Cystitis is one of the most common urological diseases. Throughout life, every fourth woman suffers from this disease, 30% of them may experience a relapse of the disease within a year and 10% may have a severe form often.
This disease is known firsthand for many girls and women, significantly reducing 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 occurrence of cystitis and, in case of symptoms, to guide further actions.
Cystitisis an inflammation of the lining of the bladder.
reason
Infections are the main cause of cystitis, non-infectious causes are much less common. The fact that women get 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, as well as hormonal characteristics. Men do not suffer from cystitis, since their urethra is long and the prostate gland is a kind of anatomical barrier for the upward entry of microorganisms into the urinary bladder. Frequent urination in men, pain in the perineum, pain at the end of puberty are signs 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 their own bacteria, which normally reside in the intestines and female genital tract. Any factor that leads to a decrease in immunity (hypothermia, stress, etc. ) causes increased reproduction of endogenous (internal) microorganisms, which lead to inflammation of the bladder mucosa. The presence of special fimbriae in these bacteria (hooks for sticking to the bladder wall), their large number and the 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 chosen properly, these infections can pass 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 causative 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;
- Reduction of the body's immune response (with diabetes, HIV infection, chemotherapy, etc. );
- The presence of obstructions in the outflow of urine (for example, a stone in the bladder, an inactive bladder due to neuropathy due to diabetes mellitus).
Symptoms of acute cystitis
- Pain at the end of urination (when the lower part of the bladder touches its neck;
- Frequent urination (more than 8 times a day);
- The presence of an increased number of leukocytes in the general analysis of urine;
- Urgent imperative urge 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;
- Lack of itching and vaginal secretions;
- 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 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, no additional diagnosis is required, but you can immediately start an empiric (proven in practice) administration of the recommended antibacterial drug. At the moment, as a rule, a single dose is enough. Only in case of treatment failure, an additional examination is indicated. Control of the general analysis of urine with signs of full recovery is also not required.
In acute cystitis in the general analysis of urine, an increased number of leukocytes is always detected.
If this is not the case, the diagnosis is doubtful and other causes of frequent and painful urination should be sought.Mask for acute cystitisit can be:
- overactive bladder;
- inflammation of the urethra caused by clear 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 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);
- anomalies in the development of the urinary system;
- prolapse (prolapse) of internal genital organs;
- lack of estrogen;
- lack of vitamin D;
- iron deficiency anemia, including latent (ferritin deficiency);
- hypothyroidism (reduced production of thyroid hormones);
- diabetes;
- vaginal dysbiosis;
- intestinal dysbiosis;
- use of diaphragms and spermicides;
To diagnose the causes of frequently recurring cystitis, use:
- general analysis of urine;
- bacterial analysis of urine with the 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 (detection of estrogen deficiency);
- blood glucose, glycated hemoglobin, insulin, C-peptide (diagnosis of diabetes mellitus);
- TSH, no T4, no T3 (diagnosis of hypothyroidism);
- general blood analysis;
- blood ferritin (detection of latent anemia);
- uroflowmetry (determination of urination speed).
If the cause of this form of cystitis cannot be found, the use of special immune preparations is considered the "golden" standard in the first line of therapy. Their mechanism of action is to take weakened strains of Escherichia coli and develop protective antibodies on them, which then prevent the microbes from multiplying.
Antibacterial drugs are also used in small doses at night, for a long time, herbal and diuretic drugs, the introduction of hyaluronic acid into the bladder (increases the protective ability of the bladder).
Postcoital cystitis
This is cystitis that appears up to 36 hours after sexual contact. Most often, women encounter it when a new sexual partner appears or at the beginning of family life. At the same time, obvious pathogens that require treatment are not always detected in men.
An important differentiating factorCauses of postcoital cystitisit'scondom test:
- there are no relapses when using condoms - the male factor (search for genital infections in the urethra, head of the penis, prostate, testicles);
- persistent relapses while using condoms. One possible cause is an allergy to latex. The use of spermicides is recommended;
- the use of condoms does not lead to healing; when you use lubricants, there is no going back. Sexual factor, possibly local traumatization of the dry mucosa during sexual 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 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 sexual 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 is due to the mandatory presence of pathology in the bladder wall or cavity:
- stones;
- tumors;
- foreign bodies;
- cystocele;
- diverticulum (extension of the wall to the outside);
- ulcers;
- leukoplakia
Cystoscopy (examination of the inner surface of the bladder) plays a major 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 surgical, are important.
menopausal cystitis
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 notices the frequent urge to urinate. At the same time, there are no significant deviations 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 beverages containing caffeine 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 exclude the use of foods (for example, carrots, beets) and drugs (riboflavin, rifampin, aspirin, triamterene, phenolphthalein, etc. ) that can change 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, rifampin, aspirin, triamterene, phenolphthalein, etc. ) that can change the color. of urine;
- If possible, do not take diuretics;
- It is not recommended to do a urine analysis during menstruation;
- Before collecting urine, it is recommended to perform a toilet of the external genital organs, but without the use of antiseptics;
- The outer labia are separated laterally with the index and middle fingers to prevent contact with the flow of urine;
- For analysis, a portion of urine is collected in the morning: the first third of the urine goes down, the second third of the urine is collected in a container for analysis, the third goes down again;
- The walls of the vessel and the genitals should not be touched;
- It is recommended to use special containers for collecting urine;
- It is necessary to deliver the urine in a tightly closed container to the laboratory no later than 2 hours after collection;
- Don't forget to take your referral with you for analysis.
How to relieve cystitis pain
- A heating pad on the lower abdomen will relieve pain and heaviness in the pelvic area;
- Taking hot baths for 15-20 minutes;
- Drink plenty of fluids so that about 2. 5 liters of urine are visible: 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 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 sex;
- Avoid hypothermia of the legs and body as a whole;
- Taking cranberry juice or fruit drinks, however, according to recent data, this method is not as 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 to choose the right treatment, which will minimize the risk of recurrence. Be healthy!
Frequently asked questions
In which cases is it necessary to immediately consult a doctor?
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 severe 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 your symptoms, even if you think they are not 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 concern you.
In what cases is hospitalization indicated?
Urgent admission to an emergency hospital is indicated:
- when signs of kidney inflammation (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;
- deterioration of the condition against the background of ongoing therapy (severe pain syndrome, persistent persistent hyperthermia).