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Cystitis (Bladder Infection & Bladder Pain)

Cystitis means an inflamed bladder. Most often it is a bladder infection — burning, frequent urges and lower-belly pain — which antibiotics usually clear quickly. Some people get infections again and again, and some have bladder pain with no infection at all. Each needs a different plan.

Call 911 or go to the nearest emergency room if someone with a bladder infection becomes very ill — confusion or disorientation, fast breathing or a racing heart, shortness of breath, extreme pain, shivering or feeling very cold, or clammy, sweaty skin. These can be signs of sepsis, the body’s extreme response to an infection and a life-threatening medical emergency; urinary tract infections are one of the infections that most often lead to it (CDC, MedlinePlus).

Get medical care the same day — your clinician, urgent care or the ER — if bladder infection symptoms come with:

See a clinician soon (don’t just wait it out) if:

What is cystitis?

“Cystitis” describes pain, pressure or burning in the bladder. Most often it is caused by germs such as bacteria; when there is no infection, it is called noninfectious cystitis (MedlinePlus). A bladder infection — also called cystitis — is the most common type of urinary tract infection (UTI). People often say “UTI” to mean a bladder infection, but UTIs can also affect the urethra and the kidneys (NIDDK).

This guide covers bladder infections, infections that keep coming back, interstitial cystitis (bladder pain syndrome) and cystitis caused by radiation, medicines or irritating products. For leaks, overactive bladder and pelvic floor exercises, see our Bladder Problems guide.

How common is it?

Very common in women. About half of all women will have a bladder infection in their lifetime, and about a quarter of them will have repeat infections; men under age 50 rarely get them (NIDDK). Women get UTIs up to 30 times more often than men, and as many as 4 in 10 women who get a UTI will get at least one more within six months (Office on Women’s Health). Children get them too: by age 7, about 8% of girls and 2% of boys have had a UTI (NIDDK).

What causes it?

Bladder infections are most often caused by bacteria; rarely, fungi (yeast) are the cause (NIDDK, Office on Women’s Health). The bacteria often come from the skin or rectum and travel up the urethra (CDC); Escherichia coli (E. coli) is the usual culprit (CDC, Office on Women’s Health). Women are more prone because the urethra is short and close to the anus (NIDDK).

Things that raise the risk

Being sexually active or using a diaphragm or spermicide; menopause; difficulty emptying the bladder; a urinary catheter, now or recently; a blockage such as a kidney stone or enlarged prostate; and diabetes or immune system problems (NIDDK). Pregnancy, older age, long periods of staying still (for example after a hip fracture) and urinary tract surgery add to the risk (MedlinePlus), as does a past UTI (CDC). After menopause, lower estrogen leaves vaginal tissue thinner and drier, making it easier for harmful bacteria to grow (Office on Women’s Health). A UTI is not a sexually transmitted infection (CDC).

Symptoms

Older adults, men, pregnancy and children

How it is diagnosed

Your clinician will ask about your symptoms, examine you and usually test a clean-catch urine sample (NIDDK, Office on Women’s Health). A urinalysis looks for white blood cells, blood, bacteria and nitrites and can diagnose an infection most of the time (MedlinePlus). A urine culture identifies the bacteria and helps choose the antibiotic, with results in a few days (NIDDK); it may be needed for repeat UTIs (CDC). Blood tests, imaging or cystoscopy (a look inside the bladder) are used for suspected kidney infection or repeat infections (NIDDK).

