Cystitis is one of the most common urological diseases. Over the course of a lifetime, one in four women suffers from this disease, 30% of them may experience a recurrence of the disease within a year and 10% may have a frequently aggravated form.
This disease is familiar to many girls and women, significantly reducing the quality of life. Often during the first episode of cystitis, patients experience severe pain and fear and do not know what to do. Our article is intended to help prevent the occurrence of cystitis and, in the event of symptoms, to guide the actions to be taken.
Cystitisis an inflammation of the lining of the bladder.
The reasons
Infections are the main cause of cystitis, non-infectious causes are much less common. The fact that women get sick with cystitis is associated with the anatomical and physiological characteristics of the body, which include a short and wide urethra, the proximity of the external opening of the urethra to the vagina and rectum, and hormonal characteristics. Men do not suffer from cystitis, because their urethra is long, and the prostate is a kind of anatomical barrier for the upward entry of microorganisms into the bladder. Frequent urination in men, pain in the perineum, pain at the end of urination are a sign of prostatitis.
It is important to note that cystitis in the vast majority of cases is not caused by microorganisms that enter the body from the external environment or during sexual intercourse, but by their own bacteria, which normally inhabit theintestines and the female genital tract. All factors leading to a decrease in immunity (hypothermia, stress, etc. ) lead to increased reproduction of endogenous (internal) microorganisms, which leads to inflammation of the bladder mucosa. The presence of special fimbria in these bacteria (adhesion hooks to the wall of the bladder), their large number and a decrease in the protective ability of the mucopolysaccharide layer of the bladder lead to the development of inflammation.
If the cystitis is not treated, or if the antibiotic therapy is not well chosen, these infections can go up the urinary tract, causing inflammation of the kidneys whose characteristic symptoms are:
- increased body temperature;
- pain in the lumbar region;
- signs of intoxication (general weakness, headache, drowsiness, chills).
The main bacteria responsible for cystitis are:
- Escherichia coli (E. coli) accounts for 75% of cases;
- In 10% - Klebsiella spp. ;
- Staphylococcus saprophyticus is involved in 5 to 10% of cases;
- Other enterobacteriaceae are even less common.
Risk factors for cystitis
- sexual activity;
- Insufficient hygiene;
- Use of intravaginal contraceptives;
- Hypothermia of the legs or general hypothermia;
- Pregnancy;
- Postmenopause;
- Decreased immune response of the body (with diabetes, HIV infection, chemotherapy, etc. );
- The presence of obstructions to the flow of urine (eg, bladder stone, underactive bladder due to neuropathy due to diabetes mellitus).
Symptoms of acute cystitis
- Pain at the end of urination (when the bottom of the bladder touches its cervix;
- Frequent urination (more than 8 times a day);
- The presence of an increased number of leukocytes in the general analysis of urine;
- Urgent and imperative need to urinate;
- Sensation of pressure or spasm in the pubic region;
- The appearance of a mixture of blood in the urine, especially at the end of urination;
- Absence of itching and vaginal discharge;
- Lack of hyperthermia (body temperature below 37. 5 degrees).
The first three symptoms above are always present in acute cystitis.
Clinical forms of cystitis
Acute uncomplicated cystitis
In the vast majority of cases, the diagnosis is obvious from the presence of characteristic symptoms (frequent urination, pain at the end of urination). As a rule, with this variant of cystitis, no additional diagnostics are required, but you can immediately begin empirical (proven in practice) administration of the recommended antibacterial drug. At the moment, as a rule, one dose is enough. Only in case of treatment failure, a complementary examination is indicated. Control of the general analysis of urine with signs of full recovery is also not necessary.
In acute cystitis in the general analysis of urine, an increased number of leukocytes is always detected.
