Cystitis is one of the most common urological diseases. Over 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 an often worsened form.
This disease is first-hand familiar to many girls and women, significantly reducing their quality of life. Often, during the first episode of cystitis, patients experience intense pain and fear and don't know what to do. Our article aims to help prevent the occurrence of cystitis and, in case of symptoms, to guide future actions.
cystitisit is 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, as their urethra is long and the prostate is a kind of anatomical barrier for the ascending 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 caused not by microorganisms that enter the body from the external environment or during sexual intercourse, but by its own bacteria, which normally inhabit the intestines and female genital tract. Any factors that lead to a decrease in immunity (hypothermia, stress, etc. ) cause an increase in the reproduction of endogenous (internal) microorganisms, which lead to inflammation of the bladder mucosa. The presence of special fimbriae in these bacteria (hooks for adhesion to the bladder wall), their large number and a decrease in the protective capacity of the mucopolysaccharide layer of the bladder lead to the development of inflammation.
If cystitis is not treated or antibiotic therapy is not selected properly, these infections can travel through the urinary tract, causing inflammation of the kidneys, whose characteristic symptoms are:
- increase in body temperature;
- pain in the lower back;
- signs of intoxication (general weakness, headache, drowsiness, chills).
The main bacteria that cause cystitis are:
- Escherichia coli (E. coli) is responsible for 75% of cases;
- In 10% - Klebsiella spp. ;
- Staphylococcus saprophyticus is the cause in 5-10% of cases;
- Other enterobacteria are even less common.
Risk factors for cystitis
- sexual activity;
- Insufficient hygiene;
- Use of intravaginal contraceptives;
- Leg hypothermia or general hypothermia;
- Pregnancy;
- Post-menopause;
- Decreased immune response of the body (with diabetes, HIV infection, chemotherapy, etc. );
- The presence of obstructions to the exit of urine (eg, a bladder stone, an 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 the neck;
- Frequent urination (more than 8 times a day);
- The presence of an increased number of leukocytes in the general analysis of the urine;
- Urgent imperative to urinate;
- Sensation of pressure or spasm in the pubic area;
- The appearance of a mixture of blood in the urine, especially at the end of urination;
- Absence of itching and vaginal discharge;
- Absence of hyperthermia (body temperature 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 evident by the presence of characteristic symptoms (frequent urination, pain at the end of urination). As a rule, with this variant of cystitis, no further diagnoses are required, but you can immediately start an empirical (proven in practice) administration of the recommended antibacterial drug. At the moment, as a rule, a single dose is sufficient. Only in case of treatment failure, a complementary examination is indicated. Control of general urine analysis with signs of complete recovery is also not necessary.
In acute cystitis in the general analysis of the urine, an increased number of leukocytes is always detected.
If this is not the case, the diagnosis is doubtful and other causes of frequent and painful urination should be sought.Acute cystitis masksCan it be:
- overactive bladder;
- inflammation of the urethra caused by overt sexual infections (chlamydia, mycoplasma genitalium, gonorrhea, trichomonas);
- vaginitis (inflammation of the vagina);
- bladder diseases (stones and tumors);
- bladder tuberculosis.
recurrent cystitis
Often 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 in life, while in others it leads to frequent relapses, the 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 analysis of urine;
- bacterial analysis of urine with determination of sensitivity to antibiotics;
- Ultrasound of the kidneys, bladder with the determination of residual urine;
- consultation with a gynecologist (detection of vaginal dysbiosis);
- FSH, estradiol (detection of estrogen deficiency);
- blood glucose, glycated hemoglobin, insulin, C-peptide (diagnosis of diabetes mellitus);
- TSH, T4-free, T3-free (diagnosis of hypothyroidism);
- general blood analysis;
- blood ferritin (detection of latent anemia);
- uroflowmetry (determination of the urination rate).
If the cause of this form of cystitis cannot be found, the use of special immune preparations is considered the "gold" standard in first-line therapy. Its mechanism of action is the ingestion of weakened strains of Escherichia coli and the development of protective antibodies on them, which subsequently prevent the multiplication of microbes.
