Cystitis is one of the most common urological diseases. One in four women will suffer from this disease in their lifetime, 30% may recur within a year, and 10% may often get worse.
Many girls and women know this disease first hand, 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 aims to help prevent the occurrence of cystitis and to take further measures in the event of symptoms.
Cystitisinflammation of the mucous membrane of the bladder.
The reasons
The main cause of cystitis is infections, non-infectious causes occur much less often. The fact that women get sick with cystitis is related to 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 forms a sort of anatomical barrier to the upward penetration of microorganisms into the bladder. In men, frequent urination, pain in the perineum, and pain at the end of urination are signs of prostatitis.
It is important to note that in the vast majority of cases, cystitis is not caused by microorganisms entering the body from the external environment or during sexual contact, but by its own bacteria, which normally live in the intestines and female genital organs. All factors that lead to a decrease in immunity (hypothermia, stress, etc. ) cause increased reproduction of endogenous (internal) microorganisms, which leads to inflammation of the mucous membrane of the bladder. The presence of special fimbriae in these bacteria (hooks for sticking to the wall of the bladder), their large number and the decrease in the protective ability of the mucopolysaccharide layer of the bladder lead to the development of inflammation.
If cystitis is not treated or the antibiotic therapy is not selected properly, these infections can travel up the urinary tract, causing nephritis, the typical symptoms of which are:
- rise in body temperature;
- pain in the lumbar region;
- signs of poisoning (general weakness, headache, drowsiness, chills).
The main bacteria that cause cystitis are:
- Escherichia coli (E. coli) accounts for 75% of cases;
- in 10% - Klebsiella spp. ;
- In 5-10% of cases, it is caused by Staphylococcus saprophyticus;
- Other enterobacteria are even less common.
Risk factors for cystitis
- sexual activity;
- insufficient hygiene;
- use of intravaginal contraceptives;
- Hypothermia of the legs or general hypothermia;
- Pregnancy;
- Postmenopausal;
- Decreased immune response of the body (in case of diabetes, HIV infection, chemotherapy, etc. );
- The presence of obstructions to the outflow of urine (for example, bladder stones, underactive bladder due to diabetic neuropathy).
Symptoms of acute cystitis
- Pain at the end of urination (when the bottom of the bladder touches the neck;
- Frequent (more than 8 times a day) urination;
- The presence of an increased number of leukocytes in the general analysis of urine;
- Urgent urge to urinate;
- Feeling of pressure or spasm in the pubic area;
- The appearance of a mixture of blood in the urine, especially at the end of urination;
- Vaginal itching and lack of discharge;
- Absence of hyperthermia (body temperature is less than 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 revealed by the presence of characteristic symptoms (frequent urination, pain at the end of urination). As a general rule, in the case of this variant of cystitis, no further diagnostics are required, but you can immediately start the empirical (proven in practice) administration of the recommended antibacterial drug. Currently, a single dose is usually sufficient. Further examination is only necessary if treatment fails. Checking the general analysis of urine with signs of complete recovery is also not necessary.
In acute cystitis, an increased number of leukocytes can always be detected in the general analysis of urine.
If this is not the case, the diagnosis is doubtful and other causes of frequent and painful urination should be sought.Acute cystitis masksmay:
- overactive bladder;
- urethritis caused by explicit sexual infections (chlamydia, mycoplasma genitalium, gonorrhea, trichomonas);
- vaginitis (inflammation of the vagina);
- bladder diseases (stones and tumors);
- bladder tuberculosis.
Frequently recurring cystitis
Frequent recurrent cystitis is the presence of 2 or more episodes within six months, or 3 or more episodes within a year.
Science does not fully understand why cystitis is an episode in the life of some women, while in others it leads to frequent relapses.
Possible causes of recurrent cystitis:
- genetic predisposition (reduction of the barrier function of the mucopolysaccharide layer of the bladder mucosa);
- disorders of 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 recurrent cystitis, use:
- general urinalysis;
- bacterial analysis of urine to determine sensitivity to antibiotics;
- Ultrasound of the kidneys and bladder with determination of residual urine;
- consultation with a gynecologist (detection of vaginal dysbiosis);
- FSH, estradiol (detection of estrogen deficiency);
- blood sugar level, glycated hemoglobin, insulin, C-peptide (diagnosis of diabetes mellitus);
- TSH, T4-free, T3-free (diagnosis of hypothyroidism);
- general blood test;
- blood ferritin (detection of latent anemia);
- uroflowmetry (determining the rate of urination).
If the cause of this form of cystitis is not found, then the use of special immune preparations is considered the "golden" standard in the first line of therapy. Their mechanism of action is the intake of weakened Escherichia coli strains and the development of protective antibodies against them, which then prevent the microbes from multiplying.
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 capacity of the bladder).
Postcoital cystitis
This is a cystitis that occurs up to 36 hours after sexual intercourse. Women most often encounter it when a new sexual partner appears or at the beginning of family life. However, obvious pathogens requiring treatment are not always detected in men.
