Cystitis is an annoying inflammation of the urinary bladder, which as we know is the organ responsible for accumulating urine (produced by the kidneys), before eliminating it externally.
The inflammation of the bladder, which characterizes cystitis, can have many causes of origin; however, in most cases, it is caused by a bacterial infection affecting the urinary tract.
From an epidemiological point of view, cystitis is a disease that mainly affects women. The reasons for this phenomenon are explained by the different anatomical characteristics with respect to the male sex. In particular, the urethra - which is that small tube through which urine is expelled from the bladder to the outside - is shorter in women. Consequently, the path that separates the pathogens from outside the bladder is shorter. Furthermore, precisely at the external level, in the woman the opening of the urethra is close to the vaginal orifice and closer to the anal area than in the man; that often the pathogens responsible for cystitis come from the intestine, this proximity explains the higher rate of cystitis in women.
After invading the urethra and rising up to the bladder, the pathogens begin to replicate at the expense of the cells of the bladder mucosa; this triggers a local inflammatory and immune response and causes the typical symptoms of infectious cystitis. urinating, pain and burning associated with passing urine, cloudy and foul-smelling urine, poor urination and pain in the lower abdomen.
Cystitis usually has a benign course and usually resolves with increased water supply and short antibiotic treatment.
The causes of cystitis are varied and numerous. We have already anticipated that in most cases, the onset of cystitis is due to a bacterial infection; for this reason, in such cases, we speak of infectious cystitis or bacterial cystitis. In many cases, the bacterium responsible for inflammation of the bladder is Escherichia coli, often originating from the intestine. However, infections can also be caused by Staphylococci, or by bacteria of the genus Proteus or Klebsiella. Less often, cystitis is triggered by viral or fungal infections.
The microorganisms responsible for infectious cystitis can reach the bladder in three different ways. We have already seen the most common one in the introductory part and consists in the ascent of pathogens of fecal or vaginal derivation from the outside through the urethra, which is why it is called the ascending route. The second and third routes are internal to the organism; in fact, the pathogens can reach the bladder through lymphatic diffusion from nearby organs (for example the prostate, colon, appendix or genital apparatus), or be carried by the blood.
In addition to the forms of infectious cystitis that we have just seen, there are also forms of cystitis NOT associated with an infection. This is the case of interstitial cystitis, which will be the subject of a dedicated video, or the forms associated with radiotherapy treatments or the use of certain immunosuppressive, anticancer, cortisone or antibiotic drugs.
Another important aspect related to the causes of cystitis is represented by the so to speak "structural" anomalies of the urinary tract. These anomalies, in fact, can hinder the normal outflow of urine, preventing the complete emptying of the bladder; the resulting stagnation of urine will therefore favor the proliferation of microbes in the bladder. In such circumstances, the obstacle to urinary outflow can be associated, for example, with the presence of a stone, with prostate hypertrophy that occludes the urethra, or more rarely with a tumor of the genitourinary tract.
In addition to structural anomalies, another factor that can favor the onset of cystitis is sexual intercourse, especially if frequent and unprotected. In women, in particular, the sexual act can favor the transfer of bacteria from the vagina or perineum to the urethral orifice; to this we can also add a mechanical damage linked to the close proximity of the vagina to the urethra and the bladder. It is no coincidence that in women, we often speak of honeymoon cystitis, to indicate the episodes that follow sexual intercourse. Estrogen deficiency, poor vaginal lubrication and pain during intercourse are other elements that can favor the appearance of cystitis after intercourse in women.
In men, on the other hand, unprotected sexual intercourse is more often the cause of urethritis; from here, however, the infection can also extend to the prostate, causing prostatitis, and to the urinary bladder. Bacterial prostatitis, after the age of 50, is often associated with benign prostatic hyperplasia problems, which also make cystitis problems more common than young males.
Other factors that can predispose to cystitis include the use of urinary catheters, poor, excessive or otherwise inappropriate intimate hygiene, alterations in the vaginal flora, constipation, use of spermicidal gel or contraceptive diaphragm and even hypersensitivity to some irritants, contained, for example, in products for intimate hygiene. Cystitis is also more common in diabetic people and in pregnant or menopausal women. The presence of sugars in the urine, the lack of estrogen and the hormonal and bodily changes associated with pregnancy, in fact, favor the onset of bladder inflammation.
