Common Conditions Service at Town Centre Pharmacy

Allergic rhinitis is inflammation of the inside of the nose caused by an allergen. Allergens include pollen, dust, mould or flakes of skin from certain animals.

Allergic rhinitis affects about 1 in 5 people.

Symptoms of allergic rhinitis

Allergic rhinitis causes cold-like symptoms, such as:

• sneezing
• an itchy nose
• a blocked or runny nose

Symptoms usually start soon after you're exposed to an allergen.

Some people only get allergic rhinitis for a few months at a time. This is because they're sensitive to seasonal allergens, such as tree or grass pollen. Other people get allergic rhinitis all year round.

Most people with allergic rhinitis have mild symptoms.

But for some people, symptoms can be severe and persistent. They can cause sleep problems and interfere with everyday life.

The symptoms of allergic rhinitis can improve with time. But this can take many years. It's unlikely that the condition will disappear completely.

Information:

Allergic rhinitis can sometimes be diagnosed and treated by a pharmacist through the Common Conditions Service. There is a fee for this service.

Non-urgent advice: Contact your GP or pharmacist if:

The symptoms of allergic rhinitis:

• disrupt your sleep
• stop you from doing everyday activities
• affect your performance at work or school

Your GP or pharmacist will ask about your symptoms and any triggers you notice.

If the cause of your condition is uncertain, your GP may refer you for allergy testing.

Diagnosing allergic rhinitis

Causes of allergic rhinitis

The immune system defends your body against illness and infection. If you have allergic rhinitis, your immune system reacts to an allergen as if it's harmful.

Your cells release chemicals that swell the mucous membrane (the inside layer of your nose). Your body produces too much mucus.

Common allergens that cause allergic rhinitis include:

• pollen (this type of allergic rhinitis is hay fever)
• mould spores
• house dust mites
• flakes of skin from some animals
• droplets of pee or saliva from some animals

Causes of allergic rhinitis

Treating and preventing allergic rhinitis

It's hard to completely avoid allergens. But you can try to reduce your exposure to allergens that may trigger your allergic rhinitis. This can help improve your symptoms.

If your symptoms are mild, it may help to:

• talk to your pharmacist about medicines that are available without a prescription
• rinse your nasal passages with a salt water solution to keep your nose free of allergens

Ask your GP or pharmacist for advice if you have tried these steps and they do not help.

They may prescribe medicines to treat or prevent allergic rhinitis.

These may include:

• antihistamines - such as cetirizine, loratadine and fexofenadine.
• steroid nasal sprays - such as momentasone, fluticasone and beclomethasone.

Complications of allergic rhinitis

Allergic rhinitis can sometimes cause other problems.

These include:

• nasal polyps - sacs of fluid that grow inside the nasal passages and sinuses
• sinusitis - an infection caused by nasal inflammation and swelling
• middle ear infections - infection of the part of the ear behind the eardrum

You can often treat these problems with medicines. But you may need surgery for severe or long-term cases.

Complications of allergic rhinitis

Non-allergic rhinitis

The cause of rhinitis is not always an allergic reaction.

Sometimes the cause is:

• an infection, such as the common cold
• breathing in poor quality air that is dusty or dry, including air from air conditioning
• overuse of nasal decongestants

This type of rhinitis is called non-allergic rhinitis (perennial).

Cold sores are tiny, fluid-filled blisters that are caused by the herpes simplex virus.

They appear on:

• the face - most often on the lips
• the genitals, in adults

Cold sores are common and usually clear up on their own within 10 days. They do not leave a scar.

Most people are exposed to the cold sore virus when they are young after close skin-to-skin contact with someone who has a cold sore.

Information:

Be careful not to spread cold sores, especially around babies and children. It can be fatal to newborn babies.

Check if it’s a cold sore

Small, fluid-filled blisters are the main symptom of cold sores in adults and children.

Adult symptoms

A cold sore usually start with a tingling, itching or burning feeling.

Over the next 48 hours, blisters may appear, leak fluid and usually crust over into a scab.

Child symptoms

Your child may have clusters of blisters inside and outside their mouth and on their tongue.

