Symptoms of Cystitis

The symptoms of Cystitis can be caused by bacteria or by non-infectious causes. Whatever the cause, the symptoms of Cystitis are quite common in all types of Cystitis, because at the base there is inflammation of the bladder.

The specific Treatment Plans for each type of Cystitis developed by Cistite.info can help you fight and prevent Cystitis.

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Our association conducted a survey of 100 women to collect statistical data on the symptoms of Cystitis. Based on this survey, a list of Cystitis symptoms was drawn up divided into: common symptoms, uncommon symptoms, rare symptoms. Use the list to move quickly through the article.

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What are the common symptoms of cystitis?

• Frequency/urgency: compelling need to urinate often
• Stranguria: urethral and bladder pain when urinating
• Nocturia: frequent urination at night
• Pyuria: foul-smelling and cloudy urine
• Tenesmus: sensation of bladder heaviness and of still needing to urinate

What are the uncommon symptoms of Cystitis

• Pollakiuria: small amounts of urine expelled frequently
• Increased adrenaline: chills and cold
• Ematuria: sangue nelle urine
• Dysuria: weak stream
• Altered local sensitivity: flank pain, burning-hot urine
• Referred pain: clitoral, vulvar, and anal pain
• Psychological discomfort: anxiety, panic, and depression
• Chronic pain: persistent pain after the infection

What are the rare symptoms of Cystitis?

• Hyperthermia: fever
• Incontinence: loss of urine
• Vagal reflex: nausea, vomiting and diarrhea

Very few women (2 out of 100) stated that they had no symptoms (but in this case we are not dealing with cases of cystitis, but with harmless asymptomatic bacteriuria).

Below you can find in-depth information on each individual symptom, their origin, and natural remedies to relieve them.

Cistite.info can help you fight these symptoms thanks to agreements with numerous professionals and the financial assistance offered to members.

Pollakiuria, urinary frequency and urgency

What is pollakiuria?

A term of Greek origin (pollakys = often and ouria = urine), it indicates an increase in the number of urinations over 24 hours.

Although etymologically the term indicates only frequency, in the clinical field it is also associated with a decrease in the amount of urine with each voiding, thus distinguishing it from polyuria, in which there is an increase in urinations, but with normal amounts of urine.

This happens because the bladder muscle (called the detrusor) contracts. Bladder inflammation in fact releases leukotrienes, substances that stimulate the contraction of smooth muscle, that is, those muscles that contract independently of our will. The detrusor is a smooth muscle, as is the uterine musculature. The bladder, when contracted in this way, becomes smaller and therefore less capacious. As a result, it will already be full with a small amount of urine and will send the brain the message: “I am full, I need to empty myself!”.

Furthermore, both inflammation and muscle contraction disrupt the bladder receptors responsible for transmitting the filling and emptying signal, which will begin to be sent regardless of the actual capacity, eventually leading to the expulsion of sometimes only a few drops at a time, despite the sensation conveyed being that of a bladder so full it is about to burst.

This disorder can be continuous or intermittent.

“I tend to pass a little drop every 30 seconds but I would like to hold everything in tight… sometimes I press with a bit of toilet paper while I urinate, I don’t know, it gives me a feeling of greater control… in those moments I feel the urethra burning a lot and it’s like a valve out of control.”
Claire 08/05/2010 (cistite.info)

“I went to the bathroom numerous times to pass small drops of pee accompanied by difficulty emptying, burning during urination and small contractions at the urethra, the urge never let up.”
Greta 03/07/2012 (cistite.info)

Advice: try to urinate when the bladder is full. To understand this, with one hand press on the abdomen (about 5 cm below the navel): if the sensation of needing to urinate increases, it means the bladder is full; if it remains the same, it means it is not. Applying heat helps reduce urgency and frequency. In our experience, it has proven useful to try not to give in to the immediate urge, but to reach at least 400 cc of filling in order to retrain the bladder to perceive filling sensations in a normal way.

Stranguria

What is stranguria?

From the Greek strangos (drop) and ouria (urine). Literally it would indicate the emission of very little urine during urination, but most texts define stranguria as pain/burning during urination, assigning the quantitative aspect of the disorder to the term pollakiuria.

The type of pain defined as stranguria is described in various ways by the women who have experienced it.

Testimonials

“I feel a thread pulling downward, as if the bladder wanted to descend through the urethra and as if there were pieces of broken glass inside the bladder... it’s an atrocious thing... painful and distressing...”
Esprit74 26/11/2014 (cistite.info)

“There remains an internal pain in the bladder as if someone were tearing my flesh: every time I urinated I felt as if nails were scratching me.”
Serena74 04/09/2010 (cistite.info)

“By terrible pee I mean that it burned a lot at the end, from the last drops let’s say, and for a good hour afterwards. Constant burning as if someone had left lemon in the area.”
Ceychan 26/05/2012 (cistite.info)

Books, doctors, studies and various scientific articles use the term stranguria without ever differentiating the location of the pain or the phase of urination in which it appears. These distinctions, however, are very important for diagnostic purposes.

