Cystitis is one of the most common urological diseases. During their lifetime, every fourth woman 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.
Many girls and women know this disease first hand, which significantly reduces 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 avoid the appearance of cystitis and, in case of symptoms, to orientate for further action.
Cystitisis an inflammation of the bladder mucosa.
Reasons
Infections are the main cause of cystitis, non-infectious causes are much less common. The fact that women suffer from 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 is a kind of anatomical barrier for the upward entry of microorganisms into the bladder. Frequent urination in men, pain in the perineum, 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 that enter the body from the external environment or during sexual intercourse, but by its own bacteria that normally inhabit the intestines and female genital tract. Any factors that lead to a decrease in immunity (hypothermia, stress, etc. ) cause increased reproduction of endogenous (internal) microorganisms that lead to inflammation of the bladder mucosa. The presence of special fimbriae in these bacteria (hooks for sticking to the wall of the urinary 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 chosen correctly, these infections can spread through 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 causative agent in 5-10% of cases;
- Other enterobacteria are even rarer.
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 urinary outflow (for example, bladder stones, 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 imperative urge to urinate;
- Feeling of pressure or cramps in the pubic area;
- 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 listed 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, this variant of cystitis does not require additional diagnostics, 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 case of treatment failure is an additional examination indicated. Control of general urinalysis with signs of complete recovery is also not required.
In acute cystitis, the general analysis of urine always reveals an increased number of leukocytes.
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 explicit sexual infections (chlamydia, mycoplasma genitalium, gonorrhea, trichomonas);
- vaginitis (inflammation of the vagina);
- bladder diseases (stones and tumors);
- bladder tuberculosis.
Often 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 in life, while in others it leads to frequent recurrences, science does not know exactly.
Possible causes of recurrent cystitis:
- genetic predisposition (reduction of the barrier function of the mucopolysaccharide layer of the bladder mucosa);
- anomalies in the development of the urinary system;
- prolapse (prolapse) of internal genital organs;
- lack of estrogen;
- lack of vitamin D;
- anemia due to iron deficiency, including latent (ferritin deficiency);
- hypothyroidism (reduced thyroid hormone production);
- diabetes;
- vaginal dysbiosis;
- intestinal dysbiosis;
- use of diaphragms and spermicides;
To diagnose the causes of recurrent cystitis, use:
- general urinalysis;
- bacterial analysis of urine with determination of sensitivity to antibiotics;
- Ultrasound of kidneys, bladder with determination of residual urine;
- consultations 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;
- 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 "golden" standard in the first line of therapy is the use of special immune preparations. Their mechanism of action is the introduction of weakened strains of Escherichia coli and the development of protective antibodies on them that subsequently prevent the reproduction of microbes.
Antibacterial drugs are also used in small doses at night, for a long time, herbal and diuretic drugs, introduction of hyaluronic acid into the bladder (increases the protective capacity of the bladder).
Postcoital cystitis
This is cystitis that occurs up to 36 hours after sexual contact. 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 detected in men.
An important factor of differentiationcauses of postcoital cystitisiscondom test:
- no recurrence when using condoms - 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 spermicide is recommended;
- the use of condoms does not lead to recovery, when using lubricants there is no recurrence. Sexual factor, possible local traumatization of the dry mucous membrane during intercourse. The use of lubricant 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 a 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-based 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 mandatory presence of pathology in the bladder wall or cavity:
- stones;
- tumors;
- foreign bodies;
- cystocele;
- diverticulum (protrusion of the wall to the outside);
- 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 removing the main cause, usually surgical, are important.
cystitis in menopause
It is caused by an insufficient level of estrogen, as well as other disorders in the body during menopause. The hormone-dependent lining of the bladder becomes thinner and more sensitive. A woman notices a frequent need to urinate. At the same time, there are no significant deviations from the norm in the general urine analysis.
Treatment includes long-term use of local 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
- Before 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;
- Before 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;
- Taking a urine test during menstruation is not recommended;
- Before collecting urine, it is recommended to perform a toilet of the external genitalia, but without the use of antiseptics;
- The outer lips are separated with the index and middle fingers to the sides to prevent contact with the flow of urine;
- The morning portion of urine is collected for analysis: 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 vessel and the genitals must not touch;
- It is recommended to use special containers for collecting urine;
- It is necessary to deliver urine in a well-closed container to the laboratory no later than 2 hours after collection;
- Do not forget to take the referral for the analysis with you.
How to relieve cystitis pain
- A heating pad on 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 separated: 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 expel 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 the latest data, this method is not so 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 in order to choose the right treatment, which will reduce the risk of recurrence. Be healthy!
Frequently Asked Questions
In which cases is an urgent consultation with a doctor necessary?
We recommend that at the first symptoms of cystitis, during pregnancy or when symptoms return after the end of therapy, gross hematuria (visible blood in the urine) appears, consult a doctor immediately. The doctor will talk to you, examine you and decide on the need to prescribe other methods of research and treatment, as well as tell about preventive measures.
How to prepare for a doctor's examination?
Write down all 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, sexual intercourse, etc. ). Be sure to write down all the questions to the doctor, so that you don't forget to ask them and discuss all the points that bother you.
In which cases is hospitalization indicated?
Emergency hospitalization in an emergency hospital is indicated:
- when signs of kidney inflammation (acute pyelonephritis) appear, namely: pain in the back or side, elevated 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 current therapy (severe pain syndrome, permanent persistent hyperthermia).