Cystitis is one of the most common infections in women. Nearly one in two women experiences it at least once in her lifetime, and one in three before the age of 25. The problem arises when it ceases to be an isolated episode: if there are three episodes in a year, or two in six months, it is considered recurrent cystitis. It is a condition that has a significant impact on quality of life, and it tends to worsen during the warmer months.
The reasons are quite concrete. When it’s hot, you sweat and often don’t drink enough, so your urine becomes more concentrated and you empty your bladder less frequently. Wearing a wet swimsuit for hours creates a hot, humid environment. And on vacation, your habits change—including your eating, bowel, and sexual habits—which remain among the most common triggers.
There’s also one point we always explain to our patients: cystitis isn’t the same at every age. In young women, the main factors are sexual activity, a new partner, and changes in bowel habits. After menopause, the picture changes, because the main factor is the drop in estrogen, which alters the tissues and the balance of the vaginal environment. These are two different situations and must be addressed differently: during menopause, for example, the most effective treatment is local vaginal estrogen therapy, one of the few treatments strongly recommended by European guidelines.
Finally, there is an aspect that is still little known outside of specialized circles: very often, cystitis originates in the intestines. That is where the Escherichia coli responsible for most cases of cystitis resides, and it is from the intestines that the bacterium spreads to the urinary tract. It is not just a matter of anatomical proximity: the balance of the microbiota and the state of the intestinal barrier—what we call permeability—also appear to influence how easily these bacteria reach the bladder. In the European consensus document, drafted in part thanks to the collaboration of the Uri team, this principle garnered widespread agreement: 95% of participants acknowledged that maintaining intestinal balance is an integral part of preventing recurrent cystitis. The gut, the vaginal environment, and the bladder are in constant communication, and much of prevention hinges on this interaction.
This is precisely where a shift in perspective begins. For years, the response has always been the same: symptoms appear, you take an antibiotic, and so on. But every unnecessary course of antibiotics fuels antibiotic resistance, which is now one of the main public health concerns. The European guidelines on urinary tract infections, updated in 2026, now also include non-antibiotic strategies, both to prevent recurrences and to alleviate symptoms during the acute phase: drinking more fluids—which in women who consume few fluids actually reduces the number of episodes; cranberry-based products; D-mannose, which prevents E. coli from adhering to the bladder wall; and certain selected strains of lactobacilli to restore the balance of the gut flora. None of these, on its own, is a miracle cure, and the level of evidence must always be explained honestly. But together, in many cases, they make it possible to prevent infections without constantly resorting to antibiotics.
The point of all this is simple. If you keep getting urinary tract infections, the right question isn’t which antibiotic to take this time, but why they keep coming back. And the answer varies from person to person: it depends on age, risk factors, and gut health. Because no two cases of recurrent urinary tract infection are exactly alike.
Iacovelli V, Ficarra V, Maestroni UV, Tutolo M, Finazzi Agrò E. Open questions on lower urinary tract infections: Results of a Delphi consensus study. Neurourol Urodyn. 2024;43(4):915-924. doi:10.1002/nau.25385
EAU Guidelines on Urological Infections, 2026 (Update).
