Cystitis is one of the most common urological diseases. Over the course of their lives, one in four women suffer from this disease, 30% of them may experience a recurrence of the disease within a year and 10% may have a frequently aggravated form.
This disease is familiar to many girls and women firsthand, significantly reducing the quality of life. Often, during the first episode of cystitis, patients experience severe pain and fear and don't know what to do. Our article is intended to help avoid the onset of cystitis and, in the event of symptoms, to guide you for further action.
Cystitisit is 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 features 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, as their urethra is long and the prostate gland 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 a sign of prostatitis.
It is important to note that cystitis in the vast majority of cases is caused not by microorganisms that enter the body from the external environment or during sexual intercourse, but by their own bacteria, which normally inhabit the intestine and the female genital tract. Any factor leading to a decrease in immunity (hypothermia, stress, etc. ) causes an increase in the reproduction of endogenous (internal) microorganisms, which lead to inflammation of the bladder mucosa. The presence of special fimbria in these bacteria (hooks for adhesion to the bladder wall), their large number and a decrease in 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 properly selected, these infections can travel 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;
- 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 bladder stone, a hypoactive 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 the neck
- Frequent urination (more than 8 times a day);
- The presence of an increase in the number of leukocytes in the general urine analysis;
- Urgent imperative need to urinate;
- Feeling of pressure or spasm in the pubic area
- The appearance of a mixture of blood in the urine, especially at the end of urination;
- Absence of itching and vaginal 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
Uncomplicated acute cystitis
In the vast majority of cases, the diagnosis is obvious by the presence of characteristic symptoms (frequent urination, pain at the end of urination). As a rule, with this variant of cystitis no additional diagnostics is required, but it is possible to immediately begin empirical administration (proven in practice) of the recommended antibacterial drug. At the moment, as a rule, a single dose is enough. Only in case of treatment failure, further examination is indicated. Checking the general urinalysis with signs of complete recovery is also not required.
In acute cystitis in the general analysis of urine, an increase in the number of leukocytes is always detected.
If not, the diagnosis is questionable and other causes of frequent and painful urination must be sought.Acute cystitis maskscan 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.
Frequently recurrent cystitis
Recurrent cystitis is the presence of 2 or more episodes in six months or 3 or more episodes in a year.
Because in some women cystitis is a life event, while in others it leads to frequent relapses, the science is not exactly known.
Possible causes of recurrent cystitis:
- genetic predisposition (decrease in 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, even latent (ferritin deficiency);
- hypothyroidism (reduced production of thyroid hormones);
- diabetes;
- vaginal dysbiosis;
- intestinal dysbiosis;
- use of diaphragms and spermicides;
To diagnose the causes of recurrent cystitis, use:
- general urine analysis;
- bacterial urine analysis 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 (estrogen deficiency detection);
- blood sugar, glycated hemoglobin, insulin, C-peptide (diagnosis of diabetes mellitus);
- TSH, T4-free, T3-free (diagnosis of hypothyroidism);
- general blood test;
- blood ferritin (detection of latent anemia);
- uroflowmetry (determination of the speed of urination).
If the cause of this form of cystitis cannot be found, the use of special immune preparations is considered the "gold standard" in the first line of therapy. Their mechanism of action is the ingestion of weakened strains of Escherichia coli and the development of protective antibodies on them, which subsequently prevent microbes from multiplying.
Antibacterial drugs are also used in small doses at night, for a long time, herbal drugs and diuretics, 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 sexual contact. Most often, women meet him when a new sexual partner appears or with the onset of family life. At the same time, obvious pathogens that require treatment are not always detected in men.
An important differentiatorcauses of postcoital cystitisiscondom test:
- there are no relapses when using condoms: the male factor (search for genital infections in the urethra, on the head of the penis, on the prostate, on the testicles);
- constant relapses when using condoms. One possible cause is a latex allergy. The use of spermicides is recommended;
- the use of condoms does not lead to healing, when using lubricants there are no relapses. Sexual factor, possible local trauma of the dry mucosa during intercourse. The use of lubricants is recommended;
- the use of condoms does not lead to healing, the use of lubricants does not lead to healing. The female factorExamination by a gynecologist to exclude the low position 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 sexual intercourse;
- Women are advised to urinate immediately after intercourse;
- 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 obligatory presence of pathology in the wall or cavity of the bladder:
- stones;
- tumors;
- foreign bodies;
- cystocele;
- diverticulum (protrusion of the wall outwards);
- ulcer;
- leukoplakia
Cystoscopy (examination of the inner surface of the bladder) plays an important role in making a diagnosis or confirming it.
In the treatment of chronic cystitis, first of all, measures aimed at eliminating the root cause, usually surgically, are important.
cystitis in menopause
It occurs due to insufficient levels of estrogen, like other menopausal disorders in the body. The hormone dependent bladder mucosa becomes thinner and more sensitive. The woman notes 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 topical estrogen in the form of creams and suppositories. In addition, it is recommended to reduce or completely eliminate the use of caffeinated drinks and to 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 exclude the use of foods (for example, carrots, beets) and drugs (riboflavin, rifampicin, aspirin, triamterene, phenolphthalein, etc. ) that can alter the color of urine;
- On the eve of the test it is recommended not to drink mineral water and exclude the use of foods (for example, carrots, beets) and drugs (riboflavin, rifampicin, aspirin, triamterene, phenolphthalein, etc. ) that can alter the color of urine;
- If possible, do not take diuretics;
- It is not recommended to perform a urinalysis during menstruation;
- Before collecting urine, it is recommended to perform a toilet of the external genitalia, but without the use of antiseptics;
- The outer lips are divided at the sides with the index and middle fingers to avoid contact with the urine stream;
- For the analysis, a morning portion of urine is collected: the first third of the urine falls, the second third of the urine is collected in a container for analysis, the third is again descended;
- The walls of the container and the genitals must not touch each other;
- It is recommended to use special containers for urine collection;
- 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 referral with you for analysis.
How to relieve the pain of cystitis
- A heating pad on the lower abdomen relieves pain and heaviness in the pelvic area;
- Do warm sitz baths for 15-20 minutes;
- Drink plenty of fluids so that about 2. 5 liters of urine stand out: urine mechanically eliminates bacteria;
- Avoid foods that irritate the bladder: caffeinated drinks, alcohol, citrus juices, spicy foods.
Prevention of recurrence of cystitis
- Frequent urination
- Consumption regime: 1. 5 liters or more per day. 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 intercourse. Women are advised to urinate immediately after intercourse;
- Avoid hypothermia of the legs and the body as a whole;
- Reception of cranberry juice or fruit drink, however, according to recent 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 genitals.
If you have symptoms of cystitis, we recommend that you consult a doctor to select the right treatment, which will minimize the risk of recurrence. Be healthy!
Frequent questions
In what cases is it necessary to consult a doctor immediately?
It is advisable to consult a doctor immediately at the first symptoms of cystitis, during pregnancy, or when symptoms return after the end of the course of treatment, at the appearance of coarse hematuria (visible blood in the urine). 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 you about preventive measures.
How to prepare for a doctor's appointment?
Write down all of 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 all questions to your doctor so you don't forget to ask them and discuss any points that bother you.
In which cases is hospitalization indicated?
Emergency admission to an emergency hospital is indicated:
- when signs of inflammation of the kidneys (acute pyelonephritis) appear, namely: pain in the back or flank, fever above 38 ° C and chills, nausea and vomiting;
- if blood appears in the urine (gross hematuria), but there are no symptoms of cystitis;
- worsening of the condition against the background of ongoing therapy (severe pain syndrome, persistent persistent hyperthermia).