As for the course, ie the evolution over time of the disease, cystitis can be acute or chronic.
Acute cystitis is characterized by a short course and by symptoms that usually appear rather abruptly. In particular, acute cystitis manifests itself with pain and burning during urination, that is, during the expulsion of urine; moreover, the urge to urinate occurs suddenly and more frequently than usual, although the subsequent urination is scarce, therefore characterized by the emission of a few drops of urine. In addition, in the presence of cystitis, the urine can take on an intense odor and appear dark and cloudy, due to the presence of white blood cells produced by the body to fight the infection. In the presence of cystitis, the urine may contain even a few drops blood, which in medical terms is called hematuria. To all these symptoms that affect the urinary sphere, in some cases back pain and fever with chills can be added. Both of these signals can be a sign of an "extension of the infectious process to the kidneys; therefore, in the presence of high fever and lower back pain it is important to seek immediate medical attention.
Turning to chronic cystitis, this is often the consequence of inadequately treated acute cystitis. In such circumstances, the infection tends to become chronic, that is to recur several times over time. In the case of chronic cystitis the symptoms are similar to those seen for the acute form, although generally less intense and of longer duration.
In the presence of the typical symptoms of cystitis, the doctor may prescribe a thorough urine analysis first.
The urine sample can be subjected to urine culture, for example. This test has the purpose of isolating the pathogen or pathogens responsible for cystitis from urine; moreover, the same microorganisms can be subjected to a sensitivity test to antibiotics, called antibiogram, to identify the most effective drug.
In addition, in the presence of cystitis, the urine test may show an increased number of white blood cells and the presence of red blood cells and nitrites, produced by some bacteria such as Escherichia coli. In addition to urinalysis, if the cystitis does not regress rapidly or if it tends to become chronic, other specific tests, such as cystoscopy, will be prescribed. The purpose of these investigations is the morphological study of the urinary tract, in order to identify any predisposing anomalies, which can therefore be the cause of cystitis.
The treatment of cystitis clearly depends on its causes of origin. For example, the therapy of choice for bacterial cystitis is based on the intake of antibiotics; these drugs will be chosen from those that are easy to eliminate through the urinary tract, where they can perform the treatment. their bactericidal action. Furthermore, it would be advisable to choose them in a targeted way based on the results of the antibiogram, and to associate them with a diet particularly rich in liquids.
In addition to antibiotics, the doctor may prescribe anti-inflammatory and antispasmodic medications for pain relief. In women, the antibiotics prescribed should respect the vaginal ecosystem, which if necessary can be rebalanced with appropriate interventions. For example, after menopause, especially in case of pain during intercourse and poor lubrication, the application of small amount of estrogen directly in the vagina. In most cases, if infectious cystitis is treated promptly and correctly, symptoms usually resolve within a few days. Sometimes, however, no cause can be identified and relapses are frequent. Therefore, small lifestyle changes can help.
Prevention of cystitis is fundamentally based on compliance with certain hygiene and dietary rules. The simplest way to prevent it is to drink a lot, at least the canonical liter and a half or better two liters of water a day; this allows the dilution and elimination of pathogens that may be present in the bladder.
It is also important to take care of intimate hygiene every day, avoiding the use of soaps or too aggressive cosmetic agents, which can favor the attack by infectious agents. It is also necessary to avoid holding urine for too many hours, always satisfying the urge to urinate and emptying the bladder well.
It is also advisable to avoid unprotected sexual intercourse, limit alcohol intake and fight constipation with an active life and adequate nutrition. As for nutrition, the usual intake of spicy foods, chocolate, coffee and tea, can irritate the urinary tract and worsen the problem of cystitis.
A natural remedy particularly suitable to counteract the disorder is cranberry or cranberry, useful both to prevent and to counteract the first symptoms. Mannose can also be useful in cases of bacterial cystitis, especially if caused by some types of Escherichia coli.
Last but not least, the habitual use of too tight clothing and underwear in synthetic fabric should be avoided. These garments, in fact, reduce the perspiration of the private parts and can cause local irritation and annoying disorders, such as skin redness and the appearance of itching, preparing the ground for bacteria.
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