If not, the diagnosis is doubtful and other causes of frequent and painful urination should be investigated.Masks from acute cystitisperhaps:
- overactive bladder;
- inflammation of the urethra caused by explicit sexual infections (chlamydia, mycoplasma genitalium, gonorrhea, trichomonas);
- vaginitis (inflammation of the vagina);
- bladder diseases (stones and tumors);
- bladder tuberculosis.
Often recurrent cystitis
Recurrent cystitis is the presence of 2 or more episodes in six months or 3 or more episodes in a year.
Why in some women cystitis is an episode of life, while in others it leads to frequent relapses, science is not exactly known.
Possible causes of recurrent cystitis:
- genetic predisposition (decreased barrier function of the mucopolysaccharide layer of the bladder mucosa);
- abnormalities in the development of the urinary system;
- prolapse (prolapse) of the internal genital organs;
- estrogen deficiency;
- vitamin D deficiency;
- iron deficiency anemia, including latent (ferritin deficiency);
- hypothyroidism (decreased production of thyroid hormones);
- Diabetes;
- vaginal dysbiosis;
- intestinal dysbiosis;
- use of diaphragms and spermicides;
To diagnose the causes of frequently recurring cystitis, use:
- general urinalysis;
- bacterial analysis of urine with determination of sensitivity to antibiotics;
- Ultrasound of the kidneys, bladder with determination of residual urine;
- consultation with a gynecologist (detection of vaginal dysbiosis);
- FSH, estradiol (detection of estrogen deficiency);
- blood sugar, glycated hemoglobin, insulin, C-peptide (diagnosis of diabetes mellitus);
- TSH, without T4, without T3 (diagnosis of hypothyroidism);
- general blood analysis;
- blood ferritin (detection of latent anemia);
- urinary flowmetry (determination of the speed of urination).
If the cause of this form of cystitis cannot be found, the use of special immune preparations is considered the "gold" standard in the first line of treatment. Their mechanism of action is the absorption of weakened strains of Escherichia coli and the development of protective antibodies on them, which then prevent the multiplication of microbes.
Antibacterial drugs are also used in small doses at night, for a long time, herbal and diuretic drugs, the introduction of hyaluronic acid into the bladder (increases the protective ability of the bladder).
Post-coital cystitis
This is a cystitis that occurs up to 36 hours after sexual intercourse. Most often, women encounter it when a new sexual partner appears or when beginning family life. At the same time, obvious pathogens requiring treatment are not always detected in men.
An important differentiating factorcauses of postcoital cystitisiscondom test:
- there is no relapse when using condoms - the male factor (search for genital infections in the urethra, on the head of the penis, prostate, testicles);
- constant relapses when using condoms. One possible cause is a latex allergy. The use of spermicides is recommended;
- the use of condoms does not lead to recovery, when using lubricants there is no relapse. Sexual factor, possibly local traumatization of the dry mucous membrane during sexual intercourse. The use of lubricants is recommended;
- using condoms does not lead to healing, using lubricants does not lead to healing. The female factor. Examination by a gynecologist to exclude low localization of the external opening of the urethra (intravaginal dystopia), symptoms of vaginitis.
In the treatment of postcoital cystitis, antibacterial drugs are also used in small doses after intercourse.
Prevention of post-coital cystitis includes:
- Hygiene procedures for all partners before and after sex;
- Women are advised to urinate immediately after intercourse;
- Avoid vaginal dryness by using water-based and estrogen-containing lubricants;
- Do not use deodorants, aerosols and cosmetics in the perineal area;
- Do not wear synthetic underwear.
Chronic cystitis
This variant of cystitis is due to the obligatory presence of pathology in the wall or cavity of the bladder:
- rocks;
- tumors;
- foreign body;
- cystocele;
- diverticulum (outward protrusion of the wall);
- ulcer;
- leukoplakia
Cystoscopy (examination of the inner surface of the bladder) plays a major role in making a diagnosis or confirming it.
