Prophylaxis and treatment of chronic cystitis

What is cystitis?

Inflammation of the urinary tract is subject to effective treatment with the correct diagnosis and after establishing the exact reasons that provoked the disease. When choosing the wrong therapy strategy, healing becomes more complicated - for curing the disease is important for it to eliminate the causative agent. The wrong approach can provoke a chronic form of cystitis. A professional experienced urologist correctly diagnoses and identifies the cause of its occurrence, and accordingly prescribes adequate treatment. In acute cystitis, the first-line drugs can be used, but it is important to understand that if the disease reoccurs more than twice a year, a thorough checkup is needed.

Short information about cystitis

Why does inflammation occur?

Cystitis, as a medical term, includes in this concept many different pathologies that are similar in their action and symptoms: all of them are associated with a violation of the integrity of the bladder mucosa.

The structure of the female body, namely the genitourinary system, differs from the male one so much that in women, inflammation of the urinary tract is diagnosed many times more often than in men.

The correct functioning of the bladder affects many associated systems, respectively, ailments also affect other physiological processes. As a result, one disease can cause other negative manifestations in the urogenital area.

What causes the inflammatory process:

- Hormonal changes (menopause, use of hormonal drugs, pregnancy);
- Allergies;
- Infections of viral or bacterial origin;
- Overcooling;
- Reduced protective properties of immunity;
- Pathology of functioning or anomalies of the structure of the urinary tract;
- Violation of the regularity and correctness of hygiene procedures;
- Serious diseases: disruptions in the endocrine system, diabetes, colitis, tumors.

Acute cystitis is accompanied by stagnation in the genitourinary system.

How germs enter the bladder?

Pathogenic bacteria can enter the urinary tract in a variety of ways. When a person resists upper respiratory tract infections, microorganisms multiply, enter the bloodstream and, along with the bloodstream, spread to the organs.

- If the patient suffers from gastrointestinal diseases, there is a high risk of infection due to the proximity of the external genitalia to the anus (especially in women).
- Inflammatory kidney disease allows microorganisms to enter the bladder directly with recycled fluid.
- The risk of developing cystitis increases from direct contact with synthetic underwear that is tightly attached to the external genitals.
- Constant unprotected sex with different partners is dangerous for women, which ensures the frequent penetration of foreign bacteria.
- Stool problems, in particular constipation, increase the likelihood of illness.

The risk of inflammation increases significantly with a decrease in immunity, which occurs:

- In the off-season (fall and spring);
- In case of improper nutrition;
- Due to frequent stress;
- Due to chronic fatigue;
- In case of lack of sleep.

How to determine the presence of a disease?

Cystitis manifests itself immediately acutely with obvious symptoms or they may be added gradually. The very first criterion, which is difficult to miss, is the frequent urge to urinate.

In the future, the symptoms increase and result in:

- Discomfort, burning and itching in the perineum (this is how toxins from the excreted fluid affect);
- Any unpleasant, unusual sensation in the ureters (the duct by which urine passes from the kidney to the bladder);
- Urine changes color, becomes cloudy, and may have a pungent odor;
- After urinating, there is no feeling of complete emptying of the bladder;
- Pain in the lower abdomen (may radiate to the back).

Later, uncharacteristic symptoms may be added, only indirectly indicating cystitis: headache, fatigue, a slight increase in temperature. A clear sign of complications of the disease is blood in the urine.

The infectious or allergic nature of the occurrence of cystitis in the vast majority of cases is manifested by characteristic symptoms with severe itching in the perineum.

Possible complications

Women face cystitis very often (almost half of all women in the world). But not always patients can reasonably assess the possible consequences of this inflammatory disease.

When the correct treatment is carried out, including the leveling of the provocateur disease, healing occurs quite quickly. However, if the therapy is chosen incorrectly, and in addition, the causative factor is constantly present, then the disease can develop into a chronic form, which significantly increases the risk of complications.

Chronic cystitis damages a significant area of the mucous membrane of the bladder, which leads to the appearance of seals, edema due to loss of elasticity of the epithelial layer.

Complications:

- Development of renal failure, pyelonephritis;
- Urethritis (inflammation of the urethra);
- Formation of adhesions (fibrous bands that form between tissues and organs);
- Violation of the structure of the bladder sometimes provokes a breakthrough, the entry of contents into the abdominal cavity, and, as a result, causes peritonitis (infectious disease of the in the abdominal cavity that can be life-threatening);
- Urolithiasis disease (stones);
- Tumors;
- Violation of reproductive function up to the impossibility of conception;
- Ulcers, bleeding in the bladder;
- Dysfunction of the urinary tract, enuresis (urinary incontinence).