Cold sores can spread to your child’s:

• fingers if they suck their fingers
• eyes if they touch an open sore and then rubs their eyes

Other symptoms in your child include:

• sore gums and throat
• swollen glands
• more saliva than normal
• a high temperature
• headaches
• refusing to drink fluids

Dangers to children and babies

Cold sores can be fatal to newborn babies and dangerous for older babies or children.

Do not kiss babies if you have a cold sore. It can lead to neonatal herpes.

Cold sores can cause complications for older babies and children, such as inflammation of the brain (encephalitis). But this is rare.

Emergency action required: Call 112 or 999 or go to your nearest emergency department (ED) if:

Your baby or child has a cold sore and:

• is confused
• has difficulty speaking
• has difficulty waking up or is very drowsy
• has behaviour changes, such as being very irritable
• is floppy and unresponsive
• has difficulty breathing, breathes faster or makes grunting noises
• has a blue tongue and skin (cyanosis)
• has a seizure (fit)

These are symptoms of encephalitis.

Caring for your baby if you have a cold sore

There are things you can do if you think you have or are about to develop a cold sore.

Do

• wash your hands before contact with your baby
• cover up cold sores before breastfeeding

Don't

• do not kiss your baby when you have a cold sore
• do not touch your cold sore and then your breast when breastfeeding

Treating cold sores at home

There are things you can do at home to treat cold sores and avoid spreading the virus:

Do

• drink lots of fluids
• eat cool, soft foods
• wash your hands often with soap and warm water
• wash your child’s clothes separately if they have a cold sore
• avoid anything that triggers your cold sores
• use sunblock lip balm (SPF15 or above) if you're outside in the sun
• take paracetamol or ibuprofen to ease pain and swelling (liquid paracetamol is available for children) - do not give aspirin to children under age 16

Don't

• do not touch cold sores – except when you put on cold sore creams
• do not share anything that comes into contact with cold sores – such as cold sore creams, cutlery and towels
• do not kiss anyone while you have a cold sore
• do not let people with a cold sore kiss your baby or child
• do not eat salty, citrus or acidic foods (these can make your blisters sting)

Non-urgent advice: Contact your GP if:

• you or your child’s cold sore has not started to heal within 10 days
• you're worried about a cold sore or think it's something else
• the cold sore is very large or painful
• your child gets a cold sore on their eyelid or around their eyes
• you or your child has swollen, painful gums and sores in the mouth (gingivostomatitis)
• you're pregnant – there's an increased risk of neonatal herpes
• you have a weak immune system
• you or your child’s cold sores keep coming back

Information:

Cold sores can sometimes be diagnosed and treated by a pharmacist through the Common Conditions Service. There is a fee for this service of €35.

Get help from your pharmacist or GP

Your pharmacist can recommend some medicines without a prescription, including:

• creams to ease pain and irritation
• cold sore patches to protect the skin while it heals

They can also prescribe antiviral creams.

Use antiviral creams as soon as you feel a cold sore coming on. They do not always work after blisters appear.

Your GP might prescribe antiviral tablets if the cold sores are very large, painful or keep coming back.

Childcare, school and contact play

Your child can usually continue going to childcare and school if they have a cold sore and they feel well.

But they should avoid close contact with other children until their cold sore heals completely.

Conjunctivitis (red or pink eye) is an eye condition caused by infection or allergies. Some sexually transmitted infections (STIs) can cause conjunctivitis.

You can usually treat it at home if you're an adult. But your child might need to go to a GP, pharmacist or have urgent treatment.

Emergency action required: Ask for an urgent GP appointment or go to the emergency department if:

• your child has conjunctivitis and is less than 4 weeks old

If your child has conjunctivitis

Symptoms of conjunctivitis

Conjunctivitis usually makes your eyes:

• bloodshot
• itchy, gritty or sore
• produce pus that sticks to your lashes
• swollen
• water

You or your child might also have flu-like symptoms.

Check if your conjunctivitis is contagious

Conjunctivitis can be contagious.

When it is caused by allergies like hay fever, conjunctivitis can make the eyes red and watery but it is not contagious.

Conjunctivitis that produces sticky pus is contagious.If eyes are red and feel gritty, the conjunctivitis is usually contagious.Conjunctivitis caused by allergies like hay fever makes your eyes red and watery, but it is not contagious.

