Cystitis

The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: “Why not self-medicate?”. Cystitis is an inflammation of the bladder (code in ICD 10 – N30). This disease is the most common among all urinary tract infections. Cystitis affects mainly women, which is associated with the anatomical feature of the urethra.

The incidence of cystitis in females is more common than in males and increases with age. And in old age, cases of cystitis are compared in frequency in both sexes.

What is actually the cause of the disease and why do some people have cystitis once in a lifetime and never repeat after a course of treatment, while others can treat the disease several times a year and the symptoms return again? Why not only adults, but also teenagers and even small children suffer from inflammation of the bladder?

Forms

There are many factors that affect the occurrence and nature of the course of cystitis. Depending on the causes that caused the disease and the characteristics of its development, it is customary to distinguish between several forms of the disease.

By origin, cystitis is classified into primary or secondary. According to the nature of the course, two forms are distinguished – acute and chronic. And according to the etiological factor, cystitis is divided into infectious or non-infectious.

Primary and Secondary

Primary cystitis is more common in women, due to the anatomical features of the urethra. Male patients are more prone to developing secondary cystitis.

Primary cystitis is characterized by acute onset in the intact bladder as an independent disease. The onset of the disease is provoked by factors that contribute to a decrease in general and local immunity, as well as non-compliance with natural hygiene procedures. In some cases, the cause of cystitis remains unknown. In almost 91% of patients with the primary form of the disease, laboratory tests confirm the presence of bacteria in the urine. Primary cystitis is characterized by frequent relapses: about every tenth woman suffers from a recurrent form of the disease. In expectant mothers in the early stages of pregnancy (in the first trimester), both primary and secondary forms of cystitis can be diagnosed.

Secondary cystitis is a complication of other diseases. Most often, malignant tumors or stones in the genitourinary system lead to it. In men, the disease often appears against the background of an inflammatory process in the prostate gland or with prostate adenoma. In women – after radiation therapy with malignant processes in the pelvic organs, with endocrinological diseases, accompanied by a decrease in hormonal levels with changes in the mucous membrane of the urinary tract. In addition, the disease can develop in parallel with tuberculosis of the genitourinary organs.

Distinguishing between primary and secondary cystitis is fundamentally important, since the treatment of both forms has significant differences. Without eliminating the cause that provoked secondary cystitis, it is quite difficult to cure inflammation. In addition, secondary cystitis, as a rule, does not respond well to antibiotic therapy and is more severe.

Acute and chronic

Acute cystitis, which usually appears after the action of a provoking factor, is characterized by frequent and painful urination. The patient is concerned about pain in the bladder and perineum, possibly bleeding at the end of urination, and symptoms of general intoxication are also possible. But it is at this stage that the disease is most amenable to treatment. If it is not treated in the acute phase or treated incorrectly, acute cystitis becomes chronic (sluggish cystitis). Then the symptoms are no longer so pronounced, but this does not mean that infection occurs easily. In the presence of chronic inflammation in the body, the infection persists, resistance to antibiotics develops, and the lining of the bladder walls is not able to recover on its own. At this stage, the disease is treated with difficulty, and with provoking factors it easily aggravates (sometimes every month). Interestingly, sluggish cystitis is more common in men and in many cases is asymptomatic.

infectious and non-infectious

Infectious cystitis is a disease caused by an infection. Depending on the type of pathogen, cystitis can be viral, bacterial or fungal.

The cause of a bacterial disease is bacteria that enter the urinary system through the urethra. In most clinical cases, cystitis of this type is diagnosed in women. Due to the peculiarities of the structure of the genitourinary system (wider urethra, close location of the opening of the urinary canal to the anus), it is easier for them to become infected. In girls who are sexually active, coitus can be the cause of cystitis. But this is no reason to believe that virgins and little girls do not have this disease. Cystitis of infectious etiology occurs even in newborns. A common cause of the disease in women is bacteria that lives in the large intestine or sexually transmitted infections.

The most frequent clinical cases are infections with Escherichia coli, Staphylococcus, Streptococcus, Klebsiella, Gonococcus, Trichomonas, Mycoplasma, Proteus, Treponema. In addition, inflammation of bacterial etiology can appear against the background of menstrual bleeding, as well as during menopause.

