Cystitis is a common infection which can be caused by bacteria from the nearby skin that can travel up the urethra and grow in your bladder, causing infection and inflammation. For many, living with cystitis can be uncomfortable, embarrassing and at times, extremely painful.

It is a common condition where the lining of the bladder becomes inflamed and makes going to the loo quite painful. Common symptoms include a stinging or burning feeling when passing urine, an urgent and frequent need to go to the loo, and passing small amounts of urine often.

Cystitis usually occurs as the result of an infection and other possible symptoms include blood in the urine, backache, lower abdominal aches and generally feeling unwell. It can ruin sleep and make working uncomfortable.

Although men can suffer with cystitis, it is adult women who are most commonly affected. For some women, cystitis is a rare event, for others it can happen four or five times a year. It affects women of all ages, being more common during pregnancy, post menopause and in those who are sexually active.

There are a number of ways of relieving the pain of cystitis. Drinking several glasses of water a day can help and cranberry juice can also help relieve symptoms. Although antibiotics have traditionally been prescribed to treat the condition, there are now natural products such as D-Mannose available on the market which may be just as effective with none of the side effects.

Dr Wright and Dr Harper give help and advice on beating the condition.

H: Host, Lis Speight
D: Dr Dawn Harper, family GP
J: Dr Jonothan Wright, physician (natural therapies)

H: Hello and welcome to the Healthcare show I'm Lis Speight and today we're going ot be talking about cystitis. Now this can be a very painful condition which affects mainly women, but you may be surprised to learn that men can also suffer from it as well. So if you do get cystitis then stick around because we're going to be talking about what causes the condition and what you can do to relieve the symptoms, and I'm very pleased to say that joining us in the studio to talk through this we have with us Dr Dawn Harper who is a family GP, specialising in women's health, or with a special interest in women's health, welcome along Dawn. And we also have Dr Jonothan Wright who is a physician who specialises in natural therapies, so welcome along to both of you. Now before we get cracking talking about cystitis I'd just like to say that this is an interactive show, and it's a live show so if you have any questions you want to ask our two doctors here, now is your chance. All you have to do is type your name in the box and your question, the box that's on the screen, press submit and it'll come through to us here on the computer and we'll try to get through as many as we can. So, Dawn and Jonothan, let's start off by talking a little bit about cystitis – Dawn, can you tell us first of all, what exactly is it for people that don't have it? People that have it I'm sure know exactly what it is!

D: The people that have it certainly know what it is, but I mean ‘itis' basically means inflammation, we talk about arthritis and all these other itis's and ‘cyst' means bladder, so it's an inflammation in the bladder, but in real terms what it means to the millions of people that suffer with it, is it's like weeing razor blades

H: Oh dear

D: And people find that they're desperate to go to the loo, they feel like they're bursting, they're going to wet themselves if they don't go quickly, and when they go not very much happens and what does happen is the liquid razor blade, it burns, it really burns. So it's miserable, and people that suffer say that you know they're going every 10, 15 minutes, they're desperate to go to the loo –

H: That's quite debilitating isn't it? If you're trying to live your life

D: Very debilitating because it carries on through the night so it effects your sleep, it means that you don't get a goodnight's sleep, it effects your work, I mean you're up and down from your desk or whatever it is you're doing – it makes you feel pretty miserable. Sometimes you have a fever with it, often you can get pain in your loin or in your groin from it, and you generally feel really steam-rollered and pretty miserable

H: So Jonothan what actually causes it?

J: 85 / 90% of the time it's the same bacteria over and over, it's one called Escherichia coli, otherwise called E-coli, and that's –

H: Oh it's E-coli is it?

J: Yes it is

H: We've all heard of E-coli, didn't know that causes –

J: It's not the famous one that kills people, there are various types of E-coli, and the so-called common E-coli actually lives happily all up and down the gut

H: Right

J: Where it does some useful things, when it's in the gut, it just doesn't belong in the bladder of course. And then 10-15% are caused by other germs

H: Right. So how do you actually get it?

D: Well as Jonothan's just pointed out the bug lives naturally in our gut all the time, and the basic fact is that it crawls from where it shouldn't be up the tube called the urethra, which links our bladder to the outside world and causes infection in the bladder. The reason why women suffer so much more frequently than men is very basic, it's because our urethras are shorter

H: Right

D: So it's much easier for those bugs to climb up into the bladder and cause a problem.