Most of the time the pain is perceived at the urethral level (urethrodynia), but it can also involve the bladder, the perineum, the anus, and the lumbar region.

The pain usually appears toward the end of urination, but it can also arise at the beginning, accompany the entire urination, appear only after urination has ended, or only when the bladder is full.

Pain during bladder filling suggests bladder inflammation (abacterial Cystitis), while pain during emptying suggests an infection (bacterial Cystitis).

In the evening the pain tends to worsen on the one hand because the fatigue accumulated during the day lowers the pain threshold and on the other because not being engaged in activities that involve your attention leads you to focus your thoughts on the bladder and to dwell on every small discomfort you feel, amplifying its perception.

“In acute periods (which can range from days to months) the pain never leaves me even between one urination and another, it worsens during the day to reach its peak in the evening”
Lalla84 15/09/2012 (cistite.info)

“Sometimes I feel a little burning before going to sleep (I noticed that 90 times out of 100 the discomfort occurs in the evening)”
Arshes 13/12/2012 (cistite.info)

Advice: try to distract yourself with television or with something you particularly like or that allows you to relax.

The pain is quite sharp even during the first urination of the morning both because at night one does not drink (and therefore the urine fills with waste substances, often irritating, or with bacteria that have all the time to multiply at night), and because at night one physiologically goes into acidosis and the urine therefore becomes acidic and thus irritating.

“I had continuous burning in the urethra in the absence of infection for about a year, so much so that in the end they diagnosed me with urethral syndrome which falls under interstitial cystitis. it worsened with concentrated urine, improved by raising the pH with bicarbonate”
Lelachio 16/03/2009 (cistite.info)

“The most bothersome pee is always the one in the morning, which leaves after-effects even for a couple of hours (intense burning in the urethra that comes and goes and that I manage to dull with a heating pad)...”
Ntinozza 19/02/2013 (cistite.info)

Advice: if you wake up at night drink a nice glass of water to dilute the urine, take D-mannose before going to sleep to prevent bacteria from reproducing during the night, alkalinize the urine with citrate salts (Regobasic, Supreme Magnesium, etc).

It also worsens in the premenstrual phase because during this phase estrogen secretion decreases, which protects us from infections.

“My symptoms have fortunately decreased now, in the sense that I still have the pins-and-needles sensations, burning and urethral pain, but fortunately rarely and always in the premenstrual phase”
Camillablu 08/09/2012 (cistite.info)

Advice: take D-mannose in the week preceding menstruation.

Another cause of worsening is constipation. In stagnant stools the number of bacteria increases; moreover, their hard consistency and volume compress and irritate the pudendal nerve, which controls the function and sensitivity of the pelvic organs and runs parallel to the rectal canal.

“does it ever happen to you that after going to the bathroom with a bit more effort, little burnings at the urethra arrive immediately afterward?????? it happens to me almost always, sometimes I immediately think that the cursed thing is about to come back, and instead as soon as the bladder begins to fill they subside—why is that??? maybe the effort triggers everything??”
Mommimimi 13/07/2009 (Cistite.info)

“I noticed that the symptoms worsen in conjunction with periods of acute constipation and when I pay less attention to my diet.
(...) These discomforts increase in the premenstrual phase, sometimes after intercourse, when I drink less, therefore I pee less often and it is more concentrated (like when I am away from home)”
Silviam 23/10/2012 (cistite.info)

Advice: read our suggestions on how to improve constipation in our forum (in Italian)

Stranguria also worsens when urinating with a half-empty bladder. In our questionnaire, to the question “Do pains increase when urinating with a not very full bladder?” 72 women out of 100 answered yes.

This probably happens because the mechanisms that, when the bladder is full, facilitate the expulsion of urine are lacking. Consequently, the urethral sphincter has to make a greater effort to open and expel the urine. This greater effort causes pain when the mucosa is already inflamed.

“damn, it often happens to me too that I pee without the urge so I can have more freedom when I go out.... and it usually gives me burning, actually it was often the cause of mild cystitis attacks!”
Sweetlady80 06/01/2011 (cistite.info)

“Damn, me too, if I pee without the urge it burns and I’m left with a sort of inflammation that only goes away by drinking a lot and then peeing again but with a full bladder and urge, who knows what that could be?? On the other hand, if I pee with a very full bladder, when I have to run or I’ll wet myself, then it never gives me any discomfort.”
Paola65 11/01/2011 (cistite.info)

Advice: try to urinate when the bladder is full. Avoid emptying it if you do not feel the need to do so.