Emergency action required: Ask for an urgent GP appointment or go to the emergency department if

you have conjunctivitis and:

• pain in your eyes
• changes in your vision, like wavy lines or flashing
• intense redness in one or both eyes

These can be signs of a more serious eye problem.

Find urgent and emergency care

Non-urgent advice: Contact your GP or optician if

you have conjunctivitis and:

• you wear contact lenses, have symptoms and spots on your eyelids - you might be allergic to the lenses
• your symptoms have not cleared up after 2 weeks

If your child has conjunctivitis

If you think your baby has conjunctivitis and they are:

• less than 6 months old, take them to your GP
• over 6 months old, take them to your GP or pharmacist

Conjunctivitis in a newborn baby.

Emergency action required: Ask for an urgent GP appointment or go to the emergency department if

your child has symptoms and:

• is less than 4 weeks old
• is in severe pain
• has blurry vision, even after you've cleaned their eyes
• might have something in their eye, such as sand or grit
• has a rash - your child could have an infection like measles
• wears contact lenses
• feels more pain when looking at light (photophobia)

Non-urgent advice:Contact your GP if your child:

• has 1 or 2 red eyes for more than 2 days
• has painful or uncomfortable eyes for more than 2 days
• is distressed by conjunctivitis symptoms
• has sticky eyes for 2 weeks or more

Information:

Conjunctivitis can sometimes be diagnosed and treated by a pharmacist through the Common Conditions Service. There is a fee for this service.

Treatment from a GP or pharmacist

Treatment for conjunctivitis depends on the cause. Antibiotics do not work on conjunctivitis caused by a virus or an allergy.

If it is a bacterial infection, you may need antibiotic eye drops. You can get these on prescription from your GP or pharmacist.

You can buy antihistamine eye drops for an allergy from a pharmacy. Some of these are only available on prescription. Your GP or pharmacist can provide a prescription for these.

They will tell you how to ease the symptoms at home if you have conjunctivitis caused by a virus.

• Antibiotics
• Antihistamines

Treating conjunctivitis at home

There are things you can do to help ease your symptoms.

1. Wash your hands.
2. Boil water and let it cool down completely.
3. Wet a clean cotton wool pad in the cooled water.
4. Gently wipe your eye from the inner to the outer corner of your eye.
5. Repeat this for your other eye - use a new cotton wool pad for each eye.

You can also hold a clean, cold flannel on your eyes for a few minutes to cool them down

Do not wear contact lenses until your eyes are better.

Using breast milk to treat your child's conjunctivitis

There is no evidence that putting breast milk in your baby's eyes clears conjunctivitis. But it is unlikely to cause harm.

Never put formula milk into your baby's eyes.

Stop contagious conjunctivitis spreading

There are things you can do to stop conjunctivitis spreading to other people.

Do

• wash your or your child's hands often with warm soapy water
• wash your child's hands immediately if they touch their eyes
• tell your child not to touch or rub their eyes
• wash pillows and face cloths in hot water and detergent

Don't

• do not share towels and pillows
• do not rub your eyes

Staying away from work or school

You do not need to stay away from work or school unless you or your child feel very unwell.

If your child has conjunctivitis, check that your childcare provider can look after your child.

Impetigo is a skin infection that's very contagious but not usually serious. It is caused by bacteria.

It usually gets better in 7 to 10 days if you get treatment or 2 to 3 weeks without treatment.

Anyone can get it, but it's very common in young children.

Check if you or your child has impetigo

Impetigo starts with red sores or blisters. The redness may be harder to see on brown and black skin.

The sores or blisters can start anywhere. But they usually start on exposed areas like your face and hands or around your tummy. When they burst, they leave crusty, golden-brown patches.

These patches can:

• look a bit like cornflakes stuck to your skin
• get bigger
• spread to other parts of your body
• be itchy
• sometimes be painful

Impetigo sores and blistersIt's also common to have sores and blistersImpetigo crusty, golden-brown patch.Information:

Impetigo can sometimes be diagnosed and treated by a pharmacist through the Common Conditions Service. There is a fee for this service.

When to contact a GP or pharmacist

Contact a GP or pharmacist if you think you or your child might have impetigo.