UTI symptoms can look like those of a sexually transmitted infection, so your clinician may discuss testing for one (CDC). Interstitial cystitis is often mistaken for repeated UTIs (MedlinePlus) — if your urine tests keep coming back clear, see the bladder pain section below.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A urine test, then an antibiotic chosen for the likely bacteria (CDC names nitrofurantoin, trimethoprim/sulfamethoxazole and fosfomycin as first choices for healthy women), finishing the course; fluids, a heating pad and short-term pain relief. For repeat infections: urine culture, vaginal estrogen after menopause, methenamine or preventive antibiotics. A step-by-step, individual plan for bladder pain syndrome. Pelvic floor physical therapy about $50–$350+ a session without insurance; Medicare Part B covers medically necessary outpatient PT (20% after the deductible). Urine tests, visits and antibiotics: cost estimate being researched. Most bladder infections can be cured; symptoms usually ease within 24 to 48 hours of starting treatment. Bladder pain syndrome has no cure, and finding what helps takes some trial and error.
Chiropractic No role in treating cystitis. A bladder infection needs medical diagnosis and, usually, antibiotics. Not a treatment for cystitis, so no cost is listed. We found no research showing chiropractic care helps bladder infections or bladder pain syndrome.
Acupuncture A course of acupuncture sessions, studied mainly to prevent repeat bladder infections in women. Not a treatment for an active infection. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. A few small trials suggest fewer repeat infections, but the evidence is low to moderate quality. Evidence for bladder pain syndrome is very limited.
Herbal medicine Cranberry products to help prevent repeat infections. D-mannose and uva ursi (bearberry) are popular, but the evidence is weak or missing. None treats an infection you already have. Cost estimate being researched. Cranberry probably lowers the risk of repeat UTIs in women who get them often. A large 2024 trial found D-mannose did not prevent them. Check with your provider first, especially if you take warfarin.
Massage therapy No role for a bladder infection. For bladder pain syndrome with tight, tender pelvic floor muscles, hands-on myofascial therapy by a specially trained pelvic floor physical therapist. Cost estimate being researched (see conventional care for physical therapy costs). In one trial of women with bladder pain syndrome, targeted pelvic floor therapy helped more than twice as many women as general full-body massage.
MBHA Wellness Coach Drinking enough water, not holding urine, urinating after sex, wiping front to back, skipping douches and feminine sprays, rethinking spermicides, and for bladder pain: a food diary, stress relief, gentle activity and better sleep. Cost estimate being researched. These habits may lower the chance of another infection or a pain flare, but you can follow them all and still get a UTI. They support — never replace — medical care.

Approach 1 of 6

Conventional medicine (AMA)

A bladder infection caused by bacteria is treated with antibiotics prescribed by a health care professional (NIDDK, CDC). If you think you have one, contact a clinician rather than waiting it out (NIDDK).

1. Antibiotics — and finishing the course

  • Which antibiotic: your clinician chooses it based on the likely bacteria and any antibiotic allergies (NIDDK). For healthy, non-pregnant, premenopausal women with an uncomplicated bladder infection, CDC’s guidance for clinicians lists nitrofurantoin, trimethoprim/sulfamethoxazole (where local resistance is low) and fosfomycin as first-line choices, and says fluoroquinolones such as ciprofloxacin should be saved for when other choices aren’t appropriate (CDC). The international guideline on uncomplicated cystitis in women, from the Infectious Diseases Society of America and European partners and co-sponsored by the American College of Obstetricians and Gynecologists and the American Urological Association, also weighed antibiotic resistance and side effects when ranking its choices (IDSA guideline, 2011).
  • How long: it depends on how severe the infection is, whether it clears, whether you get repeat infections, and whether there is a problem in your urinary tract; men may need a longer course (NIDDK). We don’t list doses or lengths here — follow your prescription.
  • Take every dose, even when you feel better. Not following the instructions can let the bacteria become resistant, making the infection harder to treat (NIDDK). Don’t share antibiotics or save leftovers (CDC).
  • Side effects: antibiotics can cause anything from a mild rash to a severe allergic reaction, and can lead to C. diff infection, which causes diarrhea and can damage the colon. Tell your clinician about side effects or trouble taking the medicine (CDC, NIDDK).
  • Not every case needs antibiotics. Sometimes symptoms and tests don’t confirm an infection, and your clinician will look for another cause instead (NIDDK). Bacteria in the urine without symptoms usually doesn’t need treatment, except in pregnancy and before certain procedures (CDC).