For all these reasons, the term “stranguria” can have a very different meaning both from woman to woman and from Cystitis to Cystitis in the same person.

On one thing, however, those who have experienced stranguria agree: among all the pains experienced, this is the least tolerable.

“I also have problems with the urethra, I know what it means, imagine that from the pain once I clung to the hot radiator, I burned my face and didn’t even notice, such was the atrocious post-urination pain.”
Cinzia60 16/03/2009 (cistite.info)

“anyway I can assure you that the pain of the cut [cesarean] is more tolerable than cystitis!!!”
Flo 17/08/2010 (cistite.info)

“I’m writing in the grip of terrible internal burning, I can’t stand it, after every pee tears come to my eyes...(…) God give me back the migraine so strong I can’t even stand the light, (...)... but this burning really hits me in the stomach”
Grace 07/11/2010 (cistite.info)

“Every time I pee I dig my nails into my legs so I don’t feel that final burning …. the kind that glues you to the toilet and makes you want to do reckless things (it’s very hard to explain the concept to those who don’t experience this kind of torture).”
Annablue 02/08/2012 (cistite.info)

Advice: to reduce pain you can use local heat (heating pads, hot water bottles), Cistalgan (read about side effects in the forum in Italian), mallow, horsetail and couch grass herbal teas, or supplements based on turmeric and piperine (natural painkiller/anti-inflammatory). Many women find relief by urinating in the bidet and directing the jet of hot water onto the vulva.

But what is the cause of this pain?
In all urinary tissues there are chemical, mechanical, thermal and pain receptors, responsible for local sensitivity.

Inflammation activates the pain receptors present especially in the deepest part of the bladder wall.

The painful stimulus travels along the nerve fibers, reaches the spinal cord where the neurons run. These finally transmit the pain message to the brain (which makes it conscious) and to the limbic system (which associates it with negative emotions).

Pain has a defensive role, as it allows you to become aware of the fact that your bladder is undergoing damage and makes you take action to resolve the problem:

• take a medication
• drink
• contact your doctor
• prevent providing further stimuli to the already inflamed bladder (sex, heavy work, travel, large meals, etc)

Once behaviors aimed at tissue repair have been implemented and inflammation and infection have been resolved, the pain normally decreases until it disappears.

Tenesmus

What is tenesmus?

From the Greek teinesmos (to stretch), it indicates bladder contraction during urination, immediately followed by the need to urinate again (even though the bladder is empty) and by pain and suprapubic heaviness.

The cause of this symptom is once again the contraction of the bladder muscle (the detrusor). As the bladder returns to a relaxed state, the sensation of incomplete emptying and the pain will tend to disappear over a period of time that can range from 10 minutes to an hour, to then reappear at the next urination. If, on the other hand, the bladder does not relax, tenesmus will persist continuously.

Another cause of tenesmus is the alteration of the nervous transmission of the voiding stimulus due to inflammation and the contraction itself.

“I pee, that discomfort remains after urination, that urge to do it again for about ten minutes, then it passes and I manage to hold it even for a few hours”
Marcela 16/03/2009 (cistite.info)

“for a couple of days I’ve had urinary urgency, (…) Specifically I feel like the need to pee often, it’s not a real urge to urinate but it’s as if I had the sensation of not emptying the bladder well, it’s a discomfort that I don’t feel constantly throughout the day, and I don’t even know how to describe it well, it’s not even a sensation of heaviness, it’s as if I perceive having a bladder, that sensation where you feel nothing and don’t think about it is missing... it seems like when you start to need to pee but at the beginning, when the urge is not yet strong.”
Federicae 16/11/2012 (cistite.info)

Advice: to reduce tenesmus, diaphragmatic breathing exercises and reverse Kegel exercises are very useful. Supplements such as Purorepair GAG plus can relieve the sensation of a full bladder. Electromagnetic therapy and TENS can relax the muscles and modulate the nerve signal. Magnesium and potassium also relax the muscles and improve the transmission of nerve messages.

Nocturia

What is nocturia?

Nocturia is the voluntary and conscious elimination of urine during the night. It should not be confused with enuresis, which is the involuntary and unconscious loss of urine during the night. In cases of Cystitis, the urine eliminated during the night is significantly less than that eliminated during the day. We could also define it as nocturnal pollakiuria.

This symptom can be caused, as with the previous symptoms, both by muscle contraction and by altered nervous transmission.

“I keep peeing miserable amounts. Basically the maximum I can manage to go without urinating is 3 hours at night when I sleep.”
Mariac 14/08/2012 (cistite.info)

Advice: try to drink as little as possible in the evening so as not to produce urine during the night. Sleep with a heat source placed on the pelvic area and on the vulva in order to relax the muscles. Take magnesium to relax the muscles and improve nerve transmission.

