Treating Cystitis in Women: A Guide

Cystitis is one of the most common female diseases. According to statistics, by the age of 27, one third of women have it, and by the age of 32, half of all women in the world. But cystitis can be avoided and still if one gets it, it can be successfully treated.

Cystitis is inflammation of the bladder. Both men and women can suffer from this disease, but men under 50 years old rarely experience bladder inflammation. This is due to the fact that men are protected from cystitis by anatomical features.

Approximately 75-95% of lower urinary tract inflammation, that is, urethra and bladder, is caused by bacteria living in the colon or on the mucous genital organs. While these microbes are in the intestine or on the skin, they do not cause any health problems. But if they get into the urinary tract or bladder, the same bacteria can cause their inflammation.

In men, the urinary tract is long and the entrance to it is far from the anus, making it difficult for bacteria to reach. In women, it is the opposite, so bacteria are more likely to enter the urethra. They can easily reach the bladder and cause inflammation.

Causes of Cystitis in Women

Besides bacteria, many other factors can cause bladder inflammation: from parasites and sexually transmitted infections to bladder stones and radiation therapy.

Therefore, cystitis is divided into two large groups: infectious and non-infectious.

Infectious cystitis is caused by pathogenic microorganisms. In young women without other diseases, bladder inflammation is usually caused by bacteria from the intestine. For example, Escherichia coli, Klebsiella, or Staphylococcus. But sometimes cystitis is caused by Chlamydia, bacteria that are transmitted from person to person sexually and cause a STD called Chlamydia.

Cystitis can be caused by other microorganisms as well, but typically it only occurs in women whose health has already been weakened. Women with chronic diseases such as type 2 diabetes and those who have recently undergone a surgery or an endoscopic examination of the bladder and women with weakened immunity can experience inflammation of the bladder.

• Candida-like fungi from the Candida genus can cause inflammation of the bladder. In healthy women, these fungi live on the skin, in the mouth and in the vagina without causing any problems. However, if the immune system weakens, the fungi can penetrate deeply into the body and cause inflammation of the internal organs from the bladder to the kidneys, heart, or even the brain.
• Adenoviruses can cause not only colds, but also inflammation of the bladder walls.
• Trichomonas. This is a protozoan parasite and the causative agent of trichomoniasis. Trichomonads are transmitted from an infected person to a healthy person through sexual contact, they settle in the urethra or bladder and can cause inflammation of these organs.

Non-infectious cystitis is caused by causes not related to pathogenic microorganisms. It is common to distinguish:

1. Chemical cystitis. In this situation, inflammation arises from increased sensitivity to chemicals that come into contact with genital organs, such as personal hygiene products or medications. Cases are known where cystitis was provoked by bath foam or vaginal suppositories.
2. Radiation cystitis. Inflammation of the bladder is a common side effect of radiation therapy in the pelvic area. Usually occurs in oncology patients.
3. Drug-induced cystitis – a side effect of some drugs. For example, the cancer drug cyclophosphamide can cause hemorrhagic cystitis – a serious inflammation of the bladder, in which blood appears in the urine.
4. Allergic cystitis. This type of cystitis is better called eosinophilic. Eosinophils are immune cells that normally fight parasites. An allergy is an error of the immune system, in which it takes harmless proteins from dust or food as parasites and releases a lot of eosinophils into the blood. These cells can cause inflammation in the bladder, esophagus, colon, and other organs.

Aside from allergic reactions and parasitosis, eosinophilic cystitis theoretically may cause autoimmune diseases like ulcerative colitis and genetic disorders where eosinophils uncontrollably multiply. Since eosinophilic cystitis is very rare – in 2006 it was only found in 83 people – we are unlikely to know about it soon.

Risk factors for cystitis

Since cystitis is caused by microbes more often, any situation that allows pathogens to reach the urinary tract increases the risk of illness.

Penetrating sex. During partners’ movements, bacteria from the anus can reach the urethra. Normally, women are protected from bacterial invasion by the mucus that covers the vagina and urethra. However, during passionate sex, the mucous membrane may be unintentionally damaged. That’s why a regular sexual life and recent change of sexual partner are important risk factors for cystitis.

Regular use of contraceptive methods with spermicides. These are usually diaphragms and condoms used with sperm-destroying substances. Spermicides kill not only spermatozoa, but also beneficial bacteria in the genital tract. This can increase the risk of infection and the development of cystitis.

Therefore, it is safer to use condoms without spermicide. As for diaphragms, it makes sense to refuse them altogether: it’s far from the most reliable contraception method in the world.

Pregnancy. Some pregnant women experience problems with bladder emptying. This is bad because urine is a great environment for bacteria growth and development. When it accumulates in the bladder, the risk of infection increases.

Menopause. The health of the vulva and vagina is maintained by female sex hormones, estrogens. However, during menopause, women produce less estrogens, which can cause the vaginal mucosa to thin. The thinner the mucosa, the worse the protection against infection.

Cystitis has additional risk factors. For example, the likelihood of getting cystitis is higher in those whose mothers and sisters had cystitis, those who had it in childhood or recently, and women who recently took antibiotics. Many antibiotics not only destroy pathogenic microorganisms, but also reduce the number of beneficial bacteria in the vagina, which protect women from infections.

Symptoms of Cystitis in Women

As a rule, women with cystitis complain of the following symptoms:

• frequent, sudden and very strong urges to urinate;
• burning pain during urination – at the same time, urine comes out in small portions, appears cloudy and has a very sharp odor;
• unpleasant sensations in the lower abdomen.

