Cystitis is one of the most common urological diseases. Throughout life, one in four women suffers 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 first-hand familiar to many girls and women, 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 prevent the onset of cystitis and, in the event of symptoms, to guide the adoption of additional measures.
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 cystitis is associated with anatomical and physiological characteristics of the body, including 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 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 not caused by microorganisms that enter the body from the external environment or during sexual intercourse, but by its own bacteria, which normally inhabit the intestines and genital tract. feminine. Any factor that leads to a decrease in immunity (hypothermia, stress, etc. ) causes an increase in the reproduction of endogenous (internal) microorganisms, which leads to inflammation of the bladder mucosa. The presence of special fimbriae 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 lead to the development of inflammation.
If cystitis is not treated, or antibiotic therapy is not properly selected, these infections can ascend through the urinary tract, causing inflammation of the kidneys, whose characteristic symptoms are:
- increased 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% to 10% of cases;
- Other Enterobacteriaceae are even less common.
Risk factors for cystitis
- sexual activity;
- Insufficient hygiene;
- Use of intravaginal contraceptives;
- Leg hypothermia or general hypothermia;
- The 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, an underactive bladder due to neuropathy from diabetes mellitus).
Symptoms of acute cystitis
- Pain at the end of urination (when the lower part of the bladder touches the neck;
- frequent urination (more than 8 times a day);
- The presence of an increased number of leukocytes in the general urinalysis;
- urgent imperative urge to urinate;
- Sensation of pressure or spasm in the pubic area;
- The appearance of an admixture of blood in the urine, especially at the end of urination;
- Absence of vaginal itching and 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 evident from the presence of characteristic symptoms (frequent urination, pain at the end of urination). As a rule, with this variant of cystitis, additional diagnostics are not required, but an empirical (proven in practice) administration of the recommended antibacterial drug can be started immediately. At the moment, as a rule, a single dose is sufficient. Only in case of treatment failure, further examination is indicated. Control of the general urinalysis with signs of complete recovery is also not required.
In acute cystitis in the general urinalysis, an increased number of leukocytes is always detected.
If this is not the case, the diagnosis is in doubt and other causes of frequent and painful urination should 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 recurring cystitis
Frequent recurrent cystitis is the presence of 2 or more episodes in six months or 3 or more episodes in a year.
Why in some women cystitis is an episode in life, while in others it leads to frequent relapses, science does not know exactly.
Possible causes of recurrent cystitis:
- genetic predisposition (decreased 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 (decreased production of thyroid hormones);
- diabetes;
- vaginal dysbiosis;
- intestinal dysbiosis;
- use of diaphragms and spermicides;
To diagnose the causes of frequent recurring cystitis, use:
- general urinalysis;
- bacterial analysis of urine 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 (screening for estrogen deficiency);
- blood glucose, glycosylated hemoglobin, insulin, C-peptide (diagnosis of diabetes mellitus);
- TSH, free T4, free T3 (diagnosis of hypothyroidism);
- general blood tests;
- 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. Its mechanism of action is the intake of weakened strains of Escherichia coli and the development of protective antibodies on them, which subsequently prevent the 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 find it when a new sexual partner appears or with the beginning of family life. At the same time, the obvious pathogens that require treatment are not always detected in men.
An important differentiating factorCauses of postcoital cystitisit iscondom test:
- there are no relapses when using condoms: the male factor (search for genital infections in the urethra, on the head of the penis, prostate, testicles);
- constant relapses when using condoms. One possible cause is an allergy to latex. The use of spermicides is recommended;
- the use of condoms does not lead to recovery, when using lubricants there are no relapses. Sexual factor, possibly local traumatization of the dry mucosa during intercourse. The use of lubricants is recommended;
- using condoms does not lead to recovery, using lubricants does not lead to recovery. The feminine factor. Examination by a gynecologist to exclude the 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:
- Hygiene 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-containing lubricants;
- Do not use deodorants, sprays 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;
- strange bodies;
- cystocele;
- diverticulum (bulge of the wall outwards);
- sore;
- leukoplakia
Cystoscopy (examination of the inner surface of the bladder) plays an important role in making or confirming a diagnosis.
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, just like other menopausal disorders in the body. The hormone-dependent bladder mucosa becomes thinner and more sensitive. The woman notices a frequent urge to urinate. At the same time, there are no significant deviations from the norm in the general analysis of urine.
Treatment includes 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 beverages containing caffeine 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 and to exclude the use of foods (for example, carrots, beets) and drugs (riboflavin, rifampin, aspirin, triamterene, phenolphthalein, etc. ) that can change the color. 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. urine;
- If possible, do not take diuretics;
- Urinalysis is not recommended during menstruation;
- Before collecting urine, it is recommended to cleanse the external genitalia, but without the use of antiseptics;
- The labia majora are separated to the sides with the index and middle fingers to avoid contact with the urine stream;
- For analysis, a portion of morning urine is collected: the first third of the urine goes down, the second third of the urine is collected in a container for analysis, the third is lowered again;
- The walls of the container and the genitals should not touch;
- It is recommended to use special containers for urine collection;
- 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 for testing with you.
How to ease the pain of cystitis
- A heating pad on the lower abdomen will relieve pain and heaviness in the pelvic area;
- Take hot sitz baths for 15-20 minutes;
- Drink plenty of fluids so that about 2. 5 liters of urine stand out - urine mechanically removes bacteria;
- Avoid foods that irritate the bladder: caffeinated drinks, alcohol, citrus juices, spicy foods.
Prevention of recurrence of cystitis.
- Frequent urination;
- Drinking regimen: 1. 5 liters or more per day. Helps eliminate bacteria from the bladder.
- Proper daily hygiene of the perineal area without the use of irritants;
- Hygienic shower for all couples before and after sex. Women are advised to urinate immediately after sex;
- 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, sprays 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 to select the appropriate treatment, which will minimize the risk of recurrence. Be healthy!
Frequent questions
In what cases is it necessary to consult a doctor immediately?
We recommend that you immediately consult a doctor at the first symptoms of cystitis, during pregnancy or the return of symptoms after the end of the course of treatment, the appearance of macroscopic 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 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're related to cystitis. Write down any medical conditions you have and any medications and supplements you take. Think about what might herald the onset of symptoms (hypothermia, sexual intercourse, etc. ). Be sure to write all questions to the doctor, so you don't forget to ask 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 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 hematuria), but there are no symptoms of cystitis;
- worsening of the condition against the background of ongoing therapy (severe pain syndrome, persistent persistent hyperthermia).