It is an important distinguishing factorcauses of postcoital cystitisthere iscondom test:
- there is no relapse when using a condom - the male factor (searching for genital infections in the urethra, head of the penis, prostate, testicles);
- constant relapses when using a condom. A possible cause is an allergy to latex. the use of spermicides is recommended;
- the use of condoms does not lead to healing, there is no relapse when using lubricants. A sexual factor, possibly local trauma to the dry mucous membrane during intercourse. The use of lubricants is recommended;
- the use of condoms does not lead to healing, the use of lubricants does not lead to healing. The female factor. Examination by a gynecologist to rule out the low position of the external opening of the urethra (intravaginal dystopia) and symptoms of vaginitis.
In the treatment of postcoital cystitis, antibacterial drugs are also used in small doses after intercourse.
Prevention of postcoital cystitis includes:
- Hygienic procedures for each partner before and after sex;
- Women are advised to urinate immediately after sex;
- 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 occurs due to the obligatory presence of pathology in the wall or cavity of the bladder:
- stones;
- tumors;
- foreign bodies;
- cystocele;
- diverticulum (protrusion of the wall);
- ulcer;
- leukoplakia
Cystoscopy (examination of the inner surface of the bladder) plays a major role in establishing or confirming the diagnosis.
In the treatment of chronic cystitis, measures aimed at eliminating the underlying cause are important, usually surgically.
cystitis in menopause
It occurs due to insufficient estrogen levels like other menopausal disorders in the body. The mucous membrane of the hormone-dependent bladder becomes thinner and more sensitive. The woman notices a frequent urge to urinate. At the same time, there is no significant deviation from the norm in the general analysis of urine.
Treatment involves the long-term use of topical estrogens in the form of creams and suppositories. In addition, it is recommended to reduce or completely eliminate the consumption of caffeinated beverages and maintain an optimal body weight.
How to collect urine for analysis
- On the eve of the test, it is not recommended to drink mineral water and exclude the use of foods (for example, carrots, beets) and drugs (riboflavin, rifampin, aspirin, triamterene, phenolphthalein, etc. ) that can change the color. from urine;
- On the eve of the test, it is not recommended to drink mineral water and exclude the use of foods (for example, carrots, beets) and drugs (riboflavin, rifampin, aspirin, triamterene, phenolphthalein, etc. ) that can change the color. from urine;
- If possible, do not take diuretics;
- It is not recommended to perform a urine test during menstruation;
- Before collecting urine, it is recommended to perform a toilet of the external genitalia, but without the use of antiseptics;
- The outer labia are separated laterally with the index and middle fingers to prevent contact with the flow of urine;
- For the analysis, the morning part of the urine is collected: the first third of the urine is lowered, the second third of the urine is collected in a container for analysis, the third is lowered again;
- The walls of the tank and the genitals must not come into contact;
- It is recommended to use special containers for collecting urine;
- Urine must be transported to the laboratory in a tightly closed container no later than 2 hours after collection;
- Don't forget to bring the referral for analysis with you.
How to relieve the pain of cystitis
- A heating pad on the lower abdomen relieves pain and heaviness in the pelvic area;
- taking a 15-20 minute hot sitz bath;
- Drink plenty of fluids to produce about 2. 5 liters of urine: urine mechanically flushes out bacteria;
- Avoid foods that irritate the bladder: caffeinated drinks, alcohol, citrus juices, spicy foods.
Prevention of recurrence of cystitis
- Frequent urination;
- Drinking system - 1. 5 liters or more per day. It helps remove bacteria from the bladder.
- Proper 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 sex;
- Avoid hypothermia of the legs and the body as a whole;
- Receiving cranberry juice or a fruit drink, however, according to the latest data, this method is not as effective.
- Do not use deodorants, aerosols 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 that minimizes the risk of recurrence. To be healthy!
Frequently Asked Questions
In which cases is it necessary to consult a doctor immediately?
We recommend that you consult a doctor immediately at the first symptoms of cystitis, during pregnancy, or after the return of symptoms after the end of treatment, in the event of the appearance of gross hematuria (visible blood in the urine). The doctor will talk to you, examine and decide whether other research and treatment methods are needed, and inform you about preventive measures.
How to prepare for the doctor's appointment?
Write down all your symptoms, even if you don't think they're related to cystitis. Make a note of any medical conditions you have, as well as any medications and supplements you take. Think about what could mean the appearance of symptoms (hypothermia, sexual intercourse, etc. ). Be sure to write down all your questions to the doctor so you remember to ask them and discuss any concerns you may have.
In which cases is hospitalization justified?
In the emergency hospital, emergency hospitalization is indicated:
- when signs of kidney inflammation (acute pyelonephritis) appear, namely: back or side pain, fever above 38°C and chills, nausea and vomiting;
- if blood appears in the urine (gross hematuria), but there are no symptoms of cystitis;
- deterioration of the condition against the background of ongoing therapy (severe pain syndrome, persistent hyperthermia).