Cystitis is one of the most common urological diseases. During life, every fourth woman suffers from this disease, 30% of them may have a recurrence of the disease within a year and 10% may have a frequently worsening form.
This disease is known firsthand 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 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 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, since their urethra is long and the prostate is a kind of anatomical barrier to the upward entry of microorganisms into the bladder. Frequent urination in men, pain in the perineum, pain at the end of urination is 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 its own bacteria, which usually reside in the intestines and female reproductive system. Any factors that lead to a decrease in immunity (hypothermia, stress, etc. ) cause increased reproduction of endogenous (internal) microorganisms, which lead to inflammation of the bladder mucosa. The presence of special filaments in these bacteria (hooks for attachment to the bladder wall), their large number and the reduction of the protective capacity of the mucopolysaccharide layer of the bladder leads to the development of inflammation.
If cystitis is not treated or the antibiotic treatment is not chosen correctly, these infections can travel to the urinary system, causing inflammation of the kidneys, the characteristic symptoms of which are:
- increase 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. ;
- Staphylococcus saprophyticus is the cause in 5-10% of cases.
- Other enterobacteria are even less common.
Risk Factors for Cystitis
- sexual activity;
- Inadequate hygiene.
- Use of intravaginal contraceptives?
- Hypothermia of the legs or general hypothermia.
- Pregnancy;
- Postmenopausal?
- Decreased immune response of the body (with diabetes, HIV infection, chemotherapy, etc. )
- The 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 her 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 blood in the urine, especially at the end of urination.
- Absence of vaginal itching and 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 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 start an empiric (proven in practice) administration of the recommended antibacterial drug. At this time, as a rule, one dose is enough. Only in case of treatment failure, additional examination is indicated. Control of the general analysis of urine with signs of complete recovery is also not required.
In acute cystitis in the general analysis of 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.Masks for acute cystitismay be:
- overactive bladder;
- inflammation of the urethra caused by definite sexual infections (chlamydia, genital mycoplasma, gonorrhea, trichomonas).
- vaginitis (inflammation of the vagina).
- diseases of the bladder (stones and tumors);
- tuberculosis of the bladder.
Often recurrent cystitis
Frequent 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 in life, while in others it leads to frequent recurrences, the 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 urinary 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 urinalysis.
- bacterial analysis of urine with the determination of sensitivity to antibiotics.
- Ultrasound of kidneys, bladder with 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).
- urometry (determination of urination speed).
If the cause of this form of cystitis cannot be found, the use of specific immune preparations is considered the "gold" standard in the first line of treatment. Their mechanism of action is to take up weakened strains of Escherichia coli and develop 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).
Postacoustic cystitis
This is cystitis that occurs up to 36 hours after sexual intercourse. Most often, women face it when a new sexual partner appears or with the start of family life. At the same time, obvious pathogens that require treatment are not always found in men.
A major differentiatorcauses of postconjunctival cystitisiscondom 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 while using condoms; A possible cause is a latex allergy. The use of spermicides is recommended.
- using condoms does not lead to recovery; when using lubricants, there are no relapses. Sexual factor, possibly local injury to the dry mucosa during sexual intercourse. The use of lubricants is recommended.
- Using condoms does not lead to recovery, using lubricants does not lead to recovery. The female factor. Examination by a gynecologist to rule out 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 postconjunctival cystitis includes:
- Hygiene procedures for all partners before and after sex.
- It is recommended that women urinate immediately after sex.
- Avoid vaginal dryness by using water-based and estrogen-based lubricants.
- Do not use deodorants, aerosols and cosmetics in the perineum 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:
- stones;
- tumors;
- foreign bodies;
- cystocele?
- diversions (protrusion of the wall to the outside).
- ulcer;
- leukoplakia
Cystoscopy (examination of the inner surface of the bladder) plays an important role in diagnosing or confirming it.
In the treatment of chronic cystitis, first of all, measures aimed at eliminating the root cause, usually surgical, are important.
cystitis in menopause
It occurs due to insufficient estrogen levels, just like other menopausal disorders in the body. The hormonally dependent lining of the bladder 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 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. ) 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 drugs (riboflavin, rifampin, 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 collecting urine, it is recommended to do a toilet of the external genitalia, but without the use of antiseptics.
- The outer lips are separated laterally with the index and middle fingers to prevent contact with the flow of urine.
- For analysis, a morning portion of urine is collected: the first third of urine is lowered, the second third of urine is collected in a container for analysis, the third is lowered again.
- The walls of the container and the genitals should not come into contact.
- It is recommended to use special containers for collecting urine.
- It is necessary to deliver the urine in a hermetically sealed container to the laboratory no later than 2 hours after collection.
- Don't forget to take your referral 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 area.
- Taking warm sitz baths for 15-20 minutes.
- Drink plenty of fluids, so that about 2. 5 liters of urine stand out: 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 remove bacteria from the bladder.
- Correct daily hygiene of the perineal area without the use of irritating substances.
- Hygienic shower for all partners before and after sex. It is recommended that women urinate immediately after sex.
- Avoid hypothermia of the legs and body as a whole.
- Taking 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 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, which will minimize the risk of recurrence. Be healthy!
Frequent questions
In which cases is it necessary to consult a doctor immediately?
We recommend that you consult a doctor immediately with the first symptoms of cystitis, during pregnancy or the recurrence of symptoms after the end of treatment, the appearance of acute hematuria (visible blood in the urine). The doctor will talk with you, examine you and decide on the need to prescribe other methods of research and treatment, as well as 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. List any medical conditions you have and any medications and supplements you take. Consider what may herald the onset of symptoms (hypothermia, intercourse, etc. ). Be sure to write down all the questions to the doctor so you don't forget to ask them and discuss any points that bother you.
In which 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, fever over 38 ° C and chills, nausea and vomiting.
- if blood appears in the urine (gross haematuria) but there are no symptoms of cystitis.
- worsening of the condition in the context of ongoing treatment (severe pain syndrome, persistent persistent hyperthermia).