Or contact a GP if you or your child:

• had treatment for impetigo but the symptoms change or get worse
• had impetigo before and it keeps coming back

Impetigo is very infectious. Check with your GP or pharmacist before you go to them.

A GP or pharmacist will check to make sure it's not something more serious, like cellulitis.

Treatment for impetigo

If you have impetigo, your GP or pharmacist can prescribe an antibiotic cream to speed up your recovery.

If the impetigo has spread a lot, your GP can prescribe antibiotic tablets.

Information:

Do not stop using the antibiotic cream or tablets early, even if the impetigo starts to clear up.

If impetigo keeps coming back

A GP can take a swab from around your nose to check for the bacteria that causes impetigo.

They might prescribe an antiseptic that you put in your nose. This is to try to clear the bacteria and stop the impetigo coming back.

How to stop impetigo spreading or getting worse

Impetigo can spread to other parts of your body or to other people until it stops being contagious.

It stops being contagious:

• 48 hours after you start using the treatment your GP or pharmacist recommended
• when the patches dry out and crust over - if you do not get treatment

To help stop impetigo spreading or getting worse while it's contagious:

Do

• stay at home
• keep sores, blisters and crusty patches clean and dry
• cover them with loose clothing or gauze bandages
• wash your hands frequently
• wash your face cloths, sheets and towels at a high temperature
• wash or wipe down toys with soap and warm water if your children have impetigo

Don't

• do not touch or scratch sores, blisters or crusty patches - this also helps stop scarring
• do not have close contact with children, or people with diabetes or a weakened immune system
• do not share face cloths, sheets or towels
• do not prepare food for other people
• do not go to the gym
• do not play contact sports

How to avoid getting impetigo

Impetigo usually infects skin that's already damaged.

Avoid infection by:

• keeping cuts, scratches and insect bites clean by washing with warm water and soap
• getting treatment for skin conditions, like eczema

Thrush is a fungal infection caused by a yeast called candida. Oral thrush means that the infection is in the mouth.

Oral thrush is common in babies and in older people with dentures.

Most of the time oral thrush can be treated with medicine you can buy without a prescription.

Check if it’s oral thrush

The signs of thrush are different in children, adults and babies.

Adults and children over 12 months

Signs of oral thrush include:

• white patches or spots in your mouth that cannot be rubbed off
• a red patch that can bleed if you wipe off a white spot
• spots that join together to form larger patches - these can become yellow
• a red or sore area under your dentures
• a red and sore mouth without white spots, especially after taking antibiotics or steroids
• food does not taste the same

Your mouth is red inside and you have white patches. When you wipe off the white patches, they leave red spots that can bleed. Spots on the tongue can join to form larger white patches.

Adults may have other symptoms including:

• cracks at the corners of your mouth
• an unpleasant taste in your mouth
• pain, such as a sore tongue or gums
• difficulty eating and drinking

Babies under 12 months

Not all babies with oral thrush have symptoms.

Signs of oral thrush in babies include:

• a white coating on their tongue that cannot be rubbed off
• white spots in their mouth
• not wanting to feed
• nappy rash
• dribbling more than usual - this may be because it hurts them to swallow

Oral thrush can spread through saliva from an infected child.

If you breastfeed when your baby has oral thrush, you can get a thrush infection of your nipple or areola (the circle around your nipple). This is called nipple thrush.

What Thrush looks like in babies:

A white coating on the tongue like cottage cheese - this cannot be rubbed off easily.Sometimes there are white spots in their mouth.Information:

Oral thrush can sometimes be diagnosed and treated by a pharmacist through the Common Conditions Service. There is a fee for this service.

Treating oral thrush in babies and children

Contact your GP if you think your baby has oral thrush, and they are less than 1 month old.

Or contact your GP or pharmacist, if your child is over 1 month old.

They may treat your baby with:

• a liquid antifungal mouth gel (for babies age 4 months and older)
• an antifungal cream - if your baby also has nappy rash

If the infection does not clear after 7 days, your GP can prescribe other treatment.

If you are breastfeeding, your GP or pharmacist may recommend an antifungal cream for nipple thrush.

Helping your child's oral thrush at home

There are things you can do to ease your child's symptoms and stop the spread of infection.

Do

• offer regular milk feeds - you may need to offer feeds more often if they are not taking as much as usual
• feed them bland foods - spicy or acidic foods could sting their mouth
• keep their hands clean so that the infection does not spread
• sterilise soothers, dummies and any toys they put in their mouth, such as teething rings, regularly
• sterilise any bottles and other feeding equipment regularly, especially the teats
• wash your hands after changing nappies and before any feeds

Your child can still attend creche if they are well enough.

Treating oral thrush in adults

Adults can treat oral thrush at home with an antifungal mouth gel or liquid medicine. You can get some of these without a prescription.

Your pharmacist will tell you how to use it.

Treatment usually lasts at least 7 days. Always follow the packet instructions. Keep all medicines out of sight and reach of children.

Oral thrush in adults is not contagious, but you should treat it as soon as possible. The infection can spread to other parts of the body if it's not treated.

Non-urgent advice: Contact your GP if you:

• do not see an improvement after 1 week of treatment with an antifungal mouth gel or liquid medicine
• have oral thrush and you have difficulty or pain swallowing

There are other conditions that can cause a sore or white tongue. Some of these can be serious if not treated. If they do not get better after 2 weeks, contact your GP.

Causes of oral thrush

You or your child might get thrush if you're:

• taking antibiotics
• taking steroid inhalers for conditions such as asthma or chronic obstructive pulmonary disease (COPD)
• taking medicine that affects your immune system, such as chemotherapy
• diagnosed with a condition that weakens your immune system, such as certain types of cancer or HIV

Preventing oral thrush

There are some things you can do to help prevent oral thrush.

Do

• brush your teeth twice a day
• clean your dentures
• go for regular dental check-ups, even if you have dentures
• brush your gums, tongue and the roof of your mouth with a soft toothbrush if you have dentures
• rinse your mouth after eating or taking medicine
• rinse your mouth after using steroid inhalers - your GP, practice nurse or pharmacist can check your inhaler technique with you
• go to your check-ups if you have a long-term condition such as diabetes

Don't

• do not wear dentures overnight
• do not wear dentures that do not fit you properly
• do not smoke

Shingles is an infection that causes a painful rash. It is caused by the chickenpox (varicella zoster) virus.

Urgent advice: Ask for an urgent GP appointment or check with your pharmacist if:

you have the first signs of shingles, which include:

• tingling or painful feeling in an area of skin - especially if it is near or around your eye
• headache or feeling generally unwell

A rash usually appears a few days after the first signs.

Your GP may prescribe medicine to help speed up your recovery and avoid longer-lasting problems.

A pharmacist can also give advice and prescribe medicine for shingles under the Common Conditions Service. There is a fee for this service.

Information:

The medicine works best if you start taking it within 3 days of the shingles rash appearing.

Check if you have shingles

Usually you get shingles on your chest and tummy, but you can also get them on your face, eyes and genitals.

The rash appears as red blotches on your skin, on 1 side of your body only. A rash on both the left and right of your body is unlikely to be shingles.

The blotches become itchy blisters that ooze fluid. A few days later, the blisters dry out and crust over.The rash can be red, but this can be harder to see on brown and black skin.The rash can form a cluster that only appears on 1 side of your body. The skin remains painful until after the rash has gone.Shingles can also make your eyes red and sore. It can affect your sight or hearing and make it hard to move 1 side of your face.

Urgent advice: Contact your GP, GP out of hours or emergency department (ED) immediately if:

• you develop shingles around your eyes

You need urgent medical attention.

Treatment for shingles

Treatment for shingles depends on:

• how bad your symptoms are - you may not need any treatment if you have a mild rash
• whether you're at risk of complications

Your GP or pharmacist may prescribe antiviral tablets if:

• you have a weakened immune system
• your pain or rash is moderate or severe
• the rash is affecting other areas of your body apart from your chest, tummy and back

For the antiviral medicine to work properly, you usually need to take it within 3 days of the rash appearing.

You may can also need medicine such as:

• painkillers - for skin, muscle or nerve pain
• steroid tablets

What you can do to ease symptoms

There are things you can do to help ease shingles.