H: And why do some people get it more than others?

D: Well there's a lot of lifestyle issues that make it much more common, so for example people who get dehydrated, people who drink a lot of alcohol and caffeinated drinks will find that they get more irritation in the bladder lining. Interestingly sexual intercourse can actually be a trigger as well, and most women that I see who've got cystitis have actually been sexually active in the week or two proceeding the event

H: Right

D: That's not to put you off sex but it can mean just the pure act of sex means that they've got a little bit of a transport system these bugs, to get up to where they want to be

H: Right, right

D: And women who suffer a lot, I often say it may not be the most romantic thing in the world to do, but actually emptying your bladder before intercourse and afterwards goes along way to help

H: Just flushes out all those nasty bugs before they can take hold

D: Absolutely

H: And are you likely to get it at different times of your life Jonathan? Are you likely to get it if you're younger, if you're older?

J: Well children are more susceptible and women after menopause are more susceptible. The hormones strengthen the lining not only in the vaginal area but also the urethra and all of the tissues in the genital areas are strengthened by hormones. Before the hormones come on or after they go away, one is more susceptible

H: Ok

J: But as Dawn says if someone is young and very active sexually, it doesn't matter what the hormones are doing

H: And is it hereditary, or has that got nothing to do with it?

D: I guess the only way that I would think of it as hereditary would be in terms of lifestyle

H: Right

J: No there's one other thing, at least one or two studies have shown that a difference of a few millimeters in the position of the openings, the anal openings and the urethral opening, if they're just a few millimeters closer together –

H: Just something as little as that

J: One is more likely, yes it makes a difference and that might of course run in families

H: And if you've had it before are you more likely to get it again, or is that again a lifestyle thing would you say?

D: I think if you've had it before yes you probably are more likely to get it again. And I guess the only thing I would say is probably the first attack is the one, particularly as it tends to affect younger people, you know your first episode is when you're younger, often people leave it, and are a bit embarrassed and don't want to come and ask for help

H: Don't know what it is, they may think they've got a sexually transmitted disease –

D: Exactly that, exactly that, and so maybe don't come forward for help. And you know the good thing is once you've had it once you recognize it and hopefully do something about it more quickly

H: Well let's move onto some of your questions now which – we have had quite a few questions coming in, and Suzanna Rosco has written in, she wants to know ‘I get cystitis every couple of months' – oh poor you – ‘I am diabetic and wondered if this is the reason I get it so often? It is a miserable and painful condition, what can I do to alleviate this?' Treatments?

D: Well sadly Suzanne I think the diabetes is relevant

H: Right

D: All bugs love sugar, you know that's what they feed off and most diabetics, even the most fastidious of diabetics will occasionally run with higher than normal sugars, and so it may well be that as her sugars are getting a little bit higher the bugs are having a little bit of a party. There are things that she can do, and certainly it's very important that she tries to maintain her diabetic control as well as possible

H: Right

D: She needs to make sure she's drinking plenty to keep her bladder flushed out, she should always be wiping front to back, so that there's no excuse for those bugs to get anywhere closer, but I think there's a launch of something new today that even diabetics can take, and I would be – Jonathan's probably better qualified to talk about it but I would certainly be encouraging her to go out and have a little look at –

J: Well I'll take my cue from Dawn saying that all bugs love sugar. Now it turns out that the E-Coli bug which makes 85-90% of these infections loves one particular sugar more than any other sugar, and that's a sugar called D-Mannose. Now actually the reason tht such a high percentage of infections up the bladder are the E-Coli is that it uniquely is able to crawl up there, like Spiderman, we've all seen Spiderman, with all the little attachments and fingers crawling up the skyscraper, and at the end of these little – they're called fimbriae but let's call them Spiderman fingers on the bacteria, is a protein that sticks to a particular sugar called D-Mannose, now it happens that D-Mannose is natural to our bodies, and in fact in the lining of the bladder and the lining of the urethra, there are bits of D-Mannose, and so here comes the E-Coli, and it does its Spiderman thing, holding on to the D-Mannose, and that way it can hang on, and other bacteria don't have this capability, so they're only able to get up there 10-15% of the time. But here comes the E-coli holding on to the D-Mannose residues, and once it's inside the bladder, it sees its friends there and it has, you know bacteria sex and little bacteria

H: It has a great time up there while you're having a miserable time with cystitis

