Cystitis is one of the most common diseases in urology. Over the course of a lifetime, 1 in 4 women will have the disease, 30% of them may experience a recurrence within a year, and 10% may experience frequent exacerbations.
Many girls and women are familiar with the disease, which greatly reduces quality of life. Often, during the first episode of cystitis, patients experience severe pain and fear and don't know what to do. Our articles are designed to help avoid cystitis and guide further action when symptoms develop.
Cystitisis inflammation of the lining of the bladder.
reason
Infections are the main cause of cystitis, and noninfectious causes are less common. The fact that women develop cystitis is related to the anatomical and physiological characteristics of the body, including the short, wide urethra, the opening of the external urethra near the vagina and rectum, and hormonal characteristics. Men don't get cystitis because their urethra is very long, and the prostate is an anatomical barrier for microbes to move up into the bladder. In men, frequent urination, pain in the perineum, and pain at the end of urination are signs of prostatitis.
Notably, the vast majority of cystitis is not caused by microbes that enter the body from the external environment or during sexual intercourse, but rather by their own bacteria that normally inhabit the gut and female reproductive tract. Anything that contributes to a weakened immune system (hypothermia, stress, etc. ) can lead to an increase in endogenous (internal) microbial reproduction, which can lead to inflammation of the bladder lining. The presence of specialized fimbriae (hooks for sticking to the bladder wall) in these bacteria, their abundance and the reduced protective ability of the mucopolysaccharide layer of the bladder lead to the development of inflammation.
If cystitis is not treated, or if antibiotic treatment is not chosen correctly, these infections can spread along the urinary tract and cause inflammation of the kidneys, which are characterized by:
- increased body temperature;
- lower back pain;
- Signs of poisoning (general weakness, headache, lethargy, chills).
The main bacteria that cause cystitis are:
- E. coli accounts for 75% of cases;
- 10% - Klebsiella;
- Staphylococcus saprophytes is the cause in 5-10% of cases;
- Other Enterobacteriaceae are less common.
Risk factors for cystitis
- sexual activity;
- inadequate hygiene;
- use of vaginal contraceptives;
- Hypothermia in the legs or whole body;
- Pregnant;
- postmenopausal;
- Decreased immune response of the body (diabetes, HIV infection, chemotherapy, etc. );
- Impairment of urine flow (eg, bladder stones, insufficiency of bladder due to neuropathy due to diabetes).
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 increased numbers of white blood cells in the general analysis of urine;
- an urgent urge to urinate;
- Feeling of pressure or cramping in the genitals;
- A mixture of blood in the urine, especially at the end of urination;
- no vaginal itching and discharge;
- No hyperthermia (body temperature below 37. 5 degrees).
The first three symptoms above are always present in acute cystitis.
Clinical forms of cystitis
acute simple cystitis
In the vast majority of cases, the diagnosis is the presence of distinct characteristic symptoms (frequency of urination, pain at the end of urination). Typically, no additional diagnosis is required for this variant of cystitis, but you can begin empiric (proven in practice) administration of recommended antimicrobials immediately. Currently, as a rule, a single dose is sufficient. Additional tests are required only if treatment fails. Nor is it necessary to control for general analysis of urine with signs of complete recovery.
In acute cystitis in general urinalysis, an increase in the number of leukocytes is always detected.
If this is not the case, the diagnosis is suspicious and other causes of frequent urination and painful urination should be looked for.acute cystitis maskCan:
- overactive bladder;
- Urinary tract inflammation caused by definite sexual infections (chlamydia, M. genitalium, gonorrhea, trichomoniasis);
- vaginitis (inflammation of the vagina);
- Bladder disease (stones and tumors);
- Bladder tuberculosis.
recurrent cystitis
Cystitis that often recurs is 2 or more episodes in six months or 3 or more episodes in one year.
Why cystitis is a bout of life in some women and causes frequent relapses in others is not entirely clear to the science.
Possible causes of recurrent cystitis:
- Genetic susceptibility (decreased barrier function of the mucopolysaccharide layer of the bladder);
- abnormal development of the urinary system;
- Prolapse of the internal reproductive organs (prolapse);
- estrogen deficiency;
- vitamin D deficiency;
- Iron deficiency anemia, including latent (ferritin deficiency);
- hypothyroidism (reduced production of thyroid hormones);
- diabetes;
- vaginal dysbiosis;
- Intestinal flora imbalance;
- use of diaphragms and spermicides;
To diagnose the cause of frequently recurring cystitis, use:
- General urinalysis;
- Urine bacterial analysis to determine susceptibility to antibiotics;
- Renal ultrasonography, bladder residual urine determination;
- Consult a gynecologist (to detect vaginal dysbiosis);
- FSH, estradiol (to detect estrogen deficiency);
- Blood sugar, glycosylated hemoglobin, insulin, C-peptide (diabetes diagnosis);
- TSH, T4-free, T3-free (diagnosis of hypothyroidism);
- General blood analysis;
- Hemoferritin (to detect latent anemia);
- uroflowmetry (measurement of the rate of urination).
If the cause of this form of cystitis cannot be found, the use of special immunologic agents is considered the "gold" standard of first-line treatment. Their mechanism of action is to ingest attenuated strains of E. coli and produce protective antibodies on them, preventing microorganisms from multiplying.
