Many people find it difficult to talk about an embarrassing health problem such as thrush and cystitis. But the truth is, they are both fairly common, especially among women. And according to experts, because of the similarity of some of the symptoms, both thrush and cystitis can sometimes be mistaken for each other.
By Lamberts Informa
Vaginal thrush affects around three out of four women at some point in their lives, with half of these women affected by thrush more than once. It’s most likely to affect women in their 20s and 30s, with women who have been through the menopause and girls who haven’t started their periods the least likely to be affected.
If, however, you have thrush four or more times in a year, you may be diagnosed with recurrent thrush (if you’re a woman who has uncontrolled diabetes or a problem with your immune system, you’re more likely than others to develop recurrent thrush). If you’re pregnant, you’re also more likely to experience thrush – though the good news is it won’t have any affect on your baby.
However, vaginal thrush isn’t the only type. Men can also get thrush – though thrush isn’t a sexually transmitted infection (if a woman has thrush, her male partner doesn’t need treatment unless they have symptoms of thrush on their penis).
Thrush can affect the mouth (oral thrush) and skin too. In fact, oral thrush is common in babies, with about one in 20 newborns affected and one in seven babies who are a month old. Older people are also more susceptible to developing oral thrush, as are those who have diabetes, an underactive thyroid, HIV or an iron or vitamin B12 deficiency.
Cystitis is a common urinary tract infection (UTI). According to the NHS, more women are affected by cystitis than men, with almost all women thought to have cystitis at least once in their lifetime. If you’re pregnant, sexually active or have had the menopause, you’re more likely to have cystitis. One in five women also experiences further bouts of cystitis – called recurrent cystitis.
And while it may be less common in men, it can be more serious, depending on what’s causing it. In fact, it can affect anyone of any age, including children. However, like thrush, cystitis isn’t a sexually transmitted disease and you can’t catch it from toilet seats.
Vaginal thrush causes embarrassing symptoms such as itching, soreness, pain or stinging during urination or sex and a sometimes a thick, creamy or watery white discharge. There may also be more severe symptoms such as swelling, cracked skin and – less frequently – sores around the vagina.
If you have oral thrush, on the other hand, you may experience white patches in your mouth, a burning or painful sensation in your mouth as well as an unpleasant taste, and cracks in the corners of your mouth. In babies, the most common system is a white coating on the tongue. Thrush in men causes irritation and redness on the head of the penis, as well as a discharge.
Meanwhile if your skin is affected, you may experience a red, sore and itchy rash in the folds of your skin, which can develop small swellings that look like blisters.
Thrush – or candidiasis – is an infection by a fungal yeast called Candida that normally lives in balance in your body (most cases are caused by Candida albicans, but other types of the fungus can also be involved). When there’s an upset in that balance, the yeast multiplies, causing the familiar symptoms of itching, burning and a sometimes a discharge.
Several things may cause this imbalance, including taking antibiotics (according to the NHS, around a third of women who take antibiotics develop vaginal thrush). Being pregnant also increases your risk of having thrush as a result of the hormonal changes that are taking place in your body. And if you have poorly controlled diabetes, you may have a higher risk of developing thrush too.
Another thing that may cause thrush is having a condition where your immune system is depressed, such as HIV or AIDS, or if you’re having chemotherapy. In either case, your immune system may be less effective at combatting the spread of the fungus.
As with women, men who have diabetes or a weakened immune may be more at risk of having thrush. It can also develop if you use fragranced soaps and shower gels, which may irritate your penis.
If you’re a man and suspect you may have thrush for the first time, it’s a good idea see your GP for a diagnosis, as the symptoms could be a sign of something else, such as a sexually transmitted infection (STI).
There is also a condition that may occasionally affect male partners of women who have thrush. Balanitis causes inflammation of the head of the penis, but it’s not usually serious (though see your doctor if you’re concerned).
Where oral thrush is concerned, several additional factors may increase your risk, including wearing dentures, having a dry mouth, smoking, using asthma inhalers and having poor dental hygiene. Oral thrush in babies is also seldom serious, but if you suspect your baby is affected, take them to see their GP, as they may need treatment.
Cystitis is an inflammation of the lining of the bladder that is most commonly caused by bacteria infecting the bladder (called severe cystitis) or by inflammation caused by irritation.
In adults, the main symptoms are pain or a stinging sensation during urination, bladder pain and needing to urinate frequently (or you may only be able to pass a few drops of urine when you feel you want to go). It can also cause your urine to look dark or cloudy, possibly with traces of blood, and you may suffer a sharp pain low in your abdomen or your lower back and feel generally unwell and with a high temperature.
The symptoms in children are slightly different, including pain during urination, weakness, vomiting and irritability.