Do

• ask your pharmacist to recommend a painkiller
• keep the rash clean and dry to reduce the risk of infection
• wear loose-fitting clothing
• hold a cool compress (a bag of frozen vegetables wrapped in a towel or a wet cloth) to the rash a few times a day

Don't

• do not let dressings or plasters stick to the rash
• do not wear clothes that irritate your skin
• do not use antibiotic cream - this can slow healing

How long shingles lasts

It can take up to 4 weeks for the rash to heal.

Your skin can be painful for weeks after the rash has gone, but it usually gets better over time.

How to stop the virus spreading

You cannot spread shingles to others. But people who have never had chickenpox can catch chickenpox from you.

Try to avoid being in contact with:

• pregnant women who have never had chickenpox
• people with a weakened immune system - such as someone having chemotherapy
• babies less than 1 month old - unless it's your own baby, who should be protected by antibodies passed from you to them

Do not go to work or school if the rash is still oozing fluid (weeping) and cannot be covered, or until the rash has dried out.

You can only infect other people with the virus while the rash oozes fluid.

You can cover the rash with loose clothing or a non-sticky dressing.

Complications of shingles

Most people recover from shingles without any problems.

But it can cause complications, such as:

• post-herpetic neuralgia - this is where pain lasts for months after the shingles rash has gone
• the rash gets infected - you may need antibiotics
• scarring or changes in skin colour after the rash has healed
• muscle weakness
• eye problems - these can lead to sight loss
• Ramsay Hunt syndrome - this is a rare condition where shingles causes weakness on 1 side of your face and sometimes hearing problems

You can reduce your risk of complications by getting treatment as soon as possible after your symptoms start.

Shingles and pregnancy

If you're pregnant and get shingles, there's no danger to your pregnancy or baby. But your GP will probably refer you to a specialist, as you may need antiviral treatment.

Shingles and chickenpox

You cannot get shingles from someone with shingles or chickenpox.

But you can get chickenpox from someone with shingles, if you have not had chickenpox before.

When you get chickenpox, the virus remains in your body. It can be reactivated later and cause shingles. This usually happens if your immune system is weakened.

Your immune system may be weak due to stress, certain health conditions, or treatments such as chemotherapy.

Chickenpox symptoms and treatment

Shingles vaccination

You can get a vaccine against shingles. It is only available privately, so you have to pay to get it. You cannot get it through your medical card or drug payment scheme.

Talk to your GP or pharmacist if you want more information about the vaccine.

Cystitis is inflammation of the bladder. It's usually caused by a urinary tract infection (UTI).

Cystitis is very common, especially in women and people with a female urinary system. It often gets better in a few days without treatment.

In some cases, your GP may prescribe antibiotics. If you get cystitis often, you may need regular or long-term treatment.

Information:

Cystitis can sometimes be diagnosed and treated by a pharmacist through the Common Conditions Service. There is a fee for this service.

Symptoms of cystitis

Cystitis can cause:

• pain, burning or stinging when you pee
• a need to pee more often and urgently than normal
• pee that's dark, cloudy or strong-smelling
• feeling like you need to pee again soon after going to the toilet
• pain low down in your tummy
• feeling unwell, achy, sick and tired
• confusion in older people - especially people with cognitive problems such as dementia

Young children with cystitis may have other symptoms, such as:

• a high temperature (fever)
• weakness and tiredness
• irritability
• not eating as much as usual
• vomiting

Non-urgent advice: Contact your GP if:

• your symptoms do not improve after 3 days or after taking antibiotics
• you have blood in your pee
• your child under age 16 has symptoms of cystitis
• you are age 65 or older and have symptoms of a urinary tract infection
• you have a male urinary system and have symptoms of cystitis
• you're pregnant and you have symptoms of cystitis
• you have symptoms of cystitis and had cystitis in the past 6 months or twice in the past 12 months
• you have pelvic pain that does not go away and problems peeing

Urgent advice:Ask for an urgent GP appointment if

you or someone you care for has symptoms of cystitis and has:

• pain in the sides or lower back
• a very high temperature
• feels cold and shivery
• vomiting or diarrhoea
• confusion

These can be symptoms of a kidney infection. Anyone with these symptoms needs to get tests and treatment quickly.

Treatment from a GP or pharmacist

Your GP or pharmacist can check if you have cystitis by asking about your symptoms.

They may:

• tell you how to treat cystitis at home
• prescribe antibiotics

Your GP may test a sample of your pee for bacteria.

Treating cystitis at home

You may not need to see a GP if you have:

• a female urinary system
• mild symptoms for less than 3 days

To help with cystitis, you can:

• ask your pharmacist for advice and to recommend a painkiller, if needed
• drink plenty of water
• hold a hot water bottle on your tummy or between your thighs
• avoid having sex

Some people use cranberry juice or products that reduce the acidity of their pee. But it's not clear if these are effective.

If cystitis keeps coming back

You may need other treatment if you have a female urinary system and have cystitis:

• 2 or more times in 6 months
• 3 or more times in 12 months

Your GP may:

• prescribe antibiotics to use whenever you get symptoms (stand-by antibiotics)
• prescribe a low dose of antibiotics to take over several months (continuous antibiotics)
• refer you for tests such as an ultrasound of the urinary tract

Preventing cystitis

It is not always possible to prevent cystitis.

But if you get cystitis often, there are some things you can try.

Do

• go to the toilet as soon as you need to pee and always empty your bladder
• stay well hydrated - this may stop bacteria multiplying in your bladder
• wipe your bottom from front to back when you go to the toilet
• empty your bladder as soon as possible after sex
• have showers instead of baths - this avoids exposing your genitals to chemicals for too long

Don't

• do not use perfumed bubble bath, soap or talcum powder around your genitals
• do not use a diaphragm as contraception
• do not wear underwear made from synthetic material such as nylon
• do not wear tight trousers

Causes of cystitis

Cystitis is usually caused by a bacterial infection.

Bacteria in the bowel or on the skin can get into the bladder through the urethra. The urethra is the tube that removes urine from the bladder and out of the body.

The urethra is shorter in the female urinary system than the male urinary system. This means bacteria are more likely to reach the bladder and cause an infection.

Some things that can increase the risk of bacteria getting into your bladder include:

• having sex
• wiping your bottom from back to front after you go to the toilet
• inserting a tampon
• having a urinary catheter (a tube that empties the bladder)
• using a diaphragm for contraception
• experiencing the menopause - changes to your hormones and urethra can make it easier to get a UTI
• having diabetes - when the level of sugar in your pee becomes too high, bacteria can multiply
• using spermicide with contraception
• conditions that block the urinary tract, such as kidney stones
• being pregnant
• conditions that make it difficult to fully empty the bladder, such as an enlarged prostate gland in men
• having a weak immune system

Less common causes of cystitis

Sometimes cystitis happens when the urethra or bladder is irritated or damaged.

This can be from:

• friction from sex
• chemical irritants, such as chemicals in perfumed soap or bubble bath
• a catheter or surgery on your bladder
• radiotherapy to your pelvis or treatment with certain chemotherapy medicines
• female genital mutilation (FGM) - an illegal practice of cutting a woman's genitals

Ketamine use

Regular use of ketamine can cause problems with your bladder and urinary system. This may be called ketamine bladder or ketamine-induced cystitis.

It's best to tell your GP or doctor if you use ketamine. It will help them to recommend the right treatment for you.

Regular ketamine use damages the lining of the bladder and affects the urinary system. It's important to get help early if you use ketamine and have bladder problems.

Interstitial cystitis

Interstitial cystitis is a rare and long-term pain condition. It's sometimes called painful bladder syndrome (PBS).

Symptoms of interstitial cystitis can be similar to cystitis. They include frequent pelvic pain and problems peeing. But there is no obvious bladder infection and antibiotics do not help.

If you think you have interstitial cystitis, talk to your GP. They can tell you about ways to reduce your symptoms.

Interstitial cystitis is not well understood and difficult to diagnose. You may need to have several tests to exclude other causes of your symptoms.

Treatment for interstitial cystitis

You may need to try several treatments to find one that works for you.

Treatments include:

• lifestyle changes - for example, exercise and avoiding certain foods such as coffee
• medicines
• physiotherapy
• surgery or procedures, if other treatments do not work

Vaginal thrush is a common yeast infection in women. It’s also known as genital thrush or vulvovaginal thrush.

It’s usually harmless but it can be uncomfortable and keep coming back. Thrush is not a sexually transmitted infection (STI).