Viral cystitis occurs in people with a weak immune response. This type of cystitis, as a rule, develops against the background of another viral disease.

Secondary viral cystitis may develop following SARS, herpes viral diseases (chicken pox, shingles, colds on the lips, genital herpes, EBV, cytomegalovirus), be a consequence of adenovirus infection. Often, against the background of viral cystitis, bacterial inflammation joins.

The cause of fungal cystitis in most cases is Candida, and the schistosome (Schistosoma haematobium), common in water bodies of Africa and Central Asia, most often leads to parasitic cystitis. Candidiasis cystitis occurs in people with very weakened immunity, with diabetes, as well as in pregnant women (more often in the 2nd trimester, but it also happens in the first weeks). Candidal cystitis rarely affects men.

Non-infectious cystitis is an inflammation of the bladder caused by non-infectious factors. In such cases, the disease can be triggered by aggressive chemicals, taking certain groups of medications, disorders in the development of the genitourinary system, urolithiasis, injuries and other causes.

There are such types of non-infectious cystitis:

1. Interstitial (painful bladder syndrome). This chronic inflammation is more common in women. The exact cause of the disease is unclear, and the condition is often difficult to diagnose and difficult to treat.
2. Medicamentous (medicinal). It occurs against the background of prolonged use of medications, the components of which cause inflammation of the bladder.
3. Beam (post-beam). Appears after radiation therapy.
4. Caused by exposure to foreign objects. May be the result of prolonged use of a urological catheter, which caused damage and inflammation of the tissues of the urethra.
5. Chemical. It happens in people who are hypersensitive to chemicals contained in household chemicals and cosmetics.
6. Allergic. Occurs as a reaction to allergens.
7. Caused by other states. May occur as a complication of other diseases such as kidney or bladder stones, enlarged prostate, diabetes, spinal cord injury. Also, cystitis can appear after an unsuccessful operation as an iatrogenic injury, or with irrational self-administration of antibiotics.

According to the degree of damage to the walls of the bladder, there are:

• catarrhal cystitis (inflammation extends only to the mucous membrane);
• hemorrhagic cystitis (manifested by hemorrhagic changes in the mucous membrane with the appearance of traces of blood in the urine);
• ulcerative (characterized by the presence of ulcerative changes on the mucous membrane of the bladder).

In addition, cystitis can be of the following varieties:

• bullous (a type of chronic cystitis, with severe swelling of the inflamed walls of the bladder);
• summer (appears in the summer);
• purulent (purulent-fibrinous plaque is formed on the walls of the bladder);
• hormonal (against the background of hormonal failure);
• cystic (cysts form on the walls of the bladder);
• cervical, or cervical (inflammation on the neck of the bladder);
• honey, or honeymoon syndrome (after the onset of sexual activity);
• neurogenic, nervous (against the background of psycho-emotional states);
• postcoital (after intimacy);
• psychosomatic (explained by psychosomatics).

Causes and factors of occurrence

Approximately 70% of patients who seek help from a urologist suffer from an infection in the urinary tract. Moreover, women suffer 14 times more often than men. As already mentioned, it’s all about the anatomical features. Women have a wider and shorter urethra than men, which makes bacteria more likely to get inside. In addition, the opening of the urethra in women is located close to the anus, which compromises the high risk of E. coli (the most common causative agent of infectious cystitis) entering the urethra. This bacterium inhabits the intestines and is part of its healthy microflora, but when it enters the urethra, it becomes a threat not only to the bladder, but to the entire urinary tract. But this is far from the only cause of the disease.

Although women are more likely to suffer from cystitis, not all of them are equally predisposed to the disease.

High risk areas include:

• not observing the rules of personal hygiene;
• having a very active sex life with frequent changes of partners (although a certain risk is just frequent and very active sex);
• girls who have just begun sexual activity (this phenomenon has its own name – honeymoon cystitis);
• using some contraceptives, in particular diaphragms with spermicides;
• pregnant women (due to hormonal changes, diagnosed in 10% of expectant mothers);
• when breastfeeding (when the body is still recovering after childbirth);
• after menopause (against the background of menopause, hormonal disruptions occur).

Often cystitis in women appears after childbirth. This is due to the peculiarities of the birth act (entering the urethra of Escherichia coli, bladder injury) or the disease is the result of infection with streptococcus or staphylococcus aureus.

