Magazine 15 June 2021

Abacterial cystitis: causes and treatment

  1. Causes of abacterial cystitis
  2. Internal causes of abacterial cystitis
  3. External causes of abacterial cystitis
  4. Treatment of abacterial cystitis

The term non-bacterial cystitis, or abacterial cystitis, refers to a series of signs and symptoms similar to those of bacterial cystitis but in the absence of bacteria in the urine. In addition to these manifestations, abacterial cystitis includes a variety of inflammatory changes, particularly in the mucosa and submucosa of the bladder.

In other words…

The urine culture is negative, but you still experience the typical symptoms of cystitis (pain when you pee, urgency and increase frequency of urination, bladder weight).

It is important to note that recent research suggests that even if urinoculture is negative, other tests such as urinary DNA analysis may reveal the presence of unconventional pathogens, such as viruses or fungi, that can cause similar symptoms.

Maybe, they prescribed antibiotics for you, but it didn’t work (I’ll explain why shortly), so you continue to live with the pain and burning when you pee, you have trouble holding it in, and you stage an endless dash to the bathroom. (Do you feel like looking for a way out right now? Reach out to me and let’s discuss it).

There are two solutions:

  1. It can be a bacteria-free or abacterial cystitis ;
  2. Perhaps there is something wrong in other respects, but the symptoms are like cystitis(so-called fake cystitis). Confusible pathologies are, for example, a pelvic contracture or vulvodynia. In addition, xanthogranulomatous cystitis is another rare condition that can mimic the symptoms of abacterial cystitis, as evidenced by recent clinical cases.

But, before I understand more about what abacterial cystitis is specifically, I want to clarify.

It is important to perform urine culture and urine tests before taking any antibiotics for a correct diagnosis. The antibiotic has the function of killing pathogenic bacteria (so, as I expected, it does not affect abacterial cystitis).

A urine culture performed during or at the end of antibiotic therapy may give us results that do not reflect the picture of the initial situation, making us erroneously conclude to be in front of abacterial cystitis.

If you need to perform a urine culture after antibiotic therapy, I recommend counting ten days from the end of the last dose so you can be sure of getting truthful results.

Causes of abacterial cystitis

Okay, we have said that with cystitis without bacteria the urine culture is negative: it is not detected, no bacteria in the urine. However, it is essential to consider that abacterial cystitis can also be a symptom of broader systemic conditions, such as autoimmune diseases, which require a more complex diagnostic and therapeutic approach.


Well, then how the hell do you diagnose it?

Let’s move on to reading other urine test values: leukocytes, which are white blood cells.

The presence of leukocytes in the urine in quantities greater than those considered “normal” signals inflammation, and as we know, cystitis is an inflammation of the bladder.

The truth is that bladder inflammation can also be caused by NON-bacterial causes (and the list of such causes is not short).

Therefore, the causes of abacterial cystitis are a all those factors that generate an immune response by irritating the internal walls of the bladder.

One of the very first defense mechanisms put in place by the immune defenses of the bladder is, precisely, an inflammatory process. Inflammation gives rise to a whole series of symptoms that act as alarm bells and push us to act, to understand what’s wrong and look for a solution.

In my experience, it is possible to distinguish the causes of cystitis without bacteria based on whether the irritation is generated by factors/characteristics within our body or by external stimuli.

Internal causes of abacterial cystitis

Some factors cannot but be irritating when they come into contact with the internal mucous membrane of the bladder(urothelium):

  • Urine with a too acidic pH.
    Your urine pH must never fall below 5 because otherwise it would be too aggressive, and it should never go above 8, which allows bacteria to multiply more rapidly. It has been observed that even minor fluctuations in pH can significantly affect bladder health, emphasizing the importance of regular monitoring.
  • Kidney stones or renal disease
    When they migrate from the kidneys into the bladder, stones or kidney stones can “scratch” the urothelium. Recent studies have shown that stone composition can vary greatly and influence the type of treatment needed, making stone typing a crucial step in the management of abacterial cystitis.
  • Irritating food or drink
    Yes, even some foods and drinks can irritate your bladder (for example, alcohol). Research has expanded the list of potentially irritating foods to include certain food additives and preservatives, which should be avoided by abacterial cystitis sufferers.
    There are foods to avoid if you are struggling with cystitis , but it is also FUNDAMENTAL to trust your body and listen to the discomfort following a meal.