If bacteria enter your bladder and multiply, they can cause an infection. This may happen if you don’t empty your bladder fully when you go to the toilet, which may be a result of being pregnant or – if you’re a man – having an enlarge prostate. A prostate infection such as prostatitis may also cause cystitis in men.
An infection can also develop if bacteria from the anus come into contact with the urethra (the tube that carries urine from the bladder). Since the female urethra is much closer to the anus than the male urethra, this is much more likely to cause cystitis in women. For instance, bacteria can be transferred during sex or during wiping after going to the toilet, or even while inserting a tampon or before having sex while inserting a diaphragm.
Meanwhile, several things can cause damage or irritation to urethra that may lead to inflammation, including bladder or kidney conditions such as a kidney infection, fragranced soaps and other bath and body products, sex and having a catheter (tube) inserted into the urethra after surgery.
Interstitial cystitis has similar symptoms as cystitis, but it isn’t caused by a bacterial infection. In fact experts aren’t sure what causes it, but there is a theory that it may be an inherited condition, or that it may be related to other conditions such as fibromyalgia or irritable bowel syndrome.
According to the NHS, approximately 400,000 people in the UK have interstitial cystitis, with nine out of 10 cases diagnosed in women, usually around the age of 40. Smoking may aggravate the symptoms, while stress may be involved in triggering flare-ups.
If you’re affected by thrush, the good news is it can be treated quickly and easily with over-the-counter (OTC) remedies such as creams, pessaries and oral capsules. These treatments usually work quickly, and your symptoms should be relieved within three days.
However, these preparations should only be used by women who are pregnant or breastfeeding under medical supervision. The oral capsule for thrush (fluconazole) also should not be taken if you’re pregnant.
Thrush remedies can also interfere with contraceptive drugs, so check before using. For instance, internal creams or pessaries may reduce the effectiveness of contraceptives such as condoms or diaphragms, so you may need to use alternative precautions for at least five days after use.
Meanwhile, cystitis remedies tend to come in the form of sachets of granules that have to be mixed with water. You take a sachet three times a day for 48 hours, and should also drink plenty of extra water in the meantime. If your symptoms don’t clear up after 48 hours, you may need a course of antibiotics, so see your GP.
Men and children with cystitis symptoms should always see their GP. If you’re a woman who is having cystitis symptoms for the first time – or if you’re a woman who has had cystitis more than three times during the past year – it’s also recommended that you visit your doctor.
Live bacteria such as L acidophilus and B bifidus are found naturally in the vagina, and there is some evidence that taking live bacteria supplements may reduce the risk of developing thrush, as it may help maintain a healthy balance of vaginal bacteria (i). Supplements containing soluble fibre, such as fructo-oligosaccharides (FOS), may also help as they feed ‘live’ bacteria the gut.
Taking a live bacteria supplement may improve your immune system too, boosting its ability to fight the spread of Candida. Indeed, a number of studies suggest that various strains of live bacteria can enhance immune function (ii). For the same reason, taking a vitamin C supplement may also be beneficial.
Arguably the most popular natural supplement for cystitis is cranberry, which is available in tablet or powder form. Several studies suggest cranberry prevents bacteria from adhering to the wall of the bladder (iii), allowing the bacteria to be flushed out of the bladder during urination. Indeed, one study confirms that bacteria find it easy to adhere to the bladder walls of women who develop frequent bouts of cystitis (iv).
Other supplements that may be beneficial include vitamin C, both for its strengthening effect on the immune system and for its action on bacteria that cause urinary tract infections (UTIs). Soluble fibre supplements may also help to maintain a healthy balance of beneficial bacteria in the gut and vagina, which in turn may help to reduce the risk of UTIs.
Medical treatments for both thrush and cystitis are usually very effective. However, as prevention is always better than cure, here are some of the things you can do to avoid developing a bout of thrush or cystitis in the first place:
(i) Reid G, Charbonneau D, Erb J, et al. Oral use of Lactobacillus rhamnosus GR-1 and L. fermentum RC-14 significantly alters vaginal flora: randomized, placebo-controlled trial in 64 healthy women. FEMS Immunol Med Microbiol. 2003;35:131-134.
(ii) Chiang BL, Sheih YH, Wang LH, et al. Enhancing immunity by dietary consumption of a probiotic lactic acid bacterium ( Bifidobacteriumlactis HN019): optimization and definition of cellular immune responses. Eur J ClinNutr. 2000;54:849-855.
(iii) Di Martino P, Agniel R, David K, et al. Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial. World J Urol. 2006 Jan 6.
(iv) Schaeffer AJ. Recurrent urinary tract infection in the female patient. Urology. 1988;32(suppl 3):12-15.