J: That's exactly right. Well, so the obvious thing to think about since D-Mannose is in us and it doesn't hurt us any, well what if we just simply give them a lot of D-Mannose and make them happy

H: Right

J: So in the States I've been accustomed to having people use a powdered form of D-Mannose, perhaps 3g every 3-4 hours. Now we have an advantage here in the UK and that is that D-Mannose is now available in tablets which is more convenient of course, so one would take perhaps one, two or maybe three, but one, two or three tablets every 3-4 hours. Alright, what does that do? Well it gets into our systems, it's more than our bodies can metabolize so it's absorbed very rapidly in the upper gut, gets into the bloodstream, out through the kidneys, down into the bladder, now imagine you're an E-Coli alright?

H: Yipee!

J: Exactly, you've got it! She's got the idea! And we're holding on for dear life to these few D-Mannoses on the inside of the bladder, and here comes an enormous cloud of D-Mannose. Oh, my we quit having bacteria sex and we call to all our friends and we say ‘party time, look look look D-Mannose.' And we detach ourselves from the inside of the bladder and we hold onto this cloud of D-Mannose and we float around and then she urinates and we're gone

H: That's amazing, so by giving more of the thing that causes it –

J: Give them what they like

H: That's amazing isn't it?

J: Yes

D: The important issue though for Suzanne is that you've been giving this stuff to diabetics

J: Yes and –

D: Because I think Suzanne will straight away think oh well that's great but it's not for me because it's sugar, but actually I think you say that you might get a very transient increase in your sugar level –

J: Right

D: But of course infection would be likely to cause an increase in your sugar level as well

H: Anyway

D: So –

H: And do you just take the D-Mannose when you have cystitis or is it a sort of prevention?

J: Well most of the time people take it when they have cystitis or let's take the honeymoon sort of cystitis when one knows they might just get it if they're off on their anniversary or whatever –

H: You don't want that do you on your holiday of a lifetime with your husband

J: No, so you know what one does? Is just before you know when one has one's champagne, and two or three D-Mannose tablets –

H: Right

J: And that way if any of those germs try to get up in there again they're met with this great cloud of stuff that makes them happy and out they go. Back to the diabetic lady for just a moment with your permission, and that is yes her sugar may go up a little bit but the key to the use of D-Mannose is that if it has not abated the symptoms of the problem within 24-48 hours, then you'd best be off to see your practitioner and get something else prescribed

H: Right

J: Now it will work 85-90% of the time, and it's especially wonderful when it's the middle of Saturday night and there's no practitioners around

H: Well exactly so be prepared really is quite a good message actually

J: Yes. You want to have those tablets handy

H: And it seems like taking quite a lot of them in a day, but they are tablets, I suppose you can just put them in your handbag and –

J: You know what, they taste good. It's sugar

H: It's sugar. It's like sweets really

J: Mary Poppins would love it!

H: It's a little bit like sweets

J: Right

H: There we are, can't be bad can it? Now we're about halfway through the show actually, we're really cracking on and we've had plenty of questions coming in already but do send some more questions in if you have any questions at all about cystitis for our two doctors here. So let's crack on with a few more and Maria has written in, she wants to know ‘I have a sore feeling in my bladder which gets unbearable. The cystoscopy was clear but there was red or white cells in the urine sample. This problem comes and goes, what is wrong?'

D: Well –

H: Is that a big question?

D: It's quite a difficult one to answer without all the medical history and investigations, but I would say that red and white cells suggest to me that there is an inflammatory process going on –

H: Right

D: In her bladder, and that's why Maria feels sore. We haven't necessarily got a cause for that and my guess is that if she's got as far as having a cystoscopy she will have had numerous samples of urine sent off to the laboratory to have a look under a microscope and to be cultured to grow even tiny amounts of bug to have a little look whether there could be a bacterial cause. And it may be, my guess would be Jonathan that this isn't a bacterial problem –

J: Right

D: That she's dealing with, it could be something else

H: Right

J: D-Mannose is only going to be effective if it's E-Coli, and E-Coli is easy enough to culture, so –

H: That should have showed up

J: If she's had a culture she shouldn't, no. Now as far as continuously taking it, didn't quite answer that last time, I've worked particularly with children who for one reason and another have just chronic, chronic, chronic urinary tract infections, their parents have had to give them the D-Mannose every 3-4 hours while the kids are awake. Of course while the kids are asleep and not urinating you don't have to take another dose. Have done that for literally 5-7 years at a stretch and in many cases it's been young girls who didn't quit having the reoccurring infections until their hormones came on then again it protected them somewhat, and yet for all those years, none of these children have had side effects

H: Oh that's interesting then isn't it, so this could be the wonder drug that cystitis sufferers have been looking for?