Important periods of development

The female body in different periods of life physiologically acquires a predisposition to cystitis, and it is advisable to have information in advance in order to protect itself as much as possible.

For the first time, the risk of the disease appears at a very early age - below 3 years. In the presence of congenital pathologies, the occurrence of ureteral reflux is likely: the reverse flow of urine - from the bladder to the kidneys. As a result of this complication, ascending infections and vulvovaginitis can occur.

For the second time, the danger of the disease lies in wait for a woman in adolescence. Here hormonal changes play the biggest role, and with the onset of sexual activity, the likelihood of getting bacteria from a partner is added.

The third period is when a woman gets pregnant and gives birth. Hormonal changes cause structural changes in the tissues, the baby renders pressure to the organs so the bladder can become inflamed, and infection can be acquired during childbirth from doctors and nurses.

And the fourth period of exposure to infection occurs with the onset of menopause. Then hormonal changes and general physiological changes in the body simultaneously play a role. So, for example, the tissues lose elasticity, which spreads to the bladder, in addition, it shifts slightly in the abdominal cavity. The combination of these changes contributes to the disease of cystitis.

Diagnostics of cystitis

During a clinical examination, the specialist pays attention not only to the diagnosis, but also to the cause of the development of the disease.
First, the doctor traditionally takes a look at a patient’s history: complaints, the approximate time of development of symptoms, previous ailments and unusual events. In addition to the clinical picture, laboratory and instrumental studies are needed:

- General analysis of blood and urine to identify characteristic deviations from the norm;
- A swab from the vagina for the study of microflora (bacteria);
- Study of the bacterial composition of urine (bacterial culture);
- PCR blood test (to detect HIV);
- Cytoscopic (endoscopic) examination of the bladder;
- Ultrasound examination of the genitourinary system.

In some cases, a biopsy may be required: it implies a removal of microscopic tissue samples for examination.

How is cystitis treated?

The main goal of therapy is to eliminate symptoms and cure the underlying cause of inflammation. The drugs are determined by the urologist, based on the data obtained. The fist line antibiotic is Macrobid or Nitrofurantoin.

In the acute form of the disease, rest, normalized dietary nutrition, and applying a heating pad are desirable. Along the way, be sure to drink plenty of fluids and diuretics to accelerate the elimination of bacteria. Antispasmodic drugs are prescribed at the same time. The usual treatment time is a week. In no case should you interrupt the course: the elimination of the primary symptoms does not indicate a complete recovery and preliminary treatment cessation can cause bacteria resistance, i.e. it will be still present in the body without symptoms and the disease will reoccur but it would be impossible to treat it with the same drug as bacteria are no longer sensitive to it.

- Antibacterial drugs are prescribed for bacterial infection (a medical recommendation is required);
- Antispasmodics - a common remedy for all forms of the disease (relieve muscle spasm, eliminate soreness, promote urinary drainage without pain);
- Anti-inflammatory drugs relieve inflammation from the mucous membrane, promote the restoration of the epithelium, reduce discomfort;
- Phytotherapy is reasonable either at the onset of the disease, or with complex treatment.

Rehabilitation therapy

As a result of bacterial activity and due to the intake of antibiotics, the microflora of the body suffers: the number of necessary beneficial bacteria decreases. This violation is leveled by the intake of probiotics, which inoculate the microflora with the necessary bacteria, restoring its normal functions. This measure is not subject to a mandatory prescription, however, it is important to follow the recommendations in the annotation and not exceed the dosage.

Therapy for chronic cystitis/Prophylaxis

To identify this form of the disease, a comprehensive diagnosis is important. All potential pathogens are investigated, and appropriate treatment is prescribed. In most cases, antibacterial drugs are used to eliminate the bacterial provocateur of the disease.

Complex treatment includes stimulation of immunity, support of hormonal levels. Most often, a number of measures are included to normalize the natural outflow of urine: diet, drinking enough water, drugs, right pH hygienic products or complete refusal of their use, refusal of local spermicides, choosing qualitative condoms and lubricants, not using other people’s towels, and so on.  There is a need for a cure for all diseases that are present at the moment, which in theory can support the inflammatory process. Surgery is sometimes required.

Upon recovery, patients are prescribed preventive measures to prevent exacerbation or relapse. Physiotherapeutic procedures, gymnastics are used here to enhance blood circulation in the small pelvis. Compliance with all recommendations is a prerequisite for recovery.

Post by: Rachel Lewis, Senior Medical Advisor at Medibank, Sydney, New South Wales, Australia