Antibacterial drugs are also used in small doses at night, and for a long time, herbal medicines and diuretics, which introduce hyaluronic acid into the bladder (increase the protective capacity of the bladder).
postcoital cystitis
This is cystitis that occurs within 36 hours of sexual contact. Most of the time, women experience this when a new sexual partner comes along or when family life begins. At the same time, obvious pathogens requiring treatment were not always detected in men.
an important differentiatorCauses of Postcoital CystitisYesCondom Test:
- No recurrence when using condoms - male factor (look for genital infections on urethra, glans penis, prostate, testicles);
- Relapses constantly while using condoms. One possible cause is an allergy to latex. Spermicide is recommended;
- There is no recovery with condom use; no recurrence with lube. Sexual factors that may cause local trauma to dry mucous membranes during sexual intercourse. Lubricant is recommended;
- Using a condom will not lead to recovery, and using lubricant will not lead to recovery. female factor. Examination by a gynecologist to rule out a low position of the opening outside the urethra (intravaginal ectopic), a symptom of vaginitis.
In the treatment of postcoital cystitis, antibiotics 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;
- Avoid vaginal dryness by using water-based and estrogen-containing lubricants;
- Do not use deodorants, sprays and makeup on the perineal area;
- Do not wear synthetic underwear.
chronic cystitis
This variant of cystitis is due to the inevitable presence of pathology in the bladder wall or lumen:
- Stone;
- tumor;
- foreign body;
- cystocele;
- Diverticula (walls that protrude outward);
- ulcer;
- Vitiligo
Cystoscopy (inspecting the inner surface of the bladder) plays a major role in diagnosis or confirmation.
In the treatment of chronic cystitis, first, measures aimed at eliminating the underlying cause, usually surgery, are important.
menopausal cystitis
It occurs due to insufficient estrogen levels, just like other menopausal disorders in the body. The hormone-dependent bladder mucosa becomes thinner and more sensitive. The woman noticed a constant urge to urinate. At the same time, the general analysis of urine did not deviate significantly from the standard.
Treatment includes long-term use of topical estrogen in the form of creams and suppositories. In addition, it is recommended to reduce or completely eliminate caffeinated beverages and maintain optimal body weight.
How to collect urine for analysis
- On the eve of the test, it is recommended not to drink mineral water, exclude the use of color-changing foods (such as carrots, beets) and drugs (riboflavin, rifampicin, aspirin, triamterene, phenolphthalein, etc. ) in urine;
- On the eve of the test, it is recommended not to drink mineral water, exclude the use of color-changing foods (such as carrots, beets) and drugs (riboflavin, rifampicin, aspirin, triamterene, phenolphthalein, etc. ) in urine;
- If possible, do not take diuretics;
- Urine testing during menstruation is not recommended;
- Before collecting urine, it is recommended to go to the toilet on the external genitals, but do not use antiseptics;
- Use the index and middle fingers to separate the outer labia to the sides to prevent contact with the urine stream;
- For analysis, the morning part of the urine is collected: the first third of the urine drops, the last third of the urine is collected in the container for analysis, and the third of the urine drops again;
- The walls of the container must not come into contact with the genitals;
- It is recommended to use a dedicated container to collect urine;
- Urine must be transported to the laboratory in an airtight container no later than 2 hours after collection;
- Don't forget to bring your referrals for analysis.
How to Relieve Cystitis Pain
- A heating pad on the lower abdomen can relieve pain and heaviness in the pelvic area;
- take a hot bath for 15-20 minutes;
- Drink plenty of water to make about 2. 5 liters of urine stand out: urine washes away bacteria mechanically;
- Avoid foods that irritate the bladder: caffeinated beverages, alcohol, citrus juices, spicy foods.
Prevent recurrence of cystitis
- frequent urination;
- Drinking regime - 1. 5 liters or more per day. Helps flush bacteria from the bladder.
- Maintain daily hygiene of the perineal area without the use of irritants;
- Provide hygienic showers for all partners before and after sex. Women are advised to urinate immediately after intercourse;
- Avoid hypothermia in the legs and overall body;
- Accept cranberry juice or juice drinks, however, according to recent data, this method is not as effective.
- Do not use deodorants, sprays, and makeup on the perineal area, as they can irritate the urethra;
- Do not dry your genitals with toilet paper.
In the event of symptoms of cystitis, we recommend that you consult your doctor to choose the right treatment, which will minimize the risk of recurrence. healthy!
Frequently Asked Questions
When do I need immediate medical attention?
We recommend that you consult your doctor immediately at the first symptoms of cystitis, when symptoms return during pregnancy or after treatment, or when you develop gross hematuria (blood in the urine). The doctor will talk to you, examine you and decide if other studies and treatments need to be prescribed, and tell you about preventive measures.
How to prepare to see a doctor?
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 might signal the onset of symptoms (hypothermia, sexual intercourse, etc. ). Be sure to write all your questions down to your doctor so you don't forget to ask them and discuss any issues that are bothering you.
Under what circumstances do you need to be hospitalized?
Requires emergency hospitalization in an emergency hospital:
- When there are signs of inflammation of the kidneys (acute pyelonephritis), namely: back or side pain, fever and chills above 38 ° C, nausea and vomiting;
- If there is blood in the urine (gross hematuria), but there are no symptoms of cystitis;
- Progression of the condition (severe pain syndrome, persistent high fever) on the background of continued treatment.