J: Well it's the wonder sugar

H: The wonder sugar. Yes it's not a drug is it actually

J: Right

H: That's probably the wrong word isn't it to use, so it's a treatment isn't it?

J: Right

H: Right, ok. Now we've had another question in from somebody who says ‘I've just had a baby and a friend of mine whose also just given birth is having a terrible time with cystitis, is this something that is more prevalent post-childbirth or during pregnancy?' There's a lot going on down there isn't there during childbirth and pregnancy?

D: Certainly women are prone to urinary tract infections during pregnancy and actually interestingly it's the one time when they present slightly differently, so whilst you and I might suffer with cystitis and we get the burning razor blade syndrome, women who are pregnant often will just feel unwell or feel feverish or have tummy pain

H: Right, that's quite scary when you're pregnant isn't it?

D: Well I think that's one reason while we get – one of several reasons – why doctors become completely obsessed with your urine when you're pregnant!

H: Gallons of it they take don't they?

D: You aren't allowed anywhere near a doctor's surgery without a urine sample, you know and it gets dip-tested constantly and that is why. The other thing to say is she doesn't mention whether she's had what we call an instrumental delivery or a caesarian section, but anything that involves a surgical procedure involving that area can make you more prone to infection

J: Right, and we should state that D-Mannose is safe to use during pregnancy and when a woman's nursing. Again it only should be used for 24-48 hours without abatement of symptoms. Now let's say the symptoms do abate in 24 hours but they're not completely gone – then one just keeps taking it till they are gone, and always for another day or two just to make sure all the little germs are clear

H: Just to make sure you've kicked them out

J: But one hardly ever needs it for longer than 5 or 6 days and that's a long time for a D-Mannose – for an acute situation

H: Yes. We were talking earlier about being prepared for an attack of cystitis

J: Yes

H: There's quite a few old wives' tales that – I don't even know if they are old wives, they're probably true actually, a lot of them are. Things like taking cranberry juice and that sort of thing –

J: Cranberry –

H: Should you have a stock of all that in your cupboard just in case?

J: Cranberry juice is actually one of the higher natural sources of D-Mannose

H: Oh right – oh there we are, so it obviously does work then, that's interesting

J: Right. But, this is quite a bit more concentrated in the tablet form

H: Right

J: And quite a bit more sure

H: Right, yes so cranberry juice you don't know what the strength you're getting –

D: Well in terms of your question there actually you're absolutely right and I have a lot of ladies who suffer with recurrent problems with cystitis, and you know I tell them you should be taking cranberry juice every day as a preventative measure, and if you don't – the interesting thing is a lot of people think they have to drink it, there's this kind of association with drinking fluid and urine, but you can take it in tablet form

J: Yes

D: If you can't stand the taste of cranberry as a juice –

H: It's quite an acquired taste isn't it? For some people. And what about clothing as well, I always sort of imagine tight jeans and things going in and out of fashion don't they?

D: That's interesting, you're unusual because most women make the association with tight clothing with thrush, and they don't make that association with cystitis, and you're absolutely right. Bugs love to be warm and damp

H: Lovely

D: That's their idea of heaven, so if you've got nice, tight, synthetic fabric underwear and you put some tight jeans on top of that, you are going to make life much worse for yourself than if you're in loose, cotton underwear – natural fibres.

H: Right, so try and get a bit of airflow down there ladies, that's the tip. Ok let's move on to some more questions and Sue wants to know ‘I'm a student and I regularly get cystitis. Could drinking alcohol have something to do with this?'

D: Sorry

H: Mmm we mentioned this earlier didn't we, this is going to be bad news I think!

D: I'm sorry, you are talking to a girl who likes a glass of wine or two so I'm not suggesting that she abstains completely but she has absolutely hit the nail on the head, she's completely right. When we drink alcohol it tends to dehydrate us a little bit so the urine becomes more concentrated, and it is also an irritant to the bladder in its own right. It can change the pH of our urine, it acidifies it slightly which means it makes the urine a better place for the bugs to multiply, so she's absolutely right, a heavy night on the pop and I'm afraid she's going to suffer the next day

H: So what should she do then, drink more water?