The nighttime elimination of urine in an amount equal to or greater than that expelled during the day is called polyuria and could reveal a kidney problem or heart failure.

“It often happens to me, even last night, that I have to urinate too often and at very close intervals. But I don’t have particular burning sensations and above all I produce a lot. Last night for example, to help you understand better, I had to rush to pee because I really had to go, at midnight. Then I went back to bed and after not even a quarter of an hour the same thing, back to the bathroom, in a rush, and again a lot of pee. Throughout the night I continued more or less like this, at intervals of about an hour I had to go to the bathroom. I didn’t sleep a wink.”
Giuliak 09/12/2012 (cistite.info)

“I went to the nephrologist (...) As far as polyuria is concerned, he says that everything is connected to my ‘sick’ kidney. It seems to me that I understood that the fault lies with the renal tubules, which absorb less and filter a lot, which is why my urine is very clear. But he added that this does not cause any damage to functionality, apart from the mere annoyance of having to wake up at night.”
Giuliak 15/12/2012 (cistite.info)

Advice: contact your primary care physician if you notice that you produce much more urine at night than during the day.

Cloudy and foul-smelling urine

Why can urine be cloudy and foul-smelling?

Urine during Cystitis appear cloudy due to the presence of leukocytes, mucus, pus (pyuria), exfoliated cells and/or bacteria.

An odor similar to that of beer is often a sign of urinary tract infections. An ammoniacal odor may indicate an infection by urease-positive bacteria (Proteus, Pseudomonas, Klebsiella, Morganella, etc). A sharp odor is often due to fecal coliforms (for example Escherichia coli).
The possible olfactory associations are the most varied and imaginative:

“the pee has that very strong bacterial smell that by now we all know!I called the lab and over the phone they told me I have e. coli”
Tersy 18/09/2012 (cistite.info)

“strange smell because, whereas in past e. coli infections there was a fishy smell, here it seems like fruit (???) sometimes lemon, sometimes broth!”
Bia 18/05/2012 (cistite.info)

“I wanted to ask you if it has ever happened to any of you to sometimes smell urine that smells kind of like ‘bleach’”
Isis 04/02/2010 (cistite.info)

“Mine for a few days smelled like burnt popcorn!!!”
Aku 07/02/2010 (cistite.info)

“Also for me it happens that when I have cystitis the urine has a very strong smell, as you have already said, of ammonia”
Alexya 06/03/2010 (cistite.info)

“in october I started to feel cystitis symptoms and a strange odor: urine culture and vaginal swab negative. (...). Why was there an odor even though no bacteria had been detected?”
Bia 15/05/2012(cistite.info)

Advice: do not be alarmed if you notice an odor different from usual. Bad odor and the appearance of urine are not always due to the presence of bacteria, but to many other factors that have nothing to do with infection: diet, urine concentration, pH, menstrual phase, hormones, concomitant illnesses, and many other harmless variables. To understand whether the unappealing appearance of your urine depends on bacteria or something else, you can perform a urine dipstick test at home.

Chills and cold

Why can Cystitis cause chills and cold?

Cold and chills can be due to a rapid rise in fever. But even more frequent during Cystitis are chills in the absence of an increase in body temperature. Severe pain or an intense emotion (fear, anxiety) in fact release adrenaline. Adrenaline activates an ancient survival reflex that has always allowed humans to flee from or fight against the painful or emotionally negative source. Adrenaline in fact directs blood to the most important organs (such as the heart, brain, muscles, indispensable for fleeing or fighting), withdrawing it from less vital and more peripheral areas (hands, feet and skin), which for this reason become cold and pale. The sudden drop in peripheral temperature activates shivering, that is, an involuntary and rhythmic muscle contraction from which a substantial production of heat arises to combat the cold.

“excruciating pain that radiates to the abdomen, to the legs, in a trembling, a shiver.”
Claire 08/05/2010 (cistite.info)

Adrenaline also opens the sweat glands, causing sweating (in this case cold).

“I feel a strong heaviness in the bladder, I sweat cold, I have chills, nausea, and a constant burning in the urethra.”
Doretta 11/08/2012 (cistite.info)

Advice: check your temperature to assess the possible extent of fever and keep an eye on it to make sure it stays below 38°, otherwise a kidney infection could be suspected. Cover yourself with warm blankets: heat will bring blood flow back to the peripheral organs and at the same time help relax the contracted muscles.

Hematuria

Why can traces of blood be found in the urine?

From the Greek haimo = blood, it indicates the presence of red blood cells in the urine. Red blood cells are the cells responsible for transporting oxygen and for the red color of blood.

