What is cystitis
The mucous membrane of the bladder is normally well protected from bacteria: it is covered with a protective layer, and regular urination mechanically washes away germs. When the defense is disrupted - due to hypothermia, stagnation of urine, hormonal changes or trauma to the mucous membrane - bacteria attach to the wall and cause inflammation.
The inflamed mucous membrane becomes swollen and sensitive. Even a small amount of urine stretches the bladder and causes a painful urge, and the passage of urine through the inflamed urethra is accompanied by pain.
Separately, non-infectious forms are distinguished: radiation cystitis after radiation therapy, chemical cystitis against the background of certain drugs, as well as interstitial cystitis (painful bladder syndrome) - a chronic condition in which urine cultures are sterile, and pain and frequent urination persist for years.
Symptoms of cystitis
- Cutting, burning and pain when urinating, especially at the end
- Frequent urges in small portions, sometimes every 15–20 minutes
- Feeling of incomplete emptying of the bladder
- False urges, in which almost no urine is released
- Nagging pain in the lower abdomen, above the pubis
- Cloudy urine, sometimes with an unpleasant odor
- Blood in the urine, often in the last portion - hemorrhagic cystitis
- Waking up at night due to urges
- Slight increase in temperature
Causes and risk factors
In the vast majority of cases, cystitis is caused by E. coli entering the bladder from the perineal area. Less commonly, other bacteria, fungi, or specific pathogens are to blame.
- Anatomy in women: short, wide urethra, close to the vagina and anus
- Hypothermia - reduces local mucosal protection
- Sexual life: mechanical irritation and transfer of flora (postcoital cystitis)
- Non-compliance or, conversely, excessive aggressive hygiene that destroys normal microflora
- Rare urination and habit of tolerating - stagnation of urine
- Insufficient fluid intake
- Sexually transmitted infections and bacterial vaginosis
- Decrease in estrogen during menopause - thinning of the mucosa
- Diabetes mellitus and immunosuppression
- Bladder catheterization and endoscopic procedures
- In men - prostate adenoma, prostatitis, urethral stricture, stones; they interfere with the flow of urine and create conditions for infection
- Bladder stones and foreign bodies
Why cystitis in men is always a reason for examination
The male urethra is long and narrow, making it difficult for bacteria to reach the bladder. If cystitis does occur, it means that something has disrupted the normal flow of urine or the protection of the mucous membrane.
- Prostate adenoma with residual urine
- Chronic prostatitis
- Urethral stricture or bladder neck sclerosis
- Bladder stone
- Bladder tumor
- Diabetes mellitus
- Consequences of catheterization
Therefore, if a man has cystitis, treatment with an antibiotic without finding the cause is almost guaranteed to lead to a relapse. The minimum program is urine analysis and culture, ultrasound with residual urine, prostate assessment, and in case of repeated episodes, cystoscopy.
Diagnostics
- General urine analysis - leukocytes, erythrocytes, bacteria, nitrites
- Urine culture to determine sensitivity to antibiotics is mandatory for relapses, in men, in pregnant women and in case of ineffective treatment
- Ultrasound of the kidneys and bladder with determination of residual urine
- Smear and PCR for sexually transmitted infections
- Examination by a gynecologist in women with a recurrent course
- Cystoscopy - for frequent relapses, blood in the urine, suspected leukoplakia, stone or tumor; not performed in the acute period
- Biopsy of the bladder mucosa - in case of suspicious changes during cystoscopy
- Diary of urination in chronic forms
Treatment of cystitis
Uncomplicated acute cystitis in women is treated with a short course of antibiotics, and relief usually occurs within the first day. But the choice of drug and duration depend on the situation, so the doctor must prescribe the regimen.
- Antibacterial therapy - a short course for uncomplicated cystitis, a longer course for complicated cystitis and in men
- Mandatory urine culture in case of relapses, so that the drug is not selected at random
- Drink plenty of fluids to mechanically flush out bacteria
- Painkillers and antispasmodics for severe pain
- Treatment of associated conditions: adenoma, prostatitis, stricture, stone, vaginal infection
- Local estrogen therapy in menopausal women - as prescribed by a gynecologist
- Instillation of drugs into the bladder for chronic and interstitial cystitis
- TUR of leukoplakia of the bladder - with confirmed changes in the mucosa that support chronic inflammation
What not to do: take the antibiotic left at home “like last time”, stop the course immediately after the pain disappears and treat with heating if there is blood in the urine or fever.
Recurrent cystitis: what to do
Recurrent cystitis is said to occur when exacerbations occur two or more times in six months or three or more times in a year. This course does not require another course of antibiotics, but a plan.
- Подтвердить диагноз посевом мочи во время обострения — иногда под маской цистита протекает другое состояние
- Search и устранить провоцирующий фактор: нарушение оттока мочи, гинекологические инфекции, дефицит эстрогенов, камень, привычку терпеть
- Наладить поведенческие меры: питьевой режим, регулярное мочеиспускание, мочеиспускание после полового акта, отказ от агрессивных средств гигиены
- Обсудить с врачом варианты профилактики: посткоитальная профилактика, длительная низкодозовая схема, неантибиотические средства
- При сохраняющихся симптомах без бактерий — обследование на интерстициальный цистит
Prevention
- Drink enough fluids throughout the day
- Avoid the urge and empty your bladder regularly
- Urinating after intercourse
- Maintain moderate hygiene without aggressive antiseptics and douching
- Avoid hypothermia, especially prolonged sitting on a cold surface
- Treat gynecological and urological diseases in a timely manner
- Control glucose levels in diabetes
- Do not wear tight synthetic underwear for a long time
Where is cystitis treated in Tashkent
For the first episode of uncomplicated cystitis, an appointment with a urologist and a urine test is sufficient. But with repeated exacerbations, blood in the urine or cystitis, a man needs a clinic with a full-fledged laboratory, ultrasound and the ability to perform cystoscopy.
In Tashkent, such examination and treatment are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic: appointment with a urologist, urine culture with selection of an antibiotic, ultrasound with determination of residual urine, cystoscopy and, if necessary, endoscopic treatment.
Advice for taking: try to get a urine culture done before you start taking antibiotics - after the first tablet, the result may turn out to be false negative, and it will be more difficult to choose an accurate treatment. Clinic contacts are below on the page.