Abacterial cystitis can also occur because of other conditions, such as:

  • Autoimmune diseases, characterized by improper functioning of the immune system.
    The immune system sees dangers where there are none and may unnecessarily trigger inflammation.
  • Interstitial cystitis: This is a real chronic (i.e. continuous over time) inflammation of the bladder of non-bacterial origin. Interstitial cystitis is now better understood, with new guidelines for diagnosis and treatment that include multimodal therapies and a personalized approach to the patient. Recent studies have identified new biomarkers such as neutrophil-to-lymphocyte ratio (NLR) that may help in the diagnosis and monitoring of interstitial cystitis.
  • History of repeated urinary tract infections that have weakened and damaged the bladder.

External causes of abacterial cystitis

Abacterial cystitis, as anticipated, is also caused by external stresses/factors:

  • Sexual intercourse.
    The relationship leads to a mechanical strain on the bladder and urethra (the duct from which urine comes out). The succession of thrusts could generate inflammation of the lower urinary tract. It has been observed that sex education and awareness of practices that reduce the risk of post-coital cystitis can have a significant impact in preventing this condition.
  • Use of harsh products (chemical cystitis) such as spermicides, foaming intimate hygiene products, intimate sprays or bubble baths used during a bath in the tub. Awareness of irritant chemicals has expanded, and it is now recommended to avoid a wider range of substances, including certain types of fabrics and underwear cleaners.
  • Some types of drugs used in chemotherapy or radiation therapy performed in the pelvic area(actinic cystitis).
    Cancer patients are at risk of developing haemorrhagic cystitis (with blood). For example, radiation from radiotherapy damages the inner wall of the bladder, which is stripped of its impermeable layer. By losing it, the bladder becomes inflamed due to the harmful substances in the urine. New supportive therapies and mitigation interventions have been developed to reduce the risk and severity of actinic cystitis in cancer patients.
    This type of cystitis can develop during treatment or sometime after treatment has ended.

Friend, let’s think about this: if abacterial cystitis does not depend on bacteria, are there other germs that can, in the same way, bother our bladder?


The answer is yes!

Some cases of non-bacterial cystitis are caused by viruses (herpes simplex virus type 1 or 2, polyomavirus, cytomegalovirus and adenovirus), Clamydia (Chlamydia trachomatis) or candida infections. Research has confirmed that the diagnosis of these infections requires specific tests and that treatment must target the specific pathogen, emphasizing the importance of a comprehensive diagnostic approach.

The presence of these microorganisms is not detected by urine culture, but through other types of specific tests.

Treatment of abacterial cystitis

The big (and unfortunate) player in abacterial cystitis is the bladder.

To treat abacterial cystitis you must, first identify what specific cause has irritated your bladder.

No, you don’t have to do it yourself or guess among the many causes I’ve listed!

No self-diagnosis, mind you 😊

Recently, the focus has shifted to treatments that not only manage symptoms but also seek to restore the balance of urogenital flora and strengthen the bladder’s natural defenses. For example, the use of urinary tract-specific probiotics is emerging as a promising approach to prevent recurrences of abacterial cystitis.

It may seem trivial, but only by relying on your doctor and doing the right tests can you identify the cause and take action to stop it.

Onceyou understand the cause, treating non-bacterial cystitis will have two major goals:

  1. Restore normal bladder health by reducing inflammation;
  2. Strengthen the bladder walls to make them stronger and ready for future stresses.

In addition to traditional treatments, research has shown the effectiveness of complementary therapies such as pelvic physiotherapy, which can help relax pelvic floor muscles and reduce pressure on the bladder, often an underlying cause of abacterial cystitis.

Precisely regarding these two points, Dimann has developed a specific kit to overcome the acute phase of abacterial cystitis and one to hinder its return.

Dimann Daily, contained in both kits, has GAGs (hyaluronic acid, chondroitin and glucosamine) naturally present in our bladder.

GAGs are critical for bladder wall repair and effective reduction of bothersome abacterial cystitis symptoms.

Other ingredients reduce inflammation and support bladder wall relaxation.

However, did you know it is crucial to customize your own course of action against cystitis?

Want to make sure these kits are right for you? Let me give you some more specific advice based on YOUR HISTORY.

I’ll be waiting for your message!

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