Hematuria is caused by the dilation of the blood vessels present in the urothelium (the bladder wall). This dilation is triggered by the inflammatory process, as a result of which the pores in the vessel walls increase in size, allowing leukocytes to leak out. Leukocytes are cells that protect tissues from the attack of bacteria or other irritating agents.
If the inflammation is severe, these pores dilate even further, allowing red blood cells to pass through as well—cells that normally would not be able to pass because they are much larger than leukocytes. The red blood cells thus spill into the bladder tissues and then into the urine, which takes on its characteristic red color.

Inflammation, in addition to dilating blood vessels, stimulates the production of new vessels (precisely to allow a greater influx of defensive elements into the affected area). The more vessels that form, the more pronounced the hematuria will be.

Hematuria can be of two types: microhematuria (when the red blood cells that leak out are few, do not color the urine, and are visible only under a microscope) and macrohematuria (when the red blood cells are sufficient to color the urine red, making their presence visible to the naked eye).

Although blood is generally very alarming to see, it is important to know that its presence does not indicate greater severity compared to Cystitis without hematuria. It is in fact necessary to distinguish hematuria from hemorrhage. Hemorrhage is a continuous loss of blood that does not stop without pharmacological intervention and that can put the patient’s life at risk if not treated.

“The first attack was hemorrhagic, but not with traces of blood—truly hemorrhagic, just blood (…) instead of urine! Treated in hospital because I was urgently admitted and my bladder was emptied with a catheter by the nurses!”
Lola 21/04/2013 (cistite.info)

Classic Cystitis-related hematuria, on the other hand, is simply a temporary presence of blood due to vasodilation and the rupture of a few capillaries. Seeing red urine is shocking, but in reality only a few drops of blood are enough to color all the urine present in the bladder.
It’s like when you brush your teeth and your gums bleed, or when you have a dental cleaning: the water you rinse your mouth with is completely red, but in reality you’ve only lost a few drops of blood. So, just like with hematuria, you are not having a hemorrhage and you are not in danger of losing your life.
In a very short time those capillaries will close again and stop bleeding—indeed, they have probably already closed, and what you are expelling is only the residue that had previously accumulated in the bladder.

Furthermore, based on the observation of a very large number of hematuria cases in the forum, we have been able to ascertain that usually, after an episode of hematuria, the healing phase begins.

“I had 2 severe hemorrhagic crises and after the last one, strangely, the cramps and burning sensations eased. (…) I could hardly believe it, and it brings tears to my eyes, but I peed another 3 times and it was not only liberating (…) but also less painful and without blood!”
Elygely 30/03/2013 (cistite.info)

Advice: in case of bladder bleeding, drink a lot and urinate frequently to flush the bladder and prevent clots from forming, which could remain in the urethra and cause pain. Do not apply heat, because warmth dilates blood vessels and could increase bleeding. The bleeding should stop within a few hours. If it lasts longer than 24 hours, contact your primary care physician.

Dysuria

What is dysuria?

From the Greek dys (abnormality) and ouria (urine). Etymologically it should indicate the set of urinary alterations; in practice, however, it refers to difficulty in passing urine. This difficulty can manifest as trouble starting urination or finishing it, a slow stream, a split stream (double stream), a tortuous stream (the urine seems to go wherever it wants), an intermittent stream (it starts, stops, and then resumes), or a stop-and-go flow.

“I’ve noticed that many times my urine stream splits into two streams instead of a single flow. Two ‘little fountains’ rather than one...”
Fittina70 20/01/2010 (cistite.info)

“for me… much more than 2 little streams, even 3 or 4… at the beginning it flows down fine… then it stops and I have to push more to get it out, and so on.”
Frens 21/01/2010 (cistite.info)

“I’ve also noticed that my stream is double and swirling, so swirling that the two streams seem to hug each other!”
Paola86 29/12/2012 (cistite.info)

This happens both because the muscles around the urethra (the pubococcygeus muscle) contract in response to inflammation, and because inflamed tissue becomes edematous (swollen). All of this narrows—or can even temporarily close—the urethral canal, obstructing the passage of urine through it.

“The pain was in the urethra and the burning was so intense that I couldn’t get the pee out properly, in the sense that, especially toward the end of urination, I tended to contract the muscles and let it come out little by little…
In any case, I have to say that this habit of contracting the muscles toward the end of urination has stayed with me, in the sense that if I feel even a slight burning, at the end of peeing I tend to contract…”
Silviam 23/10/2012 (cistite.info)

Advice: follow these guidelines to relax the pelvic muscles. To reduce inflammation, you can drink herbal teas made from mallow, couch grass, and horsetail, or take natural anti-inflammatory/pain-relieving supplements (try Purodefend Urto).

Inflammation and muscle contraction alter the conduction of the nerve signal, which is then unable to deliver to the urethral sphincter the command to open during urination, so it remains closed. Sometimes, in order to allow urine to flow out, it becomes necessary to push using the abdominal muscles (the same ones used during defecation, called the abdominal press), to assume a squatting position, or to press on the abdomen with the hands.

