Why are some doctors unsympathetic to cystitis sufferers?

If they seem unsympathetic, we think it may be that bladder infection (in women) is wrongly seen by some doctors as a self-imposed illness, caused by poor personal hygiene.

Sometimes, it has to be admitted, they are correct, but they are usually wrong. There is a lot of evidence to show that, especially in repeat sufferers, the E.coli have colonised the bladder, and may be happily living there behind a protective biofilm, just waiting for you to have sex to shake some loose into your urine, allowing them to multiply rapidly, or for your immune system to get low, again allowing them to multiply. So it doesn't necessarily mean you've been unhygienic.

There is also the fact that cystitis-causing bugs become increasingly immune to the antibiotics that doctors use, indicating that the infections are being caused by survivors of previous antibiotics. E.coli mutate and survive much like the 'survival of the fittest' in evolutionary theory. Since they multiply non-sexually, when they divide, they have genetically identical 'offspring', and occasional mutations that allow there to be enough variation that some can survive under conditions (such as an antibiotic attack) that kill off the others. The survivors multiply again until you have a colony of antibiotic survivors.

If you had a new infection there is much less chance that you would be infected by a resistant bug.

Nevertheless, you can talk this over with a doctor who thinks you are constantly reinfecting yourself , and is telling you to wipe your bottom from front to back, and lecturing you on other aspects of personal hygiene. Such a doctor will probably treat each infection as a new infection, instead of as a reinfection or a recurrence of the same infection, despite the fact that antibiotics leave many women with vaginal E.coli still present after 6 weeks (see below). So they'll give you the same dosage as last time, and if it's the same bug you were fighting before it will take that antibiotic longer to kill the infection, (if it works at all) helping the bug to build up resistance.

The cost of treatment can also be a great part of the decision taken on what antibiotic is used to treat you.