2. Easing the pain while the antibiotic works

  • Drink more liquids — water is best — to help flush bacteria out, unless a heart, kidney or bladder control problem means you need your provider’s advice on how much (NIDDK).
  • A heating pad on your back or belly, and over-the-counter pain relievers such as ibuprofen or acetaminophen if your provider suggests them (NIDDK).
  • Phenazopyridine eases burning, pain and urgency. It is not an antibiotic and does not cure an infection (MedlinePlus). It is meant for short-term relief only: its label says that for a UTI it should not be used for more than 2 days alongside an antibiotic, and not at all by people with kidney problems; it turns urine reddish-orange and can stain clothes and contact lenses (FDA-approved label). Call your doctor right away for yellow skin or eyes, bluish skin or shortness of breath, and tell them first if you have G6PD deficiency (MedlinePlus).

3. If it reaches the kidneys

A kidney infection is treated with antibiotics; people who are very sick may need antibiotics through a vein (IV) in the hospital or at home (NIDDK). A hospital stay is more likely for older adults, people who can’t keep down medicine or fluids, and pregnant people with a fever (MedlinePlus).

4. Repeat infections, bladder pain and noninfectious cystitis

Preventing repeat infections (including vaginal estrogen after menopause and methenamine), treating interstitial cystitis/bladder pain syndrome, and managing cystitis from radiation or medicines each have their own sections below: repeat infections, bladder pain syndrome and cystitis without infection.

Who to see

A primary care provider, gynecologist or urgent care clinic can usually diagnose and treat a bladder infection. For repeat infections or ongoing bladder pain, ask about a urologist or urogynecologist; people with bladder pain syndrome may also benefit from a pain specialist (NIDDK).

What it costs

  • Urine tests, office, urgent care or telehealth visits, and antibiotics: cost estimate being researched.
  • Pelvic floor physical therapy (for bladder pain syndrome): a cost guide puts physical therapy at about $50–$350 or more a session without insurance; with insurance, typically a $10–$75 copay or 10%–50% coinsurance (CostHelper). Medicare Part B covers medically necessary outpatient physical therapy when your provider certifies you need it; you pay 20% of the Medicare-approved amount after the deductible (Medicare.gov).

What to expect

Most UTIs can be cured. Bladder infection symptoms most often ease within 24 to 48 hours of starting treatment; a kidney infection may take a week or longer (MedlinePlus). Diagnosed early and treated properly, most bladder infections don’t lead to complications (NIDDK). Contact your provider if symptoms come back shortly after treatment (MedlinePlus).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating cystitis. A bladder infection needs diagnosis with a urine test and, usually, antibiotics (NIDDK), and we found no research showing that spinal adjustments help bladder infections or bladder pain syndrome. Don’t let any treatment delay seeing a clinician, especially if you have a fever, back or side pain, or any of the warning signs at the top of this page.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been studied mainly as a way to prevent bladder infections in women who keep getting them. It is not a treatment for an infection you have right now — that needs a clinician (NIDDK).

What the research says

  • A 2020 review pooled 5 randomized trials (341 women) of acupuncture for repeat uncomplicated UTIs. Repeat infections were less likely with acupuncture than with no treatment (two trials) or with sham acupuncture (one trial of 53 women). The reviewers rated the studies’ quality and the strength of evidence as low to moderate and called for better trials (Qin et al., 2020).
  • A 2024 trial of 137 women compared 12 acupuncture sessions over 18 weeks plus cranberry with cranberry alone. At 6 months the difference was small and could have been chance (59% vs. 46% free of UTIs). Between 6 and 12 months, more women in the acupuncture group stayed infection-free (66% vs. 45%). The authors said further studies are needed (Ots et al., 2024).
  • Bladder pain syndrome: a 2025 scoping review found the evidence on acupuncture for interstitial cystitis limited in quality, with small studies, risk of bias and no standard protocols; of the few randomized trials it found, most were in rats (Infantes Rosales et al., 2025).

