I suffer from frequent bouts of cystitis and am trying to get more information on how the disease works in order to prevent further attacks. I am very careful with hygiene and always urinate after sex, but I seem to get infections anyway. Can susceptibility be affected by diet, lifestyle, etc.? I don't want to be on drugs forever.

--Rosanne

Cystitis implies bacterial infection of the bladder and should be confirmed by urine culture if it is occurring frequently. The need to urinate frequently and pain with urination may be due to other causes, such as urethritis (inflammation of the urethra, the tube that carries the urine out of the body), vaginal infections and irritations, or interstitial cystitis (a condition of the bladder wall).

Because the urethra is short in women, it is easier for bacteria to gain entry into the bladder. Sexual intercourse can "push" vaginal bacteria into the bladder as well. Proper hygiene is essential -- wash your hands before touching your genitals (the same goes for sexual partners), and always wipe from front to back, especially after a bowel movement. Empty your bladder before and after sex. Avoid caffeine, which can irritate the bladder. The use of a diaphragm or spermicides can alter the vaginal environment and increase the chance of a bladder infection; other forms of contraception may be helpful. Cranberry and blueberry extracts (not your basic cranberry juice cocktail -- there's too much sugar) can make the bladder less "sticky" so bacteria cannot gain hold. For infections associated with intercourse, the use of a low-dose antibiotic just before sex can decrease infections.

To get to the root of your problem, you need a thorough GYN exam, including vaginal cultures, as well as a urology evaluation. If urine and vaginal cultures are negative, then a cystoscopy (looking in the bladder with a telescope-like instrument) is needed to rule out interstitial cystitis or a structural problem of the urinary tract.