Dysuria worsens (and sometimes appears only) when the bladder is excessively full.

Testimonials

"does it ever happen to you that you have to squeeze to get the first pee of the morning out???? it's like it doesn't want to come out even though the bladder is full??"
Mommimimi 03/10/2009 (cistite.info)

“Same thing happens to me, actually it even happened this morning, (…) my bladder was very full and only a tiny stream came out. I tried not to push, but it’s a bad sensation. Then sometimes it also happens that a good amount comes out and it seems like I’m finished, and instead after a while the flow starts again…”
Sabrina 19/10/2009 (cistite.info)

“What worries me the most is this: when I hold my urine for a long time I experience a blockage—I go to the bathroom to urinate and nothing comes out, not even if I push. After about half an hour, little by little and intermittently, I manage to empty, but it’s very difficult.”
Gaiadom 01/08/2010 (cistite.info)

“In the meantime I had undergone a test to check whether I had residual urine in the bladder after urination. It turned out positive (…) I have to admit that I was never convinced by that exam: I drank a liter and a half of water, or maybe more, but the doctor was late, so I had to hold it much longer than expected and, once I entered the office, I couldn’t urinate anymore because my bladder was so sore! I don’t know if this happens to you, I don’t know if it’s normal, but if I hold it too long then I can’t pee everything in one go, I feel sort of sore.”
MariaChiara 04/11/2010 (cistite.info)

This happens because the contractile force of the detrusor (the bladder muscle) that expels urine is maximal when bladder filling is between 150 and 500 ml; below and above these values it decreases, significantly reducing urinary pressure and therefore the strength of the stream.
Moreover, the incorrect habit of holding urine for excessive periods causes the bladder to dilate and become lax (like a balloon kept inflated for a long time and then deflated), losing its ability to contract effectively even at volumes between 150 and 500 ml.

Advice: try not to overfill your bladder and to empty it when you feel a fairly strong urge, but without getting to urinary urgency (“if I don’t run, I’ll wet myself”).

Altered local sensitivity

Why is altered local sensitivity perceived during Cystitis?

During a Cystitis attack, bladder, urethral, and vulvar sensitivity changes due to local inflammation.

Pain nerve fibers, on their way to the brain, are enclosed in a kind of bundle, intertwined with fibers responsible for carrying tactile, thermal, pressure, chemical, and acid/alkaline signals. The close proximity of all these fibers with different functions implies cooperation and therefore mutual influence. Inflammation therefore alters not only pain signaling, but also thermal and tactile information.

For this reason, the bladder, urethra, and vulva will be extremely sensitive and painful even in response to stimuli that would not normally cause pain:

• urine that is too acidic or too alkaline will cause burning
• the pressure applied by the doctor when palpating your abdomen will feel like a truck pressing on your belly
• even the warmth of urine will seem boiling as it passes through the urethra or over the vulva (even though it is actually only 37°)
• the minimal pressure exerted by urine in the bladder will cause pain as if it were completely full
• certain foods, when they come into contact with the urothelium, will be highly irritating
• the normal physiological presence of a few drops of urine in the urethra will be perceived as a massive amount of fluid
• any movement that causes even minimal pressure on the urethra will be perceived as painful

Exactly like when our skin is sunburned: the hot water of the shower will feel scalding, and rubbing with a towel will cause pain.

This phenomenon, in which a non-painful stimulus is perceived as painful, is called allodynia.

“The sensation of having the urethra full of pee when I bend over (…) has come back after the cystitis I had on August 15th. Not often, I have to say, but sometimes in the morning I have the feeling, when I bend down, that the little tube is full and about to drip. (…) My urethra (…) is certainly still infected, but above all weakened by repeated infections.”
Alice56 16/03/2009 (cistite.info)

“I’ve noticed something: I feel the discomfort in my urethra much more when I take certain positions, especially in the morning when I’m sitting in the car to go to work (45 minutes) and then I get up—there it comes! And if I then bend forward, don’t even get me started.”
Ely 25/03/2010 (cistite.info)

“On the ‘lady parts’ front, let’s say she’s cooked too, poor thing (…) what remains is vestibular neuropathy: when I pee it always feels warm, burning hot, and the poor mucous membranes feel scalded.”
Antonietta 05/08/2012 (cistite.info)

Advice: to help remodel nerve transmission, electrical stimulation (such as TENS) can be useful, as well as supplements based on neurotrophic substances (for example Fibro24, Etinerv, Alanerv, etc.), acupuncture, and synthetic neuromodulators.

Pain in the side or at the lumbar level, often during Cystitis, is simply referred pain or pain caused by drinking too many fluids in a short time, which overloads the kidneys with work and causes pain.

