Urology-Online

Cystitis

Anatomy bladder

definition

It is an inflammation of the urinary bladder that usually only affects the upper layers of the mucous membrane.
About 10-15% of adult women suffer from a bladder infection (cystitis) at least once a year, which is mainly characterized by painful urination.

causes

In the majority of cases, germs such as Escherichia coli bacteria (approx. 80%) are possible pathogens, and more rarely also mycoplasmas, staphylococci or chlamydia.

In women in particular, the direct “neighborhood” of the urethral outlet and anus plays an important role in the development of infections.
Because of this proximity, germs that are normally found in the intestine can get into the urethra and from there into the bladder by means of smear infections (e.g. when using toilet paper).

Other causes can be:

Irradiation of the small pelvis (so-called radiogenic cystitis), e.g. as part of cancer therapy:
The mucous membrane and thus the protective layer of the urinary tract are destroyed. This leads to bleeding, which causes reactive cystitis.
Cytostatic therapy (drug cancer therapy, especially cyclophosphamide):
Toxic breakdown products of these drugs develop in the liver, which destroy the lining mucous membrane and lead to bleeding. This ultimately results in cystitis. Mercaptoethanesulfonate can be administered here as a preventative measure.
sexual contact (so-called "honeymoon - cystitis") of the sexually mature woman
Malformations of the urinary tract:
Constrictions (stenoses) or bulges (diverticula) of the ureter lead to a longer retention time of the urine in the drainage system. The longer it "stands", the more likely it is for bacterial colonization and infection.
Gynecological diseases or pregnancy:
Here, too, the anatomical proximity can impede the flow of urine.

Cystitis from cold feet

Cold feet can provoke the development of a bladder infection. This is due to the relationship between the blood flow in the feet and the blood flow in the urinary tract. This connection arises from nerve-vessel reflexes. In addition, an adequate endogenous blood flow serves to improve the body's immune activity, and insufficient blood flow can provoke an immune deficiency and thus the development of infections.

Read about this: Cystitis from cold feet

therapy

Here you will find information about therapy: Therapy of a cystitis

The following article may be of interest to you on the subject of preventing cystitis: Vaccination against cystitis

When do you need an antibiotic?

Antibiotics are often required when the bladder infection is advanced, immune deficiency, or other risk factors for developing complications. Which antibiotic agents are indicated depends on the type of cystitis. The reason for this is that one distinguishes an uncomplicated from a complicated cystitis.

In uncomplicated cystitis, sulfamethoxazole, trimethoprim or a combination of both active ingredients, co-trimoxacol, are used as antibiotic agents. In addition, fosfomycin or nitrofurantoin can be effective as an alternative. In any case, antibiotic therapy is required for a complicated cystitis. In these cases, reserve antibiotics such as cephalosporins or gyrase inhibitors, each combined with an aminoglycoside, are given intravenously.

Home remedies for cystitis

There are several home remedies that can help with cystitis. It is essential to keep the lower body warm. A hot water bottle or a heat pillow can have a soothing effect. A hot bath can also be beneficial at the first sign of a bladder infection. In addition, Sitz baths or “Sitz steam baths” can promote the healing process. Chamomile extract can be used for this. Chamomile tea should be boiled in an old saucepan. When it's ready and brewed, it should be placed in the toilet bowl. Then sit on the toilet.It is important that the body is kept warm by covering the abdomen well with towels or blankets. In this way the vapors can have a beneficial effect. If these Sitz baths are well tolerated, they can be repeated several times a day. Furthermore, the feet must definitely be kept warm.

In addition, pelvic floor exercises can stimulate blood circulation in the lower body.

Another basis for a good healing of a cystitis is to drink lots, lots, lots. Different beverages are recommended by different authors. It is individual which is subjectively and objectively suitable. For example, it is recommended to drink a glass of cranberry juice daily for prophylaxis. In addition, it is recommended to take a cure with bearberry leaf tea up to a maximum of 3 times a year, by drinking it daily for a short time in the amount of 3 large cups.

