Recurrent Cystitis
Struggling with recurrent cystitis getting in the way of your daily life? Our effective treatments can help you feel comfortable and back in control.
Fast effective relief for women experiencing frequent bladder infections.
Trusted treatments that support your bladder’s natural defence and reduce infection recurrence.
Find the right recurrent cystitis treatment for you
View All Products
What you should know about recurrent cystitis treatments
Recurrent cystitis is usually caused by bacteria entering the bladder repeatedly, often due to factors like :
- Structural issues that block or slow urine flow, or cause urine to flow back up the urinary tract
- Thinning and drying of the vaginal walls (atrophic vaginitis), common after menopause
- Small pouches in the bladder wall (bladder diverticula) that don’t empty well
- Pelvic organ prolapse in women, where organs like the bladder drop from their normal position
- Bladder problems like overactive bladder or urinary leakage (incontinence)
- Not fully treating the first bladder infection properly
- Bacteria becoming resistant to antibiotics, making infections harder to clear
- Older men with prostate problems or nerve issues causing incomplete bladder emptying
- Sexually active women who don’t have obvious physical problems but still get frequent infections
- Things inside or around the bladder or urinary tract like bladder stones, tumours, catheters, or scar tissue that block urine flow
- Conditions like ureteroceles (swelling of the tube from kidney to bladder), urinary fistulas (abnormal connections), and kidney stones
- Vesicoureteric reflux, where urine flows backward from the bladder to the kidneys, seen in many children with their first UTI
Yes, drinking plenty of water, wiping from front to back, avoiding harsh soaps, and using vaginal oestrogen creams after menopause can help reduce the risk.
Antibiotics are the main treatment, but long-term use can cause side effects and resistance. Other options like methenamine hippurate or cranberry products may be recommended.
If infections are very frequent, severe, or don’t improve with treatment, your doctor may suggest further tests or specialist referral.
Most people recover fully with treatment. However, repeated infections can be uncomfortable and affect daily life, so managing and preventing them is important.
Methenamine hippurate is a medication used to help prevent recurrent urinary tract infections. It works by turning into formaldehyde in acidic urine, which kills bacteria and helps keep the bladder free from infection without using traditional antibiotics.
Unlike antibiotics, methenamine hippurate doesn’t directly kill bacteria systemically or promote antibiotic resistance. Instead, it creates a hostile environment in the bladder that stops bacteria from growing, making it a useful alternative for long-term prevention.
Side effects are generally mild but can include stomach upset or irritation of the bladder. It’s important to avoid urine alkalinising agents like potassium citrate while taking methenamine hippurate, as these can reduce its effectiveness.
Additional information
Recurrent cystitis
Recurrent cystitis is a common and often frustrating condition, especially among women. It happens when someone experiences two or more bladder infections within six months or three or more within a year. These infections are mostly caused by bacteria like Escherichia coli (E. coli), which can travel up the urinary tract and cause inflammation. Women are more prone to recurrent cystitis due to anatomical differences, hormonal changes, and lifestyle factors [1] [2].
- Recurrent cystitis involves repeated bladder infections, usually caused by bacteria such as E. coli.
- It mainly affects women, with risk increasing after menopause and with certain contraceptive methods.
- Diagnosis can include urine tests and sometimes imaging, with treatment focusing on antibiotics and lifestyle changes.
- Non-antibiotic options like vaginal oestrogen, cranberry products, and methenamine hippurate (Hiprex tablets) may help prevent recurrence.
- Good hygiene, hydration, and working with healthcare professionals are key to managing recurrent cystitis effectively.
What is recurrent cystitis?
Cystitis is an inflammation of the bladder, usually caused by a bacterial infection. When cystitis keeps coming back, it is called recurrent cystitis. Doctors define it as having two or more infections in six months or three or more in a year [1],[2]. The main culprit is often E. coli, a type of bacteria that normally lives in the gut but can enter the urinary tract and cause infection [3].
Women are more likely to get recurrent cystitis because their urethra (the tube that carries urine out of the body) is shorter than men’s, making it easier for bacteria to reach the bladder. Hormonal changes, especially during and after menopause, can also affect the natural balance of bacteria in the vagina, increasing the risk of infection [2].
How does infection start? Why does it keep coming back?
Bacteria such as E. coli usually live harmlessly in the gut, but if they travel to the urinary tract (for example, from the back passage to the urethra), they can cause trouble. The bladder isn’t naturally equipped to deal with these bacteria, so when they arrive, the immune system kicks in, leading to inflammation and the classic symptoms of cystitis [1] [4]. This is why wiping from front to back after using the toilet is so important. In some people, especially women, the bacteria have a much shorter journey to make, which is why cystitis is more common in women than men [3].