Also, cystitis is promoted by wearing tight underwear, constipation and bowel disease. An infection during surgery or trauma can provoke an ailment. In many women, clinical signs of inflammation appear during certain phases of the menstrual cycle: some before menstruation, others during or after, and still others on the day of ovulation.

Without any predisposing cause, cystitis is rare in men. As a rule, the secondary form affects persons older than 40 years.

Risk factors for men:

• violation of urination (due to prostatic hypertrophy, the presence of stones in the urinary tract and in the bladder, cancer);
• inflammatory processes (in any area of ​​the urogenital area);
• weakening of the immune response (against the background of diabetes mellitus, HIV infection, chemotherapy);
• long-term use of catheters to remove urine (in the elderly or those with chronic diseases);
• developmental anomalies in the urinary system.

The most common cause of infectious cystitis is sexual intercourse. Postcoital cystitis (especially if this is the first sexual intercourse with a new partner) is 13 times more common than for other reasons. In this case, the first symptoms of the disease appear within 24 hours after intercourse, a maximum of a day. Other causes of the disease include parasites, contact dermatitis, and even a psychological factor.

Children’s cystitis can be the result of hypothermia, beriberi, anomalies in the development of the urinary system, genetic predisposition, taking certain medications, and poor hygiene. Cystitis in infants is almost always the result of an untimely diaper change.

The course of the disease

Although cystitis always begins rapidly, it should take some time from infection to the onset of the first symptoms (usually up to 24 hours). In addition, some predisposing factors are necessary for the onset of the disease.

Under normal conditions, the bladder mucosa is inherently resistant to infection. For this reason, for the development of the disease, only the penetration of infection into the cavity of the organ is not enough. Other predisposing factors are needed for acute cystitis to start. This may be a reduced body resistance caused by beriberi, hypothermia, overwork, exhaustion, recent serious illnesses, hormonal disruptions, surgery, immunodeficiency. In men, urinary stasis caused by neurogenic dysfunction of the bladder, prostate adenoma, urethral stricture, and stones in the urinary system can lead to the development of the disease. If circumstances are favorable for the infection, then the disease develops and manifests itself with specific clinical symptoms.

Symptoms

The first symptoms of cystitis are usually acute and are characterized by the appearance of typical signs in the form of frequent and painful urination, as well as pain in the suprapubic region and cloudy urine. In some cases, bleeding may be seen at the end of urination.

Uncomplicated cystitis in the initial stage is less painful. More trouble for a person brings a neglected, often recurrent ailment.

Cystitis in men in an acute form is usually manifested by pain in the vulva, and women are concerned about vaginal discomfort (pain and burning are given to the clitoris), sometimes there is pain in the chest. Elderly women with inflammation complain of weakness, confusion, fever. Postpartum cystitis can be recognized by urinary retention, pain at the end of urination, cloudy urine. In children under the age of 5 years, typical symptoms of the disease are often absent. Instead, the child’s appetite disappears, irritability appears, urinary incontinence is possible, but parents do not always pay enough attention to this symptom, explaining it with age-related features. Acute cystitis is rarely accompanied by an increase in body temperature, and its appearance and the appearance of chills indicate a complicated course – ascending pyelonephritis, due to the occurrence of vesicoureteral reflux. The clinical picture of chronic cystitis depends on the etiology of the disease and the general condition of the patient.

Stages

The initial stage of the disease is acute cystitis, which occurs suddenly and in most cases lasts from a week to 10 days. If adequate treatment is started on time, the signs disappear after 3-4 days, although the inflammatory process itself continues latently (until the end of therapy). Depending on many factors, the acute period of the disease varies. For example, in older people and in men, the recovery process can be significantly delayed. The same applies to secondary cystitis caused by urolithiasis.

With improper treatment (if the pathogens remain in the urinary system), the disease becomes chronic, accompanied by relapses. The latent period of chronic cystitis can drag on for several years, but with a slight hypothermia or infection, it instantly passes into an acute phase. Often, recurrent cystitis worsens more than three times a year, in which case therapy continues for preventive purposes for 6-12 months.

Diagnostics

When the first symptoms of cystitis appear, you should not postpone a visit to the doctor. Correct and timely prescribed treatment is the key to successful treatment of cystitis with the exclusion of the risk of ascending infection and transformation into a chronic form. During the first visit, the doctor will conduct a physical examination and collect an anamnesis of the disease, then the patient will be asked to take tests to confirm the disease, its form. It is very important to make the correct diagnosis, since similar symptoms can be with urethritis, prostatitis, benign prostatic hyperplasia, gonorrhea, chlamydia, candidiasis.

The most important test for differentiating the disease is a general urine test. The urine is checked for bacteria, white blood cells, red blood cells and protein, as well as urine density. In the case of secondary cystitis, an instrumental diagnostic method is performed – cystoscopy. During this examination, an endoscope (a catheter with optical and lighting systems) is inserted into the patient’s urethra. With this device, it is possible to examine the inner surface of the bladder, as well as take a tissue sample for cytological examination. If there is a suspicion of other possible causes of secondary cystitis, the patient should undergo an x-ray examination or ultrasound. Women additionally undergo a gynecological examination and take a smear for bakposev.

Treatment

Medical products (drugs, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor’s prescription. Recommended reading: “Why can’t you take medications without a doctor’s prescription?”. The method of treatment of cystitis depends on the type and form of the disease. Which drugs to prescribe, the doctor determines individually, based on the results of the tests and taking into account the type of bacteria found in the patient’s urine. There are features of the treatment of cystitis in an adult patient, a teenager and a baby. Medicines are carefully selected for women during lactation and pregnancy, as well as for serious diseases of the liver or kidneys. In addition, different therapy programs will be needed for the primary, secondary and recurrent form of the disease. Self-medication of cystitis is not acceptable. Only a competent specialist should deal with the diagnosis and selection of therapy in order to avoid complications of the disease.

Cystitis of an infectious nature is treated with antibiotics and anti-inflammatory drugs. Therapy for non-infectious cystitis depends on the cause of the disease. As a rule, resort to symptomatic therapy. Depending on the patient’s condition, drugs for oral administration or for injection directly into the bladder may be recommended. If the patient has a pronounced pain syndrome, hematuria and dysuria are indications for hospitalization. If medical treatment does not work and the seizures return again, the doctor may advise an operative method to solve the problem.

For the treatment of cystitis, as well as other urinary tract infections, in addition to basic drug treatment, methods of physiotherapy and herbal medicine are used. Herbal preparations (kidney tea) and juices (for example, from cranberries), which have antibacterial and anti-inflammatory properties, are widely used. Herbal treatment at home helps to relieve the symptoms of the disease without the use of medicines, so it is suitable even for breastfeeding, pregnant women and children. Sitz baths are also recommended, which are suitable as home treatments. For many, this type of home treatment helps to overcome a recurring attack of cystitis.

Cyst limitations

Treatment of cystitis is not limited to just taking medications. The disease makes adjustments to the usual mode, creating a number of contraindications in the way of life. There are a number of prohibitions for people prone to recurrent cystitis.

In the acute period of the disease, it is forbidden to swim in the pool and play sports. Also banned are intimacy, a bath and a very warm bath. Hypothermia is also highly undesirable for people with chronic cystitis, as it is a factor leading to an exacerbation. It is not recommended to take warming procedures on the area of ​​​​inflammation. This method of treatment is dangerous, especially if the form and cause of the disease is not established. If you warm the stomach with hemorrhagic cystitis, you can cause bleeding. For the same reason, sitz baths are also prohibited during the acute period of the disease. From sexual intercourse, doctors advise to abstain at least until the first good urine tests.

Speaking of temporary bans on sports, doctors always mean strength exercises, bodybuilding, cycling. They cause undesirable tension of the pelvic muscles in cystitis. In the acute period of the disease, it is also undesirable to sled or ski, play hockey or go to the skating rink.

It is not recommended to wear tight synthetic underwear, as well as overly tight outerwear made of non-breathable materials. Tight clothing disrupts blood circulation in the organs of the genitourinary system, and synthetic fabrics contribute to increased sweating and the growth of bacteria in the urogenital area.

Food

The text is for informational purposes only. We urge you not to use diets, do not resort to any medical menus and fasting without medical supervision. Recommended reading: “Why you can not go on a diet on your own.” It is important for people prone to recurrent cystitis, as well as directly during the treatment of the disease, to adhere to a healthy diet. The right diet helps to strengthen the immune system and prevent bladder irritation.

The first dietary rule for patients: drink at least 2 liters of pure non-carbonated water per day (maybe mineral water like Essentuki, but without gas). Frequent urination helps to eliminate the infection and its waste products. Along with water, it is useful for patients to drink fruit drinks, vegetable juices (except tomato), fruit drinks, compotes. Useful for the urinary system are drinks made from lingonberries and cranberries. It is better to drink tea from urological herbs – bearberry, corn stigmas or kidney collection. It is useful to supplement the menu with products with a diuretic effect. It is good to eat fresh berries, fruits and vegetables, in particular cucumbers, carrots, spinach, watermelon and other gourds. During the rehabilitation period, you can gradually introduce fermented milk and dairy products (milk, kefir, cottage cheese), and then fish and meat.

In the acute period excluded from the diet:

• drinks containing caffeine (coffee, black tea);
• carbonated drinks;
• alcohol (including beer);
• spices;
• sugar;
• citrus fruit;
• tomatoes.

Also on the “black list” is all salty, spicy, canned, smoked, sour foods, foods with the addition of dyes and preservatives.

Possible consequences

Cystitis, turning into chronic, is far from the only consequence of an untreated disease. If the infection that caused the disease is not eliminated from the body, it will multiply and spread throughout the genitourinary system.

If the disease is treated correctly and on time, then inflammation of the bladder rarely leads to serious complications. However, if the recommendations of the urologist are not followed, the infection from the bladder quickly rises to the kidneys, causing the development of pyelonephritis. Young children and the elderly are most at risk for complications.

Another danger of untreated cystitis is gross hematuria and bleeding. In this case, the formation of ulcerative defects of the bladder wall or the formation of malignant tumors is possible. For women, untreated inflammation of the bladder can result in infertility, for men – impotence.

preventive measures

It is possible to prevent the recurrence of the disease and the discomfort associated with it by natural means. The best prevention, according to researchers, is cranberry juice, which contains proanthocyanidins that have antibacterial properties. Researchers have calculated that it is enough to drink at least half a glass of juice daily to improve the condition of the urinary organs.

In addition, to prevent the disease, doctors give the following recommendations:

• drink plenty of clean water;
• do not postpone a visit to the toilet, but urinate as soon as the need arises;
• empty the bladder as soon as possible after intercourse;
• in order to avoid postcoital cystitis, women should undergo hygiene procedures before sex, and men after;
• after defecation, it is important for women to properly carry out hygiene measures (in the direction from the vagina);
• for people susceptible to infections, it is better to take a shower rather than a bath;
• avoid deodorant sprays or scented intimate hygiene products.

Answers to questions

Do they give sick leave for cystitis

If the fact of illness is confirmed in the form of test results and a doctor’s conclusion, then it is quite realistic to get a short sick leave, and for sick pregnant women this is a necessity. In most cases, in the presence of acute cystitis, a disability certificate opens for a period of 5-8 days. To do this, the patient must either come to the clinic himself or call a doctor at home. An exacerbation against the background of chronic cystitis is less painful, so in this case you can do without opening a sick leave. However, each case is decided on an individual basis after examination by a doctor and additional examination.

Is it possible to get pregnant with cystitis

If a woman is planning a pregnancy and at the same time has reason to believe that she is suffering from cystitis in an acute or chronic form, she should immediately consult a doctor. Any inflammatory process in the body of a future mother adversely affects the development of the fetus. Meanwhile, from a physiological point of view, the presence of uncomplicated cystitis does not prevent conception. That is, theoretically, pregnancy can occur. Another thing is women who, against the background of advanced cystitis, had complications, and the inflammatory process from the bladder passed to the ovaries, appendages, kidneys, menstruation became irregular, delays appeared. In this case, even before planning the conception, you will have to restore health, adjust the cycle. If the complicated disease is not treated, infertility is possible.

How will the illness of the expectant mother affect the development of the fetus? If a woman suffers from chronic cystitis, then there is a very high probability that during the bearing of a child, the disease will worsen and it will be difficult to avoid taking medications, including antibiotics, which is highly undesirable.

Inflammation of the bladder is not the worst diagnosis: the disease is treated and, with proper therapy, does not cause complications. But to ignore it, waiting for the symptoms to go away on their own, is absolutely not worth it.

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