Other recommendations for prevention and supportive treatment include drinking up to 5 cups of rose hip tea or a large cup of sage tea 3 times a day. A tea with dried dandelion leaves and roots, which is drunk twice a day, can also be beneficial. A tea made from daisies or watercress, which is drunk slowly, can also have a supportive effect. In addition, drinking cranberry juice daily for prophylaxis and supportive treatment can have a positive effect. Some authors also recommend drinking water mixed with a pinch of baking soda 2 times a day for 3 days. This is supposed to favor a basic environment and thus, according to some authors, seemingly counteract the bacteria.

Other authors recommend acidifying the urine instead, for example by taking (high-dose) vitamin C or acidic fruit juices. It is also advisable to drink radish juice or birch leaf, nettle, juniper or horsetail tea. There are also special tea blends from various manufacturers that are supposed to counteract cystitis. In addition, a cut, lightly steamed onion can be filled in a clean linen bag and then placed on the bladder. Other authors recommend eucalyptus compresses. There are more proposals and some of them are discussed controversially.

For more information, see: Home remedies for cystitis

Homeopathy for a cystitis

In the case of a bladder infection, some people also use homeopathic remedies. The application depends on the symptoms, causes and individual components.

Arnica montana is often used when a bladder infection has developed due to injury, pressure, surgery, or retention of urine for too long.

If the cystitis is the result of a drug or food allergy or an inflammation of the stomach or intestine and shows certain symptoms, Arsenicum album may be advisable. This homeopathic remedy is used when the flow of urine is disturbed, burning pain occurs, exhaustion, restlessness and anxiety are present and the symptoms often intensify around midnight.

If the bladder infection is the result of heat stroke, sunburn, or a consequence of scarlet fever, then Cantharis vesicatoria is often recommended. The appropriate symptoms are, among other things, characterized by a permanent painful urge to urinate with burning and cutting pains before, during and after urination, which is only possible in drops.

When the development of a cystitis is related to anger, anger, injustice, or the cold, Colocynth is often used. The symptoms for this indication are, for example, cramp-like pain when urinating and that the person concerned is cramped, angry and irritated with pain. The choice of means, dosage and potency should be discussed with a doctor.

What to do without antibiotics

For prevention and at the first signs of a bladder infection, non-antibiotic agents and measures may be sufficient. Home remedies and homeopathic remedies are often used successfully in these cases.

In addition, compliance with certain rules of behavior is necessary for a healing process. Attention should be paid to adequate hygiene of the intimate area with fragrance-free and well-tolerated hygiene articles. After using the toilet, you should always wipe from front to back, as intestinal bacteria often trigger cystitis. If possible, you should briefly go to the toilet to urinate after intercourse to prevent bacteria from "climbing" to the bladder.

Of course, damp clothes or a wet bathing suit should never be left on after swimming. Whirlpools should be avoided, especially if there is a tendency to develop bladder infections, as they are an ideal breeding ground for bacteria. Furthermore, you should avoid sitting down on cold or wet surfaces. In addition, the underwear worn should, if possible, be made of natural material and not cause any friction. Synthetic clothing should be avoided. The laundry should also be washed with a well-tolerated detergent to avoid irritation.

If you feel an urge to urinate, this should be followed up. Furthermore, if possible, no underwear should be worn while sleeping. The reason for this is that the underwear can chafe and rub, which means that intestinal bacteria can be transported into the vagina via the urethra and into the bladder.

Furthermore, urinary bladder inflammation can be prevented and heals better if the menu contains a lot of whole grain products, fruit, vegetables and fiber. Eating cranberries can also reduce the risk of developing bladder infections and support the healing process. Coffee, alcohol and spicy dishes should be avoided as these can irritate the bladder.

Symptoms

Typical symptoms (symptoms) of a cystitis are uncomfortable (alguria) or painful (mostly burning) urination (dysuria), burning sensation after urination, strong and frequent urination (pollakiuria) and pressure pain in the bladder region.
The time of day does not play a role in the intensity of the pain. Usually there is no fever.

Symptoms in women

In women, both complicated and uncomplicated bladder infections can be caused. The forms of cystitis differ not only from the treatment, but also from the symptoms.