If you want to try it for prevention, think of it as an add-on to your clinician’s plan, not a replacement, and keep getting urine tests when symptoms appear.

Safety

Relatively few complications have been reported, but acupuncture delivered improperly or with non-sterile needles can cause serious harm, including infections. The FDA requires needles to be sterile and single-use, and most states license acupuncturists (NCCIH).

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics charge about $50–$90 (The Pricer). Medicare covers acupuncture only for chronic low back pain, so it won’t pay for bladder treatment (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement treats a bladder infection you already have. If you think you have one, see a provider rather than relying on a supplement (NCCIH, NIDDK). Researchers don’t think diet can prevent or treat bladder infections, though drinking enough liquids helps (NIDDK). We don’t list doses or brands.

Cranberry — for prevention only

  • A 2023 Cochrane review of 50 studies (8,857 people) found cranberry products probably lower the risk of symptomatic, lab-confirmed UTIs in women with repeat UTIs, in children and in people at risk after a medical procedure. The evidence doesn’t support it for older people in care facilities, people whose bladders don’t empty fully, or pregnant women (Cochrane review, 2023).
  • NCCIH notes that findings have been inconsistent and that the FDA allows only a “limited” evidence claim on cranberry supplement labels, and “limited and inconsistent” for cranberry juice drinks (NCCIH).
  • Safety: cranberry by mouth is generally thought to be safe, though very large amounts can upset the stomach. Evidence conflicts on whether it interacts with the blood thinner warfarin — if you take warfarin or any other medicine, talk with your provider first. If you are pregnant or breastfeeding, ask before using more than food amounts (NCCIH).

D-mannose

  • D-mannose is a sugar thought to stop E. coli from sticking to the bladder wall. A 2022 Cochrane review found only 7 small trials (719 people), all with very low certainty evidence, and concluded there is little to no evidence to support or refute its use to prevent or treat UTIs (Cochrane review, 2022).
  • A 2024 placebo-controlled trial in 99 primary care practices in the UK (598 women with repeat UTIs) found daily D-mannose did not reduce UTIs over 6 months (51% vs. 56% with placebo, a difference that could be chance). The authors concluded it should not be recommended for prevention in this group (Hayward et al., 2024).

Uva ursi (bearberry leaf)

  • The European Medicines Agency’s herbal committee accepts bearberry leaf only as a “traditional use” remedy for symptoms of mild, repeat lower urinary tract infections: there is not enough evidence from clinical trials, and no clinical studies of bearberry leaf on its own. It advises using it only after a doctor has ruled out serious conditions, only in adult women, for no longer than one week, and never by women with kidney disorders; nausea, vomiting and stomach ache have been reported (European Medicines Agency).
  • Its arbutin is broken down to hydroquinone, and because of potential toxicity it should generally be avoided while breastfeeding (NIH LactMed).

Before you try any supplement

Talk with your health care professional before using supplements or other complementary products for your bladder (NIDDK), and tell them everything you take — supplements can interact with medicines (NCCIH).

Approach 5 of 6

Massage therapy

Massage doesn’t treat a bladder infection, and it shouldn’t be used to put off seeing a health care provider (NCCIH). Where hands-on therapy does have a place is interstitial cystitis/bladder pain syndrome — but the evidence is for targeted pelvic floor physical therapy, not a general massage.

Pelvic floor (myofascial) physical therapy for bladder pain

  • If you have bladder pain symptoms or spasms in your pelvic floor muscles, you may be referred to a physical therapist who specializes in pelvic floor problems, who will help stretch tight muscles and keep them relaxed (NIDDK). Pelvic floor physical therapy aims to relieve pain and release tight and scarred tissues (MedlinePlus).
  • In a North American trial at 11 centers, 81 women with recent bladder pain syndrome and tender pelvic floor muscles had 10 sessions of either myofascial physical therapy or global (full-body) therapeutic massage. 59% improved moderately or markedly with physical therapy versus 26% with massage; pain was the most common side effect in both groups, and there were no serious side effects (FitzGerald et al., 2012).
  • Avoid strengthening exercises such as Kegels if you have bladder pain, unless a physical therapist is guiding you (NIDDK).