“In the evening I got home and started to feel a lot of pain in the lower back area. (…) Along with the pain, the fear came back: ‘could it be my kidneys?’ I thought… (the pain was also radiating to my sides). (…) and a whole series of jumbled thoughts. A bit of heaviness and burning came back too (pre-ovulation days). I feared a bad relapse. I had to wait until morning to do the urine stick test and finally, with daylight, the fears also dissolved… like morning fog. The stick was perfectly clean. No fever. I calmed down (…) A day wrapped in fleece. Things improved and on Monday I went to the office ready to face a difficult day.”
Laura69 24/10/2012(cistite.info)

Advice: drink small amounts frequently so as not to overload the kidneys. Do not exceed 3 liters per day. In case of kidney or flank pain, reduce or stop heavy hydration and resume it when the pain disappears, but with a smaller amount of fluids.

However, flank pain may not be a simple referred pain, but a symptom of an infection ascending to the kidneys. Keep in mind, though, that in cases of pyelonephritis the pain is often accompanied by fairly high fever (around 39–40°C), extreme exhaustion, nausea, and vomiting.

In-depth look: Characteristics of a kidney infection and how to treat it

Referred pain

What is it and how does referred pain work?

Often, in addition to pain in the urinary tract during Cystitis, pain is also felt in other parts of the body:

• pain in the legs
• pain in the flank
• lower back pain
• clitoral pain (clitoridodynia)
• pain similar to menstrual pain (dysmenorrhea)

This happens because of new nerve connections that form under the stimulus of NGF released by mast cells (inflammatory cells). The pain is thus radiated to areas different from where it originated, so it spreads to the uterus, bladder, anus, and legs, even though these are not actually damaged.
This phenomenon, in which pain is perceived in locations different from the injured one, is called a trigger point (when it involves a specific painful spot) or a trigger area (when an entire region is involved).

“For me, cystitis—or whatever it is—mainly causes exhaustion and a strong desire to cover up and stay warm. It’s a bit like a truck has run over my legs and pelvis.”
Dudu 25/04/2009 (cistite.info)

“only a few drops come out, with excruciating pain that radiates to the abdomen and to the legs.”
Claire 08/05/2010 (cistite.info)

“I also believe that the repeated cystitis episodes have ‘hypersensitized’ my clitoris… my boyfriend can’t touch me without me jumping three meters in the air.”
Meowmeow 24/07/2012 (cistite.info)

Advice: follow our suggestions for the treatment of trigger points

Pain in the clitoris or vulva may not be due to Cystitis, but to a condition that is often mistaken for a urinary tract infection: Vulvodynia.

“If I apply pressure to the clitoris and the urethral opening I feel a painful discomfort that then spreads throughout the vulvar area, whereas if I touch along the urethra from the inside I feel nothing—so much so that my gynecologist told me that in her opinion there is nothing wrong with my urethra!!”
Sere87 23/09/2009 (cistite.info)

In-depth look: how to treat Vulvodynia

Fever

Why can body temperature rise during Cystitis?

The bladder’s inflammatory reaction can sometimes cause a slight rise in body temperature (a few tenths above 37°C). Fever is in fact a systemic defense mechanism (meaning it involves the whole body), which comes into play when the local inflammatory response is not sufficient to eradicate the infection.

Fever increases heart rate (which allows a greater flow of blood), and the heat promotes vasodilation, thus enabling defensive cells (leukocytes) to exit the blood vessels. In addition, fever kills many thermolabile bacteria (those that cannot withstand high temperatures).

However, if the fever increases and reaches temperatures around 39°C, a kidney infection should be suspected—especially if this hyperpyrexia (very high fever) is accompanied by asthenia (extreme fatigue), nausea, and lower back pain.

“Fever over 40°C, emergency admission to the ER… urinary tract infection — ‘you have urine more polluted than the Ganges,’ the friendly nurse tells me as she greets me while I’m delirious in the emergency room. (…) They discharge me with a diagnosis of pyelonephritis.”
Dharma 12/01/2011(cistite.info)

Advice: in case of fever, don’t be alarmed if it stays below 38°C. If, in addition to fever, flank pain, nausea, and fatigue appear, contact your doctor immediately.

Urine leakage

Why can urine leakage occur during Cystitis?

Because of muscle contraction, the pelvic floor muscles are no longer able to function properly and to effectively hold urine. In addition, the local neurological alteration disrupts the function of the urinary sphincters, compromising the normal ability to retain urine.

