Cystitis is one of the most common urological diseases. Every fourth woman suffers from this disease throughout her life, 30% of them may have a recurrence of the disease within a year, and 10% may have a more severe form.
Many girls and women are familiar with this disease, which significantly reduces the quality of life. Often, during the first episode of cystitis, patients feel severe pain and fear, they do not know what to do. Our article aims to help prevent the occurrence of cystitis and guide further actions when symptoms are detected.
Cystitisis an inflammation of the mucous membrane of the bladder.
The reasons
Infections are the main cause of cystitis, non-infectious causes are less common. The occurrence of cystitis in women 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 gland is a sort of anatomical barrier for microorganisms to enter the bladder upwards. In men, frequent urination, pain in the perineum, pain at the end of urination are signs of prostatitis.
It should be noted that, in most cases, cystitis is not caused by microorganisms entering the body from the external environment or during sexual intercourse, but by its own bacteria that normally reside in the intestines and female genital organs. Any factor that causes a decrease in immunity (hypothermia, stress, etc. ) causes the reproduction of endogenous (internal) microorganisms, which causes 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 abundance 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 antibiotic therapy is not selected correctly, these infections can pass to the urinary tract and cause inflammation of the kidneys, the characteristic symptoms of which are:
- increase in body temperature;
- pain in the lower back;
- signs of intoxication (general weakness, headache, drowsiness, tremors).
The main bacteria that cause cystitis are:
- Escherichia coli (E. coli) accounts for 75% of cases;
- in 10% - Klebsiella spp. ;
- Staphylococcus saprophyticus causes 5-10% of cases;
- Other enterobacteria are 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 (with diabetes, HIV infection, chemotherapy, etc. );
- The presence of obstructions to the flow of urine (for example, 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 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 urge to urinate;
- A feeling of pressure or spasm in the pubic region;
- The appearance of blood in the urine, especially at the end of urination;
- Vaginal itching and lack of 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 most cases, the diagnosis is clear from the presence of characteristic symptoms (frequent urination, pain at the end of urination). As a rule, no further diagnosis is required with this variant of cystitis, but you can immediately start using the recommended antibacterial drug empirically (proven in practice). Currently, as a rule, one dose is enough. Only when treatment fails, further examination is indicated. With signs of complete recovery, control of the general analysis of urine is also not required.
An increase in the number of leukocytes is always detected in the general analysis of urine in acute cystitis.
If not, the diagnosis is doubtful and other causes of frequent and painful urination should be sought.Acute cystitis maskscan be:
- overactive bladder;
- inflammation of the urethra caused by open sexual infections (chlamydia, mycoplasma genitalium, gonorrhea, trichomonas);
- vaginitis (inflammation of the vagina);
- bladder diseases (stones and tumors);
- bladder tuberculosis.
Frequent recurrent cystitis
Frequent recurrent cystitis is 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, in others it often causes relapses, science does not know exactly.
Possible causes of recurrent cystitis:
- genetic predisposition (decreased barrier function of the mucopolysaccharide layer of the bladder mucosa);
- anomalies in the development of the urinary system;
- internal genital prolapse (prolapse);
- estrogen deficiency;
- lack of vitamin D;
- iron deficiency anemia, including latent (ferritin deficiency);
- hypothyroidism (decreased production of thyroid hormones);
- diabetes;
- vaginal dysbiosis;
- intestinal dysbiosis;
- use of diaphragms and spermicides;
To determine the causes of recurrent cystitis, use:
- general urinalysis;
- urine bacterial analysis with determination of sensitivity to antibiotics;
- Ultrasound of the kidneys and bladder with the determination of the amount 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, without T4, without T3 (diagnosis of hypothyroidism);
- general blood analysis;
- blood ferritin (detection of hidden anemia);
- uroflowmetry (determination of the rate of urine output).
If the cause of this form of cystitis cannot be found, the use of special immune drugs is considered the "gold" standard in the first line of therapy. Their mechanism of action is the reception of weakened strains of Escherichia coli and the development of protective antibodies on them, which subsequently prevent the reproduction of microbes.
Antibacterial drugs are also used in small doses at night, long-term herbal and diuretic drugs, injection of hyaluronic acid into the bladder (increases the protective capacity of the bladder).
Postcoital cystitis
This is cystitis that occurs 36 hours after intercourse. Often, women experience this when a new sexual partner appears or when they start a family life. At the same time, obvious pathogens that require treatment are not always detected in men.
An important differentiating factorCauses of postcoital cystitisdoescondom test:
- there are no relapses when using condoms - the male factor (searching for genital infections in the urethra, 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, there are no relapses when using lubricants. Sexual factor, possibly local traumatization of the dry mucosa during 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 the lower location of the external opening of the urethra (intravaginal dystopia), signs of vaginitis.
In the treatment of postcoital cystitis, antibacterial drugs are also used in small doses after sexual intercourse.
Prevention of postcoital cystitis includes:
- Hygiene procedures for all partners before and after sex;
- Women are advised to urinate immediately after intercourse;
- Prevent 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 pathology in the wall or cavity of the bladder:
- stones;
- tumors;
- foreign objects;
- cystocele;
- diverticulum (extrusion 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, first of all, measures aimed at eliminating the root cause, usually surgically, are important.
cystitis during menopause
Like other menopausal disorders in the body, it occurs due to insufficient levels of estrogen. The mucous membrane of the bladder, which depends on the hormone, becomes thinner and more sensitive. A woman often mentions the urge to urinate. At the same time, there is no significant deviation 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 that can change color (for example, carrots, beets) and drugs (riboflavin, rifampin, aspirin, triamterene, phenolphthalein, etc. ). urine;
- On the eve of the test, it is recommended not to drink mineral water and to exclude the use of foods that can change color (for example, carrots, beets) and drugs (riboflavin, rifampin, aspirin, triamterene, phenolphthalein, etc. ). 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 perform a toilet of the external genitalia, but without using antiseptics;
- The outer labia are divided to the sides by the index and middle fingers to prevent contact with the flow of urine;
- The morning part of the urine is collected for analysis: the first third of the urine descends, the second third of the urine is collected in a container for analysis, the third descends again;
- The walls of the container and genitals should not touch;
- It is recommended to use special containers to collect urine;
- After collecting urine in a tightly closed container, it is necessary to bring it to the laboratory no later than 2 hours;
- Do not forget to take your application with you for analysis.
How to relieve cystitis pain
- A heating pad under the abdomen will relieve the feeling of pain and heaviness in the pelvic region;
- take a hot bath for 15-20 minutes;
- Drink plenty of fluids to produce about 2. 5 liters of urine: 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.
- 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 intercourse;
- Avoid hypothermia of the legs and the body as a whole;
- Taking cranberry juice or fruit drink, but according to recent data, this method is not very 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 to consult a doctor to choose the right treatment that will minimize the risk of recurrence. Bless you!
Frequently asked questions
In which cases should you immediately consult a doctor?
At the first signs of cystitis, during pregnancy or after the end of the course of treatment, we recommend to consult a doctor immediately if the symptoms return, gross hematuria (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 provide information on 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 your current medical condition and any medications and supplements you are taking. Think about what might herald the onset of symptoms (hypothermia, sexual 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 all the 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: 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 signs of cystitis;
- deterioration of the condition against the background of ongoing therapy (severe pain syndrome, persistent persistent hyperthermia).