Cystitis is one of the most common urological diseases. During their lifetime, every fourth woman suffers from this disease, 30% of them may have a relapse of the disease within a year, and 10% may have a frequently worsening form.
This disease is known firsthand to many girls and women, which significantly reduces the quality of life. Often, at the first episode of cystitis, patients experience severe pain and fear and do not know what to do. Our article aims to help avoid the occurrence of cystitis and, in case of symptoms, to guide further actions.
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 features. Men do not suffer from cystitis because their urethra is long and the prostate gland is a kind of anatomical barrier to the entry of microorganisms up 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 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 that usually inhabit the intestines and female genital organs. All factors leading to a decrease in immunity (hypothermia, stress, etc. ) cause increased reproduction of endogenous (internal) microorganisms, which leads to inflammation of the bladder mucosa. The presence of special fimbriae in these bacteria (hooks for sticking to the wall of the bladder), their large number and the reduction of the protective ability of the mucopolysaccharide layer of the bladder leads to the development of inflammation.
If cystitis is not treated or antibiotic therapy is not correctly selected, these infections can move up the urinary tract, causing inflammation of the kidneys, the characteristic symptoms of which are:
- increase in body temperature;
- pain in the lumbar region;
- signs of intoxication (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. ;
- 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;
- Hypothermia of the legs or general hypothermia;
- Pregnancy;
- Postmenopause;
- Decreased immune response of the body (with diabetes, HIV infection, chemotherapy, etc. );
- Presence of obstructions to the outflow of urine (for example, a stone in the bladder, 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 its neck);
- Frequent (more than 8 times a day) urination;
- The presence of an increased number of leukocytes in the general analysis of urine;
- Urgent urges to urinate;
- Sensation of pressure or spasm in the pubic area;
- The appearance of blood in the urine, especially at the end of urination;
- Absence of vaginal itching and discharge;
- Absence 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 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 diagnosis is required, but you can immediately start empirical (proven in practice) application of the recommended antibacterial drug. Currently, as a rule, one dose is sufficient. Only in the event of treatment failure is further investigation indicated. Also, control of the general analysis of urine with signs of complete recovery is not required.
In acute cystitis, an increased number of leukocytes is always 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.Masks for acute cystitiscan be:
- overactive bladder;
- inflammation of the urethra caused by obvious sexual infections (chlamydia, mycoplasma genitalium, gonorrhea, trichomonas);
- vaginitis (inflammation of the vagina);
- bladder diseases (stones and tumors);
- bladder tuberculosis.
Frequently recurring cystitis
Often recurrent cystitis is the presence of 2 or more episodes in six months or 3 or more episodes in one year.
Why in some women cystitis is an episode of life, and in others it leads to frequent relapses, science is not exactly known.
Possible causes of recurrent cystitis:
- genetic predisposition (reduction of the barrier function of the mucopolysaccharide layer of the bladder mucosa);
- abnormalities in the development of the excretory system;
- prolapse (prolapse) of the internal genital organs;
- estrogen deficiency;
- vitamin D deficiency;
- iron deficiency anemia, including latent (ferritin deficiency);
- hypothyroidism (reduced 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 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;
- ferritin in the blood (detection of latent anemia);
- uroflowmetry (determining the rate of urination).
If the cause of this form of cystitis cannot be found, the use of special immune preparations is considered the "golden" standard in the first line of therapy. Their mechanism of action is the acceptance of weakened strains of Escherichia coli and the development of protective antibodies on them, which subsequently 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 ability of the bladder).
Postcoital cystitis
This is cystitis that occurs up to 36 hours after intercourse. Most often, women encounter it when a new sexual partner appears or with the beginning of family life. At the same time, obvious pathogens that require treatment are not always found in men.
An important differentiating factorCauses of postcoital cystitisiscondom test:
- no relapses 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. A possible cause is an allergy to latex. The use of spermicides is recommended;
- the use of condoms does not lead to recovery, when using lubricants there are no relapses. Sexual factor, possible local traumatization of the dry mucous membrane during sexual intercourse. The use of lubricants is recommended;
- the use of condoms does not lead to recovery, the use of lubricants does not lead to recovery. The female factor. Examination by a gynecologist to exclude the 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 postcoital cystitis includes:
- Hygienic procedures for all partners 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 is due to the mandatory presence of pathology in the bladder wall or cavity:
- stones;
- tumors;
- foreign bodies;
- cystocele;
- diverticulum (protrusion of the wall outwards);
- ulcer;
- leukoplakia
Cystoscopy (examination of the inner surface of the bladder) plays a major role in making the diagnosis or confirming it.
In the treatment of chronic cystitis, first of all, measures aimed at eliminating the root cause, usually surgical, are important.
menopausal cystitis
It occurs due to insufficient levels of estrogen, similar to other menopausal disorders in the body. The hormone-dependent lining of the bladder becomes thinner and more sensitive. The woman notes frequent urges to urinate. At the same time, there are no significant deviations from the norm in the general analysis of urine.
Treatment involves 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 an 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 foods (for example, carrots, beets) and drugs (riboflavin, rifampin, aspirin, triamterene, phenolphthalein, etc. ), which 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 drugs (riboflavin, rifampin, aspirin, triamterene, phenolphthalein, etc. ), which can 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 wash the external genitalia, but without the use of antiseptics;
- The external labia are separated laterally with the index and middle fingers to prevent contact with the stream of urine;
- A morning portion of urine is collected for analysis: 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 container and the genitals should not touch;
- 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 bring your analysis referral with you.
How to relieve cystitis pain
- A heating pad in the lower abdomen will relieve pain and heaviness in the pelvic area;
- Taking hot sitz baths for 15-20 minutes;
- Drink plenty of fluids so that about 2. 5 liters of urine are excreted: urine mechanically washes away bacteria;
- Avoid foods that irritate the bladder: caffeinated drinks, alcohol, citrus juices, spicy foods.
Prevention of recurrence of cystitis
- Frequent urination;
- Drinking regime - 1. 5 liters or more per day. It helps flush out 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 body as a whole;
- Taking cranberry juice or a fruit drink, however, according to recent 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 consulting a doctor to choose the right treatment that will minimize the risk of recurrence. Be healthy!
Frequently Asked Questions
In what 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 the return of symptoms after the end of the course of treatment, the appearance of gross hematuria (visible blood in the urine). The doctor will talk with you, examine you and decide on the need to prescribe other methods of examination and treatment, as well as tell you about preventive measures.
How to prepare for a doctor's appointment?
Write down all your symptoms, even if you think they are not related to cystitis. Write down any medical conditions you have and any medications and supplements you take. Consider what may herald the onset of symptoms (hypothermia, intercourse, etc. ). Do not forget to write down all the questions to the doctor so that you do not forget to ask them and discuss any points that concern you.
In what cases is hospitalization indicated?
Urgent hospitalization in an emergency hospital is indicated:
- when signs of inflammation of the kidneys (acute pyelonephritis) appear, namely: pain in the back or side, temperature 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 continued therapy (severe pain syndrome, persistent persistent hyperthermia).