“among the various symptoms, sometimes I happen to have involuntary urine leakage… something unbearable because it feels like I’m wetting myself.”
Gattina1982 21/06/2012 (cistite.info)

“Let me explain better: I get a sudden urge to urinate, and if I don’t go right away I can’t hold it for long and I have urine leakage.”
Angelo77 30/10/2012 (cistite.info)

“Dr. Pesce maintains that my urine leakage is due to my pubococcygeus muscles, which, by contracting, choke the urethra and cause dripping leakage. In fact, I notice that on days when the contraction eases, the urine leaks disappear. I remember that every time I left the Professor after rehabilitation, I felt looser when urinating and I didn’t leak even half a drop. But as soon as the pelvic floor contracts again, here they come attacking.”
Pablita 16/03/2013 (cistite.info)

Advice: to improve bladder capacity, regularly perform reverse Kegel exercises. It is essential to empty the bladder regularly without waiting until it becomes excessively full. The fuller the bladder is, the more the muscle strains to hold urine and, paradoxically, over time it loses its contractile ability. Bladder muscle function can be restored through specific pelvic floor rehabilitation. On our forum you can find a list of professionals who specialize in uro-genital muscle rehabilitation.

Nausea, vomiting, and diarrhea

Why can gastrointestinal symptoms occur during Cystitis?

Nausea and vomiting can be symptoms of a kidney infection, provided that the other classic signs of pyelonephritis are also present: fever, asthenia, and lower back pain. Much more often and more easily, however, the kidneys are perfectly healthy and these symptoms are simply the result of a neurovegetative reflex triggered by the fear and pain experienced during an acute Cystitis episode.

Anxiety, fear, and pain (especially when coming from hollow organs such as the bladder, stomach, or intestines) stimulate the parasympathetic system, a part of the nervous system, which activates the vomiting center and increases peristalsis (intestinal movements), causing nausea, vomiting, and diarrhea.

“Every time I get cystitis, I immediately have 2–3 bouts of diarrhea and a burning sensation that involves the urethra, vagina, perineum, and anus.”
Alimari 01/05/2009 (cistite.info)

Advice: for nausea you can eat ginger, which has an excellent antiemetic action (against vomiting). It also has anti-inflammatory effects.

Anxiety, panic, and depression

How does Cystitis affect the psyche? 

When pain becomes conscious, it is not only the painful area that suffers, but the entire organism is involved, psyche included. Unfortunately, it is not uncommon for depression to be seen by doctors, friends, and relatives as the cause of this condition (“It’s all in your head”). In reality, depression arises as a consequence of prolonged and repeated pain. Only later does it become a factor that further amplifies the pain itself.

“they dismiss everything with… ‘ma’am, you’re stressed,’ and of course I’m stressed!!! Try feeling like a truck is running over your abdomen all day long, while shooting flames at you and throwing you onto the toilet with cramps, and now even bites in the vagina—let’s see how calm you feel then.”
Stephanie 19/10/2010 (cistite.info)

The pain signal is also transmitted to the cerebral limbic system, which is the part of the brain responsible for regulating emotions. In the acute phase, this system produces anxiety, restlessness, anguish, and panic—feelings that, from an evolutionary perspective, pushed individuals to flee from danger and from the source of pain, to search for a solution and thus ensure survival.
When the painful condition persists, however, this initially “useful” anxiety turns into depression. Depression lowers the pain threshold, causes neurophysiological alterations, and leads to the release of substances that further increase inflammation and suffering. This, in turn, heightens the focus of attention on the illness and generates more depression, creating a degenerative vicious circle.

For the same reason, frustrating or stressful psycho-social stimuli worsen symptoms, whereas when attention is distracted by strong, different stimuli or by important motivations, the pain threshold rises. When you are happy, or when you are engaged in a pleasant or meaningful activity, you tend to feel your pain less. When, instead, you are alone and inactive, depression increases and with it the discomfort.
This is precisely why symptoms often worsen in the evening and on weekends, when work commitments that normally divert attention from the affected organ and depressive feelings are absent (something common to all chronic conditions, such as the well-known “weekend headache”).

“Pessimism… well… I’m not coming from 2–3 years of cystitis, but 15 years. Fifteen years. After 15 years of attacks—some extremely painful—tests, medications, various treatments, hospitalizations (…) I challenge anyone to stay positive! When I’m well, the psychological damage isn’t felt; when I’m unwell, the vortex of deep depression starts again.”
Annette 18/03/2012 (cistite.info)

Chronic pain

How does pain become chronic?

In the medical literature, no distinction is made between the symptoms experienced during an acute phase of Cystitis and those experienced when Cystitis becomes chronic (that is, when symptoms remain present even between one episode and another), taking it for granted that once the bacteria are eliminated, the woman enjoys perfect urinary health.

…If only!

Between one episode of Cystitis and the next, you continue to feel the aftereffects of the previous one. The greater the number of Cystitis episodes you’ve had, the stronger and more persistent these residual symptoms tend to be.

Advice: neuromodulators (such as antidepressants and antiepileptics) allow the nervous system to rest and avoid constant overstimulation. If your doctor prescribes this type of medication, it won’t be because they think you’re “crazy,” but because they know how to treat neuropathic pain.

In-depth look: chronicization of symptoms

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