When bacteria reach the bladder, the local environment isn’t always able to fight them off, especially if protective bacteria (like lactobacilli in the vagina) are low. If the immune system can’t clear the infection, or if antibiotics don’t fully get rid of the bacteria, the infection can come back. Sometimes, the same bacteria linger and flare up again (a relapse), or a new batch arrives (a reinfection) [2], [3].
Why do symptoms happen?
The burning sensation, frequent urge to wee, and lower abdominal pain occur because the bladder lining becomes inflamed as your body tries to fight off the bacteria. This inflammation makes the bladder more sensitive, causing those classic symptoms. In some cases, you might also notice cloudy or strong-smelling urine, or even a bit of blood. These symptoms are your body’s way of signalling that something’s not quite right and that the bladder is under attack [1], [3].
Causes and risk factors
Several factors can increase the risk of recurrent cystitis, including:
- Incomplete emptying of the bladder, which allows bacteria to multiply.
- Changes in the vaginal microbiome, especially a decrease in protective lactobacilli bacteria after menopause.
- Use of spermicides or diaphragms as contraception.
- Frequent sexual activity, which can introduce bacteria into the urinary tract.
- Personal hygiene habits, such as wiping from back to front or using harsh soaps.
- Underlying medical conditions like diabetes or urinary tract abnormalities.
Some women are more vulnerable due to hormonal changes, especially after menopause, as the protective bacteria in the vagina decrease, creating an environment where harmful bacteria can thrive [2],[3].
Diagnosing recurrent cystitis
Diagnosis usually starts with a review of your symptoms, such as frequent urination, burning sensation when urinating, and lower abdominal pain. Your healthcare provider may also ask for a urine sample to test for bacteria and may suggest further tests like ultrasound if infections keep coming back or if there are unusual symptoms [1], [2].
It’s important to distinguish between a relapse (the same infection returning soon after treatment) and a reinfection (a new infection caused by different bacteria) as this affects treatment decisions [4].
Treatment options
Antibiotics are the main treatment for recurrent cystitis. Your doctor will choose the right antibiotic based on urine test results to target the bacteria effectively. It’s important to complete the full course of antibiotics to clear the infection [1] [3].
For prevention, low-dose antibiotics may be prescribed either continuously or after specific triggers, such as sexual activity. However, long-term antibiotic use can lead to side effects and antibiotic resistance, so other options are also considered [2].
Non-antibiotic preventive measures include:
- Drinking plenty of water to flush bacteria from the bladder.
- Practising good hygiene, like wiping from front to back and avoiding harsh soaps or douching.
- Using vaginal oestrogen creams after menopause to restore healthy vaginal bacteria [3].
- Cranberry products and D-mannose supplements, which may help reduce infections, though evidence is mixed [3].
- Methenamine hippurate (Hiprex tablets), a medicine that helps keep urine free of bacteria, as an alternative to antibiotics [3].
Living with recurrent cystitis
Recurrent cystitis can affect your quality of life, but with the right treatment and lifestyle changes, it can be managed effectively. Staying hydrated, practising good personal hygiene, and working closely with your healthcare team are essential steps [1] [2].
If infections are severe, frequent, or don’t respond to treatment, further tests may be needed to check for underlying problems like kidney stones or bladder issues [4].
Remember, if you experience symptoms like:
- Fever or chills: A high temperature, shivering, or feeling very unwell can indicate the infection has spread to your kidneys or bloodstream.
- Flank or back pain: Pain in your lower back or sides (just below your ribs) may suggest a kidney infection.
- Nausea or vomiting: Feeling or being sick, especially with other symptoms, can be a sign of a more serious infection.
- Blood in your urine (haematuria): Passing blood, especially if it’s new or increasing, always needs checking.
- Confusion or drowsiness: Particularly common in older adults, confusion or unusual sleepiness can be a sign of a severe infection.
- Difficulty passing urine: If you can’t wee at all, or it’s suddenly very painful, seek help.
- Symptoms not improving with treatment: If your symptoms don’t improve after a course of antibiotics, or they get worse, let your doctor know.
Disclaimer: This article is for informational purposes only and does not replace professional medical advice.
References
[4] Aggarwal, N. and Leslie, S. (2025) Recurrent urinary tract infections. StatPearls.
BSc Pharmacy, Independent Prescriber, PgDip Endocrinology, MSc Endocrinology, PgDip Infectious Diseases
Superintendant Pharmacist, Independent Prescriber
BSc Pharmacy
Compounding Pharmacist