Antibacterial drugs are also used in small doses at night, for a long time, herbal medicines and diuretics, the introduction of hyaluronic acid into the bladder (increases the protective capacity of the bladder).
post-coital cystitis
This is cystitis that occurs up to 36 hours after sexual contact. Most often, women are faced with the appearance of a new sexual partner or the beginning of family life. At the same time, obvious pathogens that require treatment are not always detected in men.
An important differentiatorcauses of postcoital cystitisIt iscondom test:
- there are no relapses when using condoms - the male factor (search for genital infections in the urethra, head of the penis, prostate, testicles);
- constant relapses when using condoms. One possible cause is a latex allergy. The use of spermicides is recommended;
- condom use does not lead to recovery; when using lubricants, there are no relapses. Sexual factor, possibly local traumatization of dry mucosa during intercourse. The use of lubricants is recommended;
- using condoms does not lead to recovery, using lubricants does not lead to recovery. The feminine factor. Examination by a gynecologist to exclude low location 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 sex;
- Prevent vaginal dryness by using water-based and estrogen-containing lubricants;
- Do not use deodorants, aerosols and cosmetics in the perineal region;
- 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:
- stones;
- tumors;
- foreign bodies;
- cystocele;
- diverticulum (protrusion of the wall outwards);
- ulcer;
- leukoplakia
Cystoscopy (examination of the inner surface of the bladder) plays an important role in diagnosis or confirmation.
In the treatment of chronic cystitis, measures aimed at eliminating the root cause, usually surgically, are important in the first place.
menopausal cystitis
It occurs due to insufficient estrogen levels like other menopausal disorders in the body. The hormonally dependent bladder mucosa becomes thinner and more sensitive. The woman notices 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 beverages that contain caffeine and maintain an ideal 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 foods (for example, carrots, beets) and medications (riboflavin, rifampicin, aspirin, triamterene, phenolphthalein, etc. ) that can 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 foods (for example, carrots, beets) and medications (riboflavin, rifampicin, aspirin, triamterene, phenolphthalein, etc. ) that can change the color of urine;
- If possible, do not take diuretics;
- It is not recommended to take a urine test during menstruation;
- Before urine collection, it is recommended to clean the external genitalia, but without the use of 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 the 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 again;
- The walls of the container and the genitals must not touch;
- The use of special containers for urine collection is recommended;
- It is necessary to deliver the urine in a tightly closed container to the laboratory no later than 2 hours after collection;
- Don't forget to take your reference for review with you.
How to relieve cystitis pain
- A heating pad in the lower abdomen will relieve pain and heaviness in the pelvic area;
- Take hot sitz baths for 15-20 minutes;
- Drink plenty of fluid so that about 2. 5 liters of urine stand out: urine mechanically eliminates bacteria;
- Avoid foods that irritate the bladder: caffeinated drinks, alcohol, citrus juices, spicy foods.
Prevention of cystitis recurrence
- frequent urination;
- Consumption regime - 1. 5 liters or more per day. Helps eliminate bacteria from the bladder.
- Adequate 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 body as a whole;
- Reception of cranberry juice or fruit drink, however, according to recent data, this method is not as effective.
- Do not use deodorants, aerosols and cosmetics in the perineal region, 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 select the correct treatment, which will minimize the risk of recurrence. Be healthy!
Common questions
In what cases is it necessary to consult a doctor immediately?
We recommend that you immediately consult a doctor at the first symptoms of cystitis, during pregnancy or at 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 research and treatment methods, as well as inform you about preventive measures.
How to prepare for a medical appointment?
Write down all of your symptoms, even if you don't think they are related to cystitis. Write down any medical conditions you have and any medications and supplements you take. Think about what could herald the onset of symptoms (hypothermia, intercourse, etc. ). Be sure to write down all questions for the doctor so you don't forget to ask and discuss any points that are bothering you.
In which cases is hospitalization indicated?
Emergency admission to an emergency hospital is indicated:
- when signs of inflammation of the kidneys appear (acute pyelonephritis), namely: pain in the back or 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 in the context of ongoing therapy (severe pain syndrome, persistent persistent hyperthermia).