With an uncomplicated cystitis, the women affected complain of a burning pain when urinating, as well as the fact that they often have to go to the toilet, but can only pass a few drops of urine. In medical terminology, this is known as pollakiuria. The reason for this is that a temporary dysregulation can be caused in the context of the inflammatory processes in the urinary tract.

In addition, an uncomplicated cystitis can provoke pelvic pain. In addition, the appearance of the urine can be changed. It can appear cloudy and flaky and have a stronger smell. There is neither fever nor pounding pain when tapping the kidney bed in uncomplicated cystitis.

On the other hand, a complicated cystitis can be recognized by the fact that the person concerned has a fever and sometimes complains of a knocking pain in the region of the kidney bed. This pain indicates that the inflammation has spread. The fever indicates that bacteria have entered the blood and that there is a risk of blood poisoning. If laboratory tests show nitrite in the blood, this may also indicate that bacteria are in the bloodstream

Blood in the urine

Blood in the urine can be caused by a variety of factors. These triggers can either be harmless or require treatment. In order to avoid complications and consequential damage, blood in the urine should always be clarified if the genesis is unclear. The technical term for this is hematuria. Bloody urine can also occur as part of a bladder infection. This can be the result of inflammatory processes in the bladder or ureters. If there are clearly visible changes in the urine, this is called macrohematuria in technical jargon. Accordingly, it is referred to as microhematuria if the blood particles cannot be seen with the naked eye, but are only detected in the course of laboratory tests. Bloody urine can have a variety of causes and should definitely be clarified by a doctor in a differentiated manner.

Read more on this topic at: Blood in the urine

itching

Itching is not a classic symptom of a bladder infection, but it can accompany it. In particular, in the course of antibiotic treatments it can happen that not only the bacteria that triggered the bladder infection are killed by the drug, but also the bacteria that belong to the normal flora of the genital area are destroyed.

The natural milieu in this area includes lactic acid bacteria, which offer protection against harmful bacteria, fungi and noxious substances to a certain extent. If these are no longer or less available, the protective function is reduced or no longer available. As a result, the risk of developing infections with viruses, bacteria or fungi is greater. This can result in itching.

Symptoms especially in men

Cystitis is more likely to occur in women. In particular, an uncomplicated form of cystitis only occurs in women. But complicated cystitis can also occur in men. This often affects men over the age of 50. Cystitis in men is often related to prostate disease. Men in particular experience painful, burning urination, a reduced amount of urine, sometimes cloudy, flaky urine, possibly increased urine odor and a strong urge to urinate, as well as pain during bowel movements and pain in the perineal area. Men complain of painful ejaculation in the context of a cystitis less often. In addition, the signs of a complicated cystitis - fever, chills and possibly knocking pain when tapping the kidney bed - can occur, as in women.

Is Cystitis Contagious?

Since a cystitis is usually a bacterial infection, it is also contagious. The greatest risk of infection arises from unprotected sexual intercourse. In theory, there is also a risk of infection if the same toilet is used. But the risk of infection is very low. As a precaution, the person concerned should not share his or her towel with anyone during this time and, at best, use a towel only once and then change it immediately after use. The toilet should also be cleaned regularly.

diagnosis

The first choice is a urine test (U status). The fastest detection is achieved with the help of a test strip that is immersed in the patient's urine for about 30 seconds.
By changing the color of the individual fields, the acid value, pH value, protein, sugar, white blood cells and red blood cells and, via the breakdown product nitrite, also bacteria can be detected indirectly.

A second method is the so-called "Urikult" system. A breeding ground for bacteria is briefly dipped into the patient's urine. Any bacteria present there settle on the nutrient medium. The number of colonies found can be used to draw the line between significant (significant) and insignificant bacterial contamination of the urine (> 105 / ml urine = significant infection).

It is also very important that the bacterium found is tested for its sensitivity to various antibiotics. Based on the test result, the doctor determines the drug therapy.

The blood / laboratory values are usually not changed. White blood cells (leukocytes) and so-called inflammatory parameters such as C-reactive protein (CRP) are an exception.

In the case of recurring (recurrent) or complicated cystitis, an ultrasound should be performed, as this can indicate anatomical malformations or flow obstructions that have not yet been recognized.