With cystitis, there is no temperature higher than 38 °C, itching, and copious discharge from the vagina. Blood in the urine appears rarely and in small quantities – no more than a couple of drops.

If you suspect you have cystitis, you should see a doctor as soon as possible. However, sometimes symptoms that resemble cystitis can be accompanied by signs that indicate kidney infection. This condition is dangerous to life, so you cannot postpone seeking help if you experience “kidney” symptoms.

Call emergency services if you experience any of the following symptoms in addition to symptoms that resemble cystitis:

• pain in the lower back or side;
• a temperature above 38°C and shivering;
• nausea and vomiting;
• blood in the urine – so that it looks pink.

Cystitis diagnosis

As a rule, women with complaints similar to cystitis first come to a gynecologist. However, this doctor does not treat cystitis, but refers to another specialist – a urologist. The urologist may suspect cystitis already on the first meeting with the patient – based on her complaints.

However, to clarify the diagnosis, the doctor will ask the patient to assess the condition using the Acute Cystitis Symptom Score (ACSS) scale.

For this, the patient will need to answer 18 questions related to sensations during a visit to the bathroom, quality of life, and accompanying diseases. Sometimes doctors suggest keeping a diary of urination for two days – this makes it easier to count the real number of visits to the bathroom and the volume of urine that is excreted.

If the doctor decides that it is an acute uncomplicated cystitis, then tests may not be required. This diagnosis is made clinically, that is, based on a conversation with the patient. Additional tests do not help to find out because their results are rarely deviated from normal.

But if the doctor suspects that it is a recurrent or chronic cystitis, then he will refer the patient for laboratory tests. Tests can be taken for free under the OMS policy or in a private clinic for money.

General, or clinical, urine analysis. This study allows to determine the number of immune cells leukocytes and red blood cells erythrocytes in the urine. The more of these cells, the higher the probability of bacterial infection.

Sometimes doctors offer to take an express test on site – they give the patient a test strip and ask her to urinate on it in the hospital toilet. The test strip allows to understand if there are leukocytes in the urine, but does not allow to determine how many of them are there.

Investigation for chlamydia and trichomoniasis. This analysis helps determine if there is genetic material of sexually transmitted infection pathogens in urine or urethral swab, which may have caused cystitis.

If a pregnant woman or a woman with recurrent cystitis or if the doctor suspects that the inflammation has affected not only the bladder but also the kidneys, he may refer the patient to a microbiological-cultural analysis of urine. This analysis helps determine which specific microorganism caused the disease and what antibiotics it is sensitive to.

Cystoscopy, or inspection of the inner surface of the bladder using an endoscope, and ultrasound examination of the kidneys or USG, are usually not prescribed for cystitis. The doctor may refer for these examinations only if he suspects inflammation of the kidneys.

How to treat cystitis in women

Unpleasant sensations and pain with cystitis can be relieved by taking over-the-counter nonsteroidal anti-inflammatory drugs. To relieve pain, it’s enough to take 400 mg of ibuprofen.

However, to cure uncomplicated acute cystitis once and for all, the doctor must select the appropriate antibiotic for the patient. The length of treatment depends on the chosen medication and can take anywhere from one day to a week.

For example, a treatment course with phosphomycin takes only one day – it’s enough to take three grams of the active substance.

But this medication is not suitable for patients with an allergy to this drug. The doctor can prescribe another antibiotic with a different active ingredient, such as cefixime. The medication should be taken for five days at a dose of 400 mg per day.

Most adult, non-pregnant women with acute cystitis are sufficient with such treatment.

But some menopausal women who often develop cystitis may benefit from vaginal estrogen replacement therapy, typically in the form of estrogen suppositories. Estrogen therapy helps restore the antibacterial defense and generally improves the quality of life. The medication should be selected in consultation with a gynecologist.

Other methods of treating cystitis are rarely used and only on the recommendation of a doctor. Special diets for cystitis do not help.

What can and cannot be done during cystitis in women

Sex. Most likely, during acute cystitis, having sex simply won’t be desirable. But if the desire still remains, it is important to make sure that this disease is not associated with sexual infection pathogens, otherwise there is a risk of infecting the partner.

Cranberry decoction. During cystitis, it is beneficial to drink plenty of liquids, including a decoction of cranberries, which has a weak bactericidal effect. Therefore, the folk advice to drink a cranberry decoction during cystitis is pointless, unless, of course, it is used not instead of, but as a supplement to the main treatment.

Alcohol. Alcoholic drinks are contraindicated during cystitis as alcohol can trigger a flare-up of cystitis and is incompatible with medications.

Hot baths and saunas. Hot water procedures during cystitis are safer to avoid. However, it is possible to take warm baths or wash under a warm shower.

Prevention of Cystitis

The most reliable way to avoid cystitis is to maintain the cleanliness of the genital area with clean running water and mild soap, especially after sexual intercourse.

There is no need to douche. This will not bring any additional benefits, but can harm the normal vaginal microflora.

Remember

• Cystitis is an inflammation of the bladder, which is very common in women. The main symptom of cystitis is frequent urination and burning pain when trying to urinate.
• Infectious cystitis, which is associated with intestinal bacteria and E. coli, is the most common type. However, there can also be non-infectious cystitis, which can be related, for example, to some medications or inappropriate bath foam.
• The main risk factors for cystitis are penetrating sex, spermicide contraceptives, pregnancy, and menopause.
• If you suspect cystitis, you should see a urologist. If you start with a gynecologist, he or she will still refer you to this doctor—gynecologists do not treat cystitis.
• Most women need antibiotics to get rid of cystitis.
• The appropriate medication can only be selected by a doctor.