Cystitis

Summary

Cystitis is an inflammation and infection of the bladder. It particularly affects women, due to the shorter urethra. It is normal for women to develop one or two urinary tract infections such as cystitis each year.
The cause is mainly bacterial (E. Coli). The risk factors are numerous and can be lack of hygiene, menopause , malformations, etc.
The main symptoms of cystitis are frequent and painful urination (urinating).
Diagnosis is usually based on anamnesis and clinical (laboratory) examination. Complications, although rare, can lead to pyelonephritis, that is, severe inflammation of the kidney. The treatment of cystitis is based on antibiotics .

Drinking lots of water and having good personal hygiene are the two main good prevention tips.

I have cystitis, what should I do?

1. The first thing to do at the first symptoms of cystitis is to drink plenty of fluids, drink directly and quickly, in about 1 hour 1 liter of water, or herbal teas based on medicinal plants. It is important to drink very quickly about 1 liter of fluids in 1 hour (eg 3 drinks of 3.3 dl every 20 minutes). The objective is to dilute the germs, including in the bladder and to facilitate their exit from the urinary tract. We should not drink too much, but until we are no longer thirsty. Drinking heavily is scientifically1 proved to be a very effective measure in the prevention of recurrent cystitis or as a therapy measure.

2. Then look for a doctor to perform urine analysis tests. Thanks to the help of some strips, it is possible to confirm whether or not it is cystitis. After detecting the bacteria responsible for cystitis, he will prescribe anti-inflammatories to calