They both cause discomfort and pain but require very different treatments, says Jane Feinmann

Any genital discomfort is worrying and it can be very easy to confuse burning or itching sensations. Yet thrush and cystitis have quite different causes and require different treatments. The good news is that with once they¹re properly identified, both can be treated effectively.

Identifying thrush
Thrush is a yeast infection which occurs when a change in the vagina's acid balance leads to an increase in the growth of a common fungus, candida. It is commonly caused by taking antibiotics that destroy the protective bacteria that normally suppress the candida population. Pregnancy, diabetes, the Pill and tight, synthetic clothing are also thought to encourage the fungus. It can also occur because of a poorly functioning immune system.

Identifying cystitis
Cystitis is an inflammation of the membrane lining of the bladder, usually the result of bacteria from the anus passing through the urinary passage. The bladder can become infected during sex, while inserting tampons, wiping the bottom from back to front after going to the toilet and even wearing tight trousers. Once inside the bladder, these bacteria find an ideal environment to multiply.

Methods of diagnosis
Both vaginal thrush and cystitis cause red soreness in the vagina. However, the classic symptoms of thrush are a severe vaginal itching and a cheesy discharge - neither of which occur with cystitis. The first sign of cystitis is a stinging, burning sensation during urination, and sufferers frequently feel a need to go to the loo when there's no urine to pass. Cystitis can cause pelvic and low back pain, too. Painful burning can occur with thrush but this happens only after the inside of the genitals have been red and swollen for so long that tiny cracks appear in the vulva. If in doubt, ask your doctor to carry out a pelvic examination and, if necessary, an inspection of the vaginal discharge under a microscope.

Possible treatments
It is important to distinguish between thrush and cystitis before starting treatment. Thrush infections can be quickly cleared up by antifungal medication that can be delivered in either by taking a tablet such as Diflucan or by a combination of a pessary inserted into the vagina, along with a cream to treat the vaginal lips. Both treatments are available from the chemist and have been shown in trials to be equally effective. It is therefore safe to choose whichever suits your lifestyle. While some women prefer to use simpler, external treatment, others view the pessary and cream as unnecessarily inconvenient and messy.

Cystitis is best treated as quickly as possible after the onset of the inflammation. Over the counter products containing potassium or sodium salts that reduce the acidity of the urine are effective - they create a more alkaline environment that is less favourable to bacteria.

Over the counter products such as Cysteme or Cymalon should be taken with plenty of liquid to flush out the water - and a teaspoon of bicarbonate of soda in a glass of water every three hours is also recommended except for people with a history of high blood pressure. Mild painkillers and a hot water bottle can help to alleviate pelvic pain.

If the symptoms persist, you should always see your doctor.

Prevention
Keeping to a few rules will improve your chances of staying free of both by conditions.

• Don't douche or clean inside the vagina
  
• Don't use vaginal deodorants, bubble baths or perfumed soaps
  
• Don't wear nylon underwear, tights or tight fitting trousers
  
• Do drink lots of water and cranberry juice
  
• Do eat extra bananas, lemons, yoghurt, parsley and garlic if you have thrush