If you are pregnant, you have a higher risk of getting thrush.

Thrush in pregnancy

Symptoms

Symptoms of vaginal thrush in women include:

• thick, white vaginal discharge (often like cottage cheese), which does not usually smell
• red, cracked and inflamed skin on your vagina and vulva
• pain when you pee
• pain during sex

Thrush in other areas

Thrush can affect other areas of your skin, such as your armpits, groin and between your fingers.

This usually causes a red, itchy or painful rash that scales over with white or yellow discharge. The rash may not be so obvious on brown or black skin.

Sometimes thrush causes no symptoms at all.

How a pharmacist can help with thrush

You can buy some antifungal creams and pessaries from a pharmacist without a prescription.

Ask your pharmacist to recommend the best treatment for you. It's OK to ask to speak with them in a private area if you prefer.

A pharmacist can also prescribe antifungal capsules and tablets, through the Common Conditions Service. There is a charge for this consultation and treatment service.

Do not use antifungal medicine more than twice in 6 months without speaking to a pharmacist or GP.

If thrush keeps coming back your pharmacist may advise you to see your GP.

Non-urgent advice: Contact a GP if you have:

• abnormal or irregular bleeding from your vagina, or bloody or smelly discharge
• sores, ulcers or blisters on or around your vagina
• symptoms of thrush for the first time
• thrush and are under age 16 or over age 61
• symptoms after using a pessary or vaginal capsule for 7 days or cream for 14 days
• thrush and are pregnant
• thrush and a weakened immune system – for example, because of diabetes, HIV or chemotherapy

You may also be able to get help from a sexual health clinic if you think you have thrush.

Find a sexual health clinic - sexualwellbeing.ie

How a GP can help with thrush

The GP will want to confirm it's thrush and rule out other infections.

They will ask you about your symptoms.

If it's not clear it's thrush or if you have thrush that keeps coming back:

• a GP or nurse may look at your vagina or skin and take a sample
• they might use a speculum - a device that is put into your vagina to open your cervix
• the sample will be sent to a lab to be tested

This test does not usually hurt. But it can be uncomfortable.

Treatment

You'll usually need antifungal medicine to get rid of thrush.

This can be a:

• capsule or tablet you take
• tablet or soft vaginal capsule you insert into your vagina (pessary)
• cream to relieve the irritation

Thrush should clear up within 7 to 14 days of starting treatment.

You do not need to treat partners unless they have symptoms.

Thrush that comes back

You might need to take treatment for longer (up to 6 months) if you keep getting thrush. For example, if you get it more than 4 times in 12 months.

Before you begin treatment, a GP can help identify if something is causing your thrush, for example your period or sex.

They'll recommend how often you should use treatment.

Things you can do

There are things you can do to ease thrush and stop it coming back.

Do

• use water and an emollient instead of soap to wash the affected area
• change out of damp swimwear or sweaty sports gear as soon as possible
• pat your vagina and vulva dry with a clean towel after washing
• use condoms during sex to stop the thrush spreading to your partner
• wear cotton underwear
• avoid sex until thrush has cleared up (if sex is uncomfortable)

Don't

• do not use perfumed soaps, shower gels, panty liners or sanitary pads
• do not use douches or deodorants on your vagina
• do not wear tight underwear or tights

Important

Antifungal creams, pessaries and soft vaginal capsules can damage condoms and diaphragms. If you have sex during treatment, this means your contraception might not work.

What causes thrush

Thrush is not classed as a sexually transmitted infection (STI). But it can be triggered by sex or passed on during sex.

Thrush is caused by a fungus called candida that is normally harmless.

Thrush tends to grow in warm, moist conditions and develops if the balance of bacteria changes.

This can happen if:

• your skin is irritated or damaged
• you're taking antibiotics
• you have poorly controlled diabetes
• you have a weakened immune system (for example, because of HIV or chemotherapy)
• you're having hormone replacement therapy (HRT)
• you're pregnant

Thrush in pregnancy

You have a higher risk of getting thrush during pregnancy. But it will not harm your baby.

If you are pregnant, go to your GP if you think you have thrush. Your GP may need to examine you. You may need a test to see if you have thrush.