Safety

The risk of harm from massage appears low, though rare serious side effects have been reported, some with vigorous types such as deep tissue massage (NCCIH). Ask for a referral to a licensed physical therapist trained in pelvic floor therapy rather than a general or spa massage for bladder pain.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your clinician’s advice into everyday habits — and talk through something many people find awkward to raise. These steps are widely recommended, but you may follow them all and still get a UTI (Office on Women’s Health), and the sources we checked don’t rate how strong the evidence is for each one. They never replace medical care.

Habits that may lower the chance of a bladder infection

Using antibiotics well

A coach can help you keep track of doses so you finish the full course, and remind you not to share antibiotics or save leftovers (CDC). Note when symptoms started and any repeat infections — useful information for your clinician.

Living with bladder pain (interstitial cystitis)

  • Keep a food diary to find your own triggers. Common ones include citrus juices, coffee, tea, soda, alcohol, tomatoes, spicy foods, artificial sweeteners, chocolate and MSG; a registered dietitian can help you build an eating plan (NIDDK). Cut foods one at a time to see what changes (MedlinePlus).
  • Stress: stress may make symptoms worse, though it doesn’t cause them (MedlinePlus). Relaxation techniques such as deep breathing can help, and support from family, friends and others with IC helps many people cope (NIDDK).
  • Sleep: pain and nighttime trips can cost you sleep; tell your provider if they do (NIDDK).
  • Gentle activity such as walking or stretching may ease symptoms, and quitting smoking can reduce bladder irritation (NIDDK).

If any of the warning signs at the top of this page appear, get medical help right away.

Another approach

When bladder infections keep coming back

Women who have two UTIs in six months, or three in a year, have recurrent UTIs; your clinician may run tests to look for a cause (Office on Women’s Health), such as a urine culture (CDC), imaging or a look inside the bladder (NIDDK). The American Urological Association’s 2025 guideline update for women with repeat UTIs emphasizes avoiding unnecessary antibiotics, expands the non-antibiotic options for prevention, and notes the value of a negative urine test in ruling a UTI out (AUA guideline update, 2025). Prevention options include:

Vaginal estrogen after menopause

  • If you are in perimenopause or menopause and have repeat bladder infections, your provider may prescribe low-dose vaginal estrogen, which increases good bacteria and helps prevent infection (NIDDK, MedlinePlus).
  • A Cochrane review (2008, 9 studies) found estrogen pills did not reduce UTIs. In two small studies, vaginal estrogen reduced the number of women with UTIs, with results varying by product and length of treatment. Reported side effects included breast tenderness, spotting, discharge and vaginal irritation, burning or itching (Cochrane review, 2008).

Methenamine hippurate (a non-antibiotic preventive)

Preventive antibiotic plans

Depending on the pattern of your infections, a provider may suggest a single antibiotic dose after sex, a supply to start at home at the first sign of infection, or a daily low-dose antibiotic (MedlinePlus, Office on Women’s Health). Because every course of antibiotics carries side effects and resistance risks (CDC), ask about non-antibiotic options too.

Other steps

Switching birth control if you use a diaphragm, unlubricated condoms or spermicide (NIDDK), cranberry products (see the herbal section) and the everyday habits in the coaching section may also help. Never start or stop a preventive medicine on your own.

Another approach

Interstitial cystitis / bladder pain syndrome

Interstitial cystitis (IC), also called bladder pain syndrome, is a long-lasting condition with pain in the bladder that usually worsens as the bladder fills and eases after urinating. Some people feel mild pressure or tenderness; others have intense pain, urgency or frequency (NIDDK). Researchers aren’t sure what causes it. Symptoms can come and go, and can flare with certain foods, a UTI, holding urine too long, tight clothing, heavy lifting, sex, stress or menstruation (NIDDK). Many people with IC also live with conditions such as fibromyalgia, irritable bowel syndrome, migraine, anxiety or depression (NIDDK).