D: Well certainly I mean –

H: Take D-Mannose?

J: Yes

D: Certainly cut down, yes

J: Both

D: Certainly cut down on your alcohol –

H: Right

D: And the other thing is try to get into the habit of alternating alcoholic drinks with a soft drink, preferably water, so that you are actually making sure that you maintain your state of hydration and by definition you're taking less alcohol

H: Right ok. And is there anything that we can do diet-wise to help with cystitis? Is there anything that might make it flare up?

J: If one knows one has allergies then investigation of food allergies in particular can make a difference. Some folks urinary tracts are reactive to allergies, it's just like some folks' lungs and some folks' skins –

H: Oh that's interesting

J: Oh yes, I in fact – one of the more common causes of recurrent bladder infections in children is dairy and then the other common allergens we all know about corn, what am I looking for citrus and things of that sort, peanuts, so just elimination of food allergies will make a difference too

H: Right ok. We're nearly out of time actually so let's crack on with a few more questions. David has written in and he said ‘my girlfriend has always got this. Can she spread it to me?' Don't laugh, now it's a serious question!

D: I thought he was going to be awfully nice and concerned about his girlfriend

H: No my poor girlfriend or anything, he's more worried about himself. Typical man!

D: Right, the issue probably is that – I suspect – that sex is triggering this –

H: Yes

D: In his girlfriend, alright, and I do see a lot of women who suffer with what we call Honeymoon cystitis, because frequent sex and vigorous sex can make you much more prone to cystitis

J: She should buy probably several boxes of D-Mannose and make liberal use of it beforehand

H: Well exactly, there we are, get yourself covered and –

D: But in terms of – no I mean there's no reason why – it's not a sexually transmitted disease

H: No

D: It's quite important we make that distinction. Yes sex can make it worse, but it's not a sexually transmitted infection

J: Right. Giving it to him is very unlikely.

H: But we just touched onto the fact as we were coming into the program that men can get it, is that right Jonathan?

J: Yes but those are usually men who, as Dawn says, have diabetes, have an impairment to the urinary tract, urethra in men is quite obviously much longer and those E-Coli, by the time they've velcroed or Spidermanned their way halfway up –

D: They're too tired

J: The urination just releases them right back out again

H: It's not quite as easy pathway is it, so it's the poor girls. Ok, Margaret has written in and she wants to know ‘I have interstitial stitial cystitis' – crikey me that's a – I'm glad I've got my teeth in – ‘and the cranberry makes the pain worse. Could you differentiate between bacterial cystitis and interstitial cystitis?' Am I saying that properly?

J: Well interstitial cystitis is an inflammation of the bladder as Dawn says, that's all cystitis is, but it's ‘unknown origin' and it does not, as far as one knows, have a specific bacterial origin as the common cystitis might. There are studies on the use of a simple amino acid called L-argenine, and fairly large but safe doses of L-argenine, the order of 3-4gms a couple of times a day have toned down the symptoms of interstitial cystitis, I don't want to give the impression they've cured it though

H: No

J: They've just made folks feel better

H: Right, ok

J: L-Argenine is also relatively safe

H: And would D-Mannose work in that situation?

J: I don't believe so

D: I don't think it would, but it may well be worth actually stopping –

H: Margaret

D: Margaret is it, I was going to say Marion, sorry, Margaret it may well be worth taking a look at the kind of – any perfumed products that you use because they can cause an irritation, and I think the awful thing about any form of cystitis is it's a completely human reaction to then feel dirty and wash like fury

H: And actually it makes it worse

D: And you can actually make things worse, so you know no bubbles baths, no perfume lotions and so on and that may well help too

J: L-Argenine you can find in your health food shop

H: Right ok so I hope that helps you Margaret. Well that's, I'm afraid, all we've got time for on the Healthcare Show today, so thanks very much to Dr Jonathan Wright and Dr Dawn Harper for coming in

D: Thank you

H: It's been really interesting, and thanks for all your questions as well at home, I'm afraid we couldn't get through all of them but I hope we've been of some help, and if you want any more information on D-Mannose or on cystitis in general then go to the website which is aorEurope.co.uk, that's aorEurope.co.uk and remember don't suffer with your cystitis, get it sorted. We'll see you next time, bye bye