Acute cystitis: causes, symptoms and treatment in an article by surgeon D. L. Kolesnikov.

Cystitis is an inflammation of the bladder.

The bladder is a hollow organ designed to store urine. Urine is produced by the kidneys and travels down the ureters to the bladder. Urine is removed from the bladder through the urethra (urethra). The walls of the bladder are formed by a special type of muscle; the inside of the organ cavity is lined with mucous membrane.

Most often, inflammation in cystitis affects only the mucous membrane, but in some cases, the muscle tissue of the walls of the bladder can also be involved in the inflammatory process.

Causes of bladder inflammation: bacterial and non-bacterial cystitis

The content of the article

When we talk about bladder inflammation, we primarily mean cystitis caused by the proliferation of bacteria in the urine - bacterial cystitis. But there are other forms of cystitis, provoked by non-bacterial and non-infectious causes. Their symptoms are very similar to true bacterial cystitis, however, their main feature is that they are not associated with an increase in the number of dangerous bacteria in the urine and bladder.

For example, ordinary hypothermia - hypothermia - can lead to the appearance of symptoms of cystitis. Low temperature irritates the bladder receptors located at the very bottom of the pelvis and weakens the natural immunity of the urethral mucosa. Under this condition, bacteria can attack the bladder by entering the genitourinary tract from outside. Those. non-bacterial cystitis can easily become bacterial.

The patient may also develop:

Fungal cystitis
, which is a type of infectious cystitis. Its cause is a fungal infection;
Post-radiation cystitis
. May occur years after pelvic radiation;
Venereal cystitis.
Inflammation of the bladder caused by sexually transmitted agents. They are not detected during routine bacteriological examination of urine; additional analysis is required to identify them.
Overactive bladder
. Cystitis associated with bladder irritation, for example due to sand in the bladder. Significant mental stress can lead to similar signs of bladder dysfunction. The condition can also be caused by an enlarged prostate gland in men, although an overactive bladder can also develop without a significant enlargement of the prostate gland.

Why it is not recommended to treat cystitis at home

The onset of cystitis occurs quickly, so most often patients begin treatment on their own and perhaps even improve.

It is important to remember that the disease does not stop once the symptoms disappear.

If the disease is not treated, it can become chronic. The inflammatory process can take an upward path and even cause pyelonephritis.

Epidemiology and clinical picture of cystitis

Classic bacterial cystitis is a disease that primarily affects women due to the specific structure of the lower genitourinary tract: a short urethra and the proximity of the bacterial flora of the vagina and intestines.

According to statistics:

About 15% of adult women develop cystitis at least once a year;
Almost two thirds of women experience bladder inflammation at least once in their lives.
Of these two-thirds, 25% suffer from recurrent bladder infections.

You can get cystitis very simply, for example, by standing barefoot on a cold tile in the bathroom. The clinical picture may be caused by irritating foods and carbonated or alcoholic drinks.

Cold tile

Symptoms of cystitis develop relatively quickly. First signs:

Frequent, painful urination with small amounts of urine. Often patients note that only a few drops are released.
Burning when urinating;
The appearance of a few drops of blood at the end of urination;
Pain or cramping in the lower abdomen above the pubic bone;
Body temperature is usually not elevated, and if present, it does not exceed 37.5 ° C.

Painful urination

Low temperature

Examination of the patient usually shows weak sensitivity in the lower abdomen, in the central part, that is, in the projection of the bladder itself.

How to relieve the symptoms of cystitis before consulting a gynecologist

Rules that you can begin to follow even before going to the doctor and together with the recommended therapy:

Bed rest. This will support the body in the fight against the disease.
As mentioned above, drinking plenty of fluids will speed up your recovery.
Food should not be spicy or salty. It is best to eat foods high in calcium - dairy products, some vegetables.
You can and should use herbal decoctions and special mixtures. Also in pharmacies there are tablets with extracts of the same herbs. If the disease is not very severe, such treatment may be sufficient. But it is better for a specialist to give recommendations regarding herbal treatment.

Bladder infection in men

Although bladder infections are more common in women, men also get cystitis.

Signs and symptoms of bladder infection (cystitis) in men:

Frequent urination;
A strong and constant need to urinate (urgency);
A burning or tingling sensation when urinating or immediately after urinating (dysuria);
Low temperature;
Cloudy urine with a strong odor;
Presence of blood in the urine (hematuria);
Problems with urination, especially if there are problems with the prostate.

Blood in the urine
Disorders that may be associated with an increased risk of bladder infection in men include the following:

Enlarged prostate (benign prostatic hyperplasia);
Stones in the kidneys;
Abnormal narrowing of the urethra (urethral stricture);
Recent urinary tract procedure: insertion of a tube to drain the bladder (catheterization) or insertion of a small camera to examine the bladder and urethra (cystoscopy).

Profitable loyalty

There is an objective anatomical reason for the fact that cystitis is predominantly female. After all, in the fair sex, the urethra is much shorter and wider than the male one, so the path upward to the bladder for pathogenic microbes becomes shorter and easier. However, for a disease to occur, the penetration of microbial agents alone is not enough. After all, the protective forces of the bladder mucosa, guarded by beneficial lacto- and bifidobacteria, are usually sufficient to give a worthy rebuff to the infection. But if local immunity is weakened, then it’s a different matter. The protective forces of the mucous membrane can be negatively affected, for example, by hypothermia, injury, stress, excessive alcohol intake, promiscuous sex life, poor intimate hygiene, chronic diseases, etc.