In the treatment of chronic cystitis, first of all, measures aimed at eliminating the root cause, usually surgically, are important.
menopausal cystitis
This happens due to insufficient levels of estrogen like other menopausal disorders in the body. The hormonally dependent bladder mucosa becomes thinner and more sensitive. The woman notes a frequent urge to urinate. At the same time, there are no significant deviations from the norm in the general analysis of urine.
Treatment includes long-term use of topical estrogens in the form of creams and suppositories. In addition, it is recommended to reduce or completely eliminate the use of caffeinated beverages and maintain optimal body weight.
How to collect urine for analysis
- On the eve of the test, it is recommended not to drink mineral water and to exclude the use of food (for example, carrots, beets) and drugs (riboflavin, rifampicin, aspirin, triamterene, phenolphthalein, etc. . ) may change the color of urine;
- On the eve of the test, it is recommended not to drink mineral water and to exclude the use of food (for example, carrots, beets) and drugs (riboflavin, rifampicin, aspirin, triamterene, phenolphthalein, etc. . ) may change the color of urine;
- If possible, do not take diuretics;
- It is not recommended to do a urine test during menstruation;
- Before collecting urine, it is recommended to perform a toilet of the external genitalia, but without using antiseptics;
- The outer lips are parted to the sides with the index and middle fingers to avoid contact with the urine stream;
- For analysis, a portion of morning urine is collected: the first third of the urine goes down, the second third of the urine is collected in a container for analysis, the third goes down;
- The walls of the container and the genitals should not touch each other;
- It is recommended to use special containers for collecting urine;
- It is necessary to deliver urine in a tightly closed container to the laboratory no later than 2 hours after collection;
- Don't forget to take your reference with you for analysis.
How to relieve the pain of cystitis
- A heating pad on the lower abdomen will relieve pain and heaviness in the pelvic region;
- Take warm sitz baths for 15 to 20 minutes;
- Drink plenty of fluids so that about 2. 5 liters of urine come out: urine mechanically eliminates bacteria;
- Avoid foods that irritate the bladder: caffeinated drinks, alcohol, citrus juices, spicy foods.
Prevention of recurrence of cystitis
- Frequent urination;
- Drinking diet - 1. 5 liters or more per day. Helps eliminate bacteria from the bladder.
- Good daily hygiene of the perineal area without the use of irritants;
- Hygienic shower for all partners before and after sex. Women are advised to urinate immediately after intercourse;
- Avoid hypothermia of the legs and the body as a whole;
- Reception of cranberry juice or fruit drink, however, according to recent data, this method is not so effective.
- Do not use deodorants, sprays and cosmetics in the perineal area, as they can irritate the urethra;
- Do not use toilet paper to dry the external genitalia.
In case of symptoms of cystitis, we recommend that you consult a doctor to choose the right treatment, which will minimize the risk of recurrence. To be in a good health!
Frequently Asked Questions
When should a doctor be consulted immediately?
We recommend that you consult a doctor immediately at the first symptoms of cystitis, during pregnancy, or the return of symptoms after the end of treatment, the appearance of macroscopic hematuria (visible blood in the urine). The doctor will talk to you, examine you and decide on the need to prescribe other methods of research and treatment, as well as tell you about preventive measures.
How to prepare for a doctor's appointment?
Write down all of your symptoms, even if you think they are unrelated to cystitis. Write down any medical conditions you have and any medications and supplements you take. Think about what might herald the onset of symptoms (hypothermia, sexual intercourse, etc. ). Be sure to write down all questions to the doctor, so that you do not forget to ask them and discuss all the points that bother you.
When is hospitalization indicated?
Emergency hospitalization in an emergency hospital is indicated:
- when signs of inflammation of the kidneys (acute pyelonephritis) appear, namely: pain in the back or in the sides, fever above 38°C and chills, nausea and vomiting;
- if blood appears in the urine (gross hematuria), but there are no symptoms of cystitis;
- worsening of the condition against the background of ongoing treatment (severe pain syndrome, persistent persistent hyperthermia).