How it is diagnosed

There is no single test. Clinicians diagnose IC by ruling out conditions with similar symptoms, using your history, an exam, a bladder diary, urinalysis and urine culture, and sometimes cystoscopy or bladder-function (urodynamic) testing (NIDDK). They will check for infections, sexually transmitted infections, bladder cancer and stones (MedlinePlus).

Treatment

There is no cure and no standard treatment; finding what works takes trial and error, and results vary (MedlinePlus). The American Urological Association’s 2022 guideline no longer ranks treatments in fixed “lines”: care is tailored to each person, several treatments may be used together, and — except for people with Hunner lesions — it usually starts without surgery (AUA guideline, 2022). Options include:

  • Self-care and bladder training (see the coaching section) and pelvic floor physical therapy with a specially trained therapist (see the massage section) (NIDDK).
  • Medicines: pentosan polysulfate sodium (the only pill approved for IC), the tricyclic antidepressant amitriptyline, and the antihistamine hydroxyzine, which can cause drowsiness (MedlinePlus).
  • Bladder instillations — medicine such as DMSO, heparin or lidocaine placed into the bladder through a catheter (MedlinePlus, NIDDK).
  • Procedures: bladder stretching under anesthesia (hydrodistention), which may relieve pain for a short time; nerve stimulation and Botox injections, which are not FDA-approved for IC but may be suggested when other treatments fail; and cauterizing Hunner lesions. Surgery to enlarge or remove the bladder is rarely needed, carries real risks and doesn’t always cure the pain (NIDDK).

Eye safety with pentosan (Elmiron): long-term use has been linked to pigment changes in the retina that may not reverse and can progress even after stopping. A baseline eye exam within six months of starting and periodic exams during treatment are suggested (FDA-approved label). Tell your provider and eye doctor about any change in your vision.

See also our Bladder Problems guide for bladder training and nighttime urination.

Another approach

Cystitis without infection: radiation, medicines and irritants

Bladder pain, burning and urgency without an infection is called noninfectious cystitis. It has been linked to radiation therapy to the pelvis, certain chemotherapy medicines, a history of severe or repeated bladder infections, and irritating products such as bubble baths, feminine hygiene sprays and spermicides (MedlinePlus).

Radiation and cancer medicines

  • Radiation to the pelvis can irritate the bladder lining (radiation cystitis), causing burning, blood in the urine, urgency, frequency, trouble emptying the bladder and pelvic cramps. These problems often start several weeks into radiation and go away several weeks after it ends. Some chemotherapy and immunotherapy medicines can also affect the bladder (National Cancer Institute).
  • The chemotherapy medicine cyclophosphamide can cause severe urinary problems. Call your doctor right away for pink or red urine or blood in the urine, or frequent, urgent or painful urination, and drink fluids and urinate often during treatment as your team advises (MedlinePlus).
  • In people being treated for cancer, a UTI can become serious and need immediate care (National Cancer Institute). Ask your care team which symptoms to call about.

Tests, treatment and outlook

A urine culture checks for infection; a cystoscopy may be done after radiation or chemotherapy, when symptoms don’t improve, or when there is blood in the urine. Treatment aims to manage symptoms: medicines that relax the bladder, phenazopyridine for burning, pain relievers, avoiding bladder irritants, bladder training and pelvic floor physical therapy (but not Kegel exercises). Symptoms most often improve over time; contact your provider if they get worse or you develop fever, blood in the urine, back or side pain, or vomiting (MedlinePlus). During cancer treatment, drinking plenty of liquids and limiting caffeine, alcohol, spicy foods and tobacco can help (National Cancer Institute).

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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