitis.

It is 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.

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