Urine infections in pregnancy – Cystitis

Infections of the urinary tract (kidney, bladder and connecting tubes) are more common during pregnancy than at other times. There are two types of infection – cystitis (infection of the bladder), and pyelonephritis (infection of the kidneys). Pyelonephritis is much more serious than cystitis, but cystitis may develop into pyelonephritis if not treated properly.

There are a number of reasons why cystitis is common in pregnancy. Under the influence of progesterone (one of the pregnancy hormones), the bladder becomes larger and more relaxed, so it does not empty so efficiently. Furthermore, the growing uterus stretches and displaces the urethra (the tube connecting the bladder to the outside world) so it may become difficult to pass urine. If the bladder is not properly emptied, bacteria in the urine left behind may multiply and cause infection.

To make things even more complicated, the lining of the bladder becomes softer and so is more open to damage and infection during pregnancy.

Symptoms of cystitis include wanting to pass urine frequently – but only managing a few drops. There may be burning or stinging when you do pass urine, and you may have a slightly raised temperature. You may have an unpleasant ‘heavy’ feeling over your bladder.

In some areas of the UK, you may be asked to supply a ‘midstream specimen’ of urine early in the pregnancy to be tested for bacteria. (This will be addition to the usual quick test for protein and glucose that should be performed at every antenatal visit.) If your urine is found to contain large numbers of bacteria, you may be offered a short course of antibiotics to reduce the risk of later infections.

If you suffer repeated urine infections during pregnancy, your doctor may recommend further tests to make sure there is no underlying kidney problem needing attention.

It may take up to six weeks for your bladder and tubes to get back to normal following the birth of your baby, so you may suffer further attacks of cystitis in this time. Make sure you keep drinking plenty of water and dilute fluids.

What can I do about it?

  • Act quickly! If cystitis is untreated the infection may spread upwards to your kidneys causing pyelonephritis and serious illness. Start drinking – at least three litres of water or dilute squash in 24 hours – to flush the bacteria out of your bladder. If you are more than twelve weeks pregnant, take a couple of paracetamol to ease the pain. If you don’t feel better in a few hours, contact your doctor who will probably prescribe antibiotics.
  • Try an over-the-counter remedy for cystitis. Ask your pharmacist to suggest a suitable prescription, making sure that you tell him or her that you are pregnant. If this remedy does not work within a few hours, contact your doctor.
  • In addition to drinking lots of water, drink several glasses of cranberry juice (sold in large supermarkets with other fruit juices). This juice may stop bacteria sticking to the walls of the bladder.

Cystitis alert

Contact your doctor or maternity unit if you feel very unwell, have a fever (maybe with chills and shivering), low abdominal, back or side pain, or severe and sudden nausea and vomiting. Your urine may also appear cloudy or dark and/or smell nasty. Any of these things may be signs of pyelonephritis.

Urine infections in pregnancy should always be taken seriously. Untreated infections may be associated with slow growth of your baby and preterm labour.

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