If the ultrasound is abnormal, a urogram may be necessary to assess the urine excretion (especially in younger patients, this can make a reflux of urine from the bladder visible).
A contrast agent containing iodine is introduced into the vein and then excreted by the kidneys. Then, after 7 and 15 minutes, x-rays are taken on which:

Kidneys
Renal pelvis
Ureter and
bladder

become visible.
You can spot abnormalities, cysts, congestion, tumors, and more. A urinary outflow disorder can be excluded in men.
In case of severe damage:

the liver
Thyroid disorders
Plasmacytoma
Contrast agent allergy or
Kidney weakness (renal insufficiency - from a serum creatinine of> 2 mg / dl)

no more urogram may be performed.
Serum creatinine is a measure of kidney function. The normal value is around 0.8-1.2 mg / dl.

An endoscopic examination (examination of the bladder with a tube camera) is prohibited during acute inflammation and can only be carried out after the symptoms have disappeared.
An endoscope (similar to gastroscopy or colonoscopy) is passed through the urethra into the bladder.
This is then filled with water and illuminated by the endoscope.
The emptying of the ureters into the bladder, inflammation of the mucous membrane, tumors, foreign bodies and stones can be recognized and, if necessary, removed. Inborn changes can also be precisely localized. The procedure is performed under local anesthesia.

With a quick and easy self-test at home, you can determine an initial suspicion of a cystitis yourself. More information is available at: Rapid test for a cystitis

Cystitis During Pregnancy

During pregnancy, the risk of developing a cystitis is relatively high. This means that it affects about 15% of pregnant women. This is probably related to the hormonal changes that occur during pregnancy.

The symptoms are similar to those of non-pregnant women. Here, too, one can differentiate between an uncomplicated and a complicated cystitis. In addition, cystitis during pregnancy can increase the risk of miscarriage or premature birth. Therefore, at the first signs of cystitis, the gynecologist should be contacted. This weighs up which treatment is optimal based on the benefit-harm ratio.

As a rule, antibiotics are also given for uncomplicated cystitis in the early stages. Only certain antibiotics come into question in certain phases of pregnancy, which the doctor uses according to the guidelines. In addition, pregnant women can support the healing process with home remedies and compliance with general rules of conduct that apply to cystitis.

Read more on the subject at: Cystitis During Pregnancy

Differential diagnoses

In women, symptoms such as pelvic pain or problems urinating can also occur Inflammation of the female genital tract (Adnexitis) originate. In men, the prostate must always be considered. Then come the chronic pelvic inflammation, Special forms (see below), foreign bodies, bladder stones, urethritis or tumors (Kidney cancer), which all initially impress with similar, unspecific symptoms.

Special forms

Irritable bladder (also frequency urgency syndrome)
There is no organ pathological finding. Disturbances in the innervation lead to a non-coordinated work of the bladder and pelvic floor muscles. The urge to urinate is more frequent and painful, although symptoms are typically less at night. Nothing abnormal was found in the urine.
Psychosomatic treatment can be indicated for the mostly female affected. Antispasmodic medication is used as a support and, in older patients, local estrogen is also used.
Interstitial cystitis
She occurs v. a. in middle-aged women. The causes are still unclear. It is assumed that the lining of the mucous membrane has barrier disorders that allow toxic urine components to pass into the tissue.
Autoimmune diseases or an insufficient supply of oxygen are also discussed.The bladder muscle is transformed into connective tissue and the capacity of the urinary bladder is reduced.
Urge incontinence (incontinence)
The diagnosis can be made using the elimination protocol and endoscopy. In the latter, you can see typical pinhead-sized bleeding from the mucous membrane after bladder distension and ulcers.
Various drugs are used for therapy, including pain relievers (analgesics), antiallergics, glucocorticoids or immunosuppressants.
Sometimes substances such as heparin, BCG, or Clorpactin are introduced directly into the bladder. If the symptoms cannot be improved, surgery is necessary (bladder expansion).
Follicular / granular cystitis:
It is a chronic inflammation with pinhead-sized lumps in the bladder lining.