By the way, frequent changes of sexual partners for women (and especially young girls with unsettled hormonal levels and not fully formed intimate microflora) are even more harmful than for men. And we’re not just talking about sexually transmitted diseases. After all, the female intimate flora is forced to adapt to the partner’s flora each time (after all, men’s intimate organs normally contain streptococci and other opportunistic flora). At some point, the adaptation process may be disrupted, and then the female microflora will suffer, and against this background, candidiasis, cystitis, and other troubles may arise. Therefore, it is especially important for girls to remain faithful to their only sexual partners, and it is better for very young ladies not to rush into “adult” life.

Diagnosis of cystitis

A definitive diagnosis cannot be made solely on the basis of symptoms and physical examination; urine sediment examination is necessary. The diagnosis of cystitis is confirmed if, together with the above-mentioned signs of the disease, an increased number of leukocytes is detected in the urine.

Patients are prescribed:

general and bacteriological urine tests;
general blood analysis;
smear for infections from the urethra;
Ultrasound of the pelvis with a detailed examination of the bladder.

In difficult cases, cysto- and urethroscopy is performed.

Before and after tests

According to standards, treatment of cystitis with antibiotics is prescribed immediately. Before treatment, only a general urine test is required to detect signs of inflammation. And if it is not possible to take it to the laboratory, you can use an express test strip. Next, antibiotics are prescribed. In more than 80% of cases, cystitis is caused by the bacterium E. coli, or Escherichia coli. But opportunistic bacteria (Klebsiella, ureoplasma, streptococcus, staphylococcus) can also be causative agents. They themselves do not cause the disease, but weaken the body’s immune defense, and against this background pathological flora - fungi, bacteria - joins.

And after a course of antibacterial therapy, it is recommended to do a bacterial culture of the urine to make sure that there is no causative agent of the disease, which means that the infection has been cured.

Treating cystitis with folk remedies is less effective than antibiotics. Therefore, warm heating pads, herbs and cranberry juice are best used only in addition to treatment. And also only with the permission of a doctor, because any drugs, even herbal ones, can cause allergies or have individual intolerance. However, medicine knows cases of spontaneous healing of cystitis, when a strong immune system managed to cope with the inflammation on its own. However, playing “roulette” with a disease is quite dangerous, especially if there are effective medications.

Proper treatment of cystitis

Despite the fact that cystitis may gradually fade away on its own, it is necessary to treat all inflammations of the bladder that lead to the appearance of symptoms and the growth of bacteria in the urine. The infection can spread to neighboring organs, cause complications, and become chronic.

It is especially important to treat:

Men and women with a significant amount of bacteria in their urine - > 100,000 (more than 10 out of 5) bacteria in one milliliter of urine;
Patients with weak immunity;
Patients with recurrent cystitis;
Patients with venereal cystitis;
Pregnant women;
Patients undergoing urological, orthopedic or gynecological surgery;
Patients before organ transplantation.

The goal of treatment for bacterial cystitis is abstinence, that is, “sterilization” of urine, and elimination of symptoms of bladder inflammation. Thus, the first choice drugs, depending on the results of the urine test, are nitrofurantoin, co-amoxiclav, cephalexin or norfloxacin.

Treatment of cystitis
These drugs are also used to treat and prevent recurrence of cystitis during pregnancy. But nitrofurantoin should not be used during the last three months of pregnancy. In pregnant women, urine cultures should be checked 14 days after treatment.

Prevention

As a preventative measure, both partners should be sure to maintain good hygiene.
Partners should avoid sexual positions that create pressure or friction on the urethra, as well as intense tempos.
It is necessary to use special lubricants (lubricants) in case of natural deficiency of vaginal mucus.
Provide timely treatment for gynecological diseases.
Do not use spermicides or vaginal diaphragms for contraception.
It is recommended to empty the bladder immediately after sexual intercourse, this allows you to “evacuate” most of the bacteria that have entered the bladder.
Immediately after contact, drink at least 300 ml of liquid.

It's time to start an investigation

But sometimes even treatment according to all the rules does not help. Therefore, if cystitis has not gone away within 7 days, it is necessary to undergo further examination, and, perhaps, begin to actively look for concomitant diseases. Among them may be, for example, other diseases of the genitourinary system (such as colpitis, bacterial vaginosis, pyelonephritis, urolithiasis, prostatitis in men), as well as genital infections (trichomoniasis, chlamydia). Patients with diabetes mellitus are also predisposed to cystitis (“sweet” urine promotes the growth of bacteria).

To identify the circle of “suspects,” the doctor must collect an anamnesis. And for this, you need to find out whether cystitis occurred for the first time or not, whether there was hypothermia before the exacerbation, whether all this was preceded by unprotected sex, whether the patient underwent aggressive treatment (chemotherapy, radiation therapy), whether he took medications and what kind, etc.

Depending on this, the doctor can refer the patient to a gynecologist and urologist, and also prescribe a list of necessary studies. As a rule, for chronic cystitis, the following are necessary: ultrasound of the pelvic organs and invasive cystoscopy (a tube with light is inserted into the urethra, and the condition of the mucous membrane is assessed).

Among the tests, you may need a urine sample according to Nechiporenko (helps to exclude or confirm the diagnosis of “pyelonephritis”) and the so-called two-glass urine sample (needed to make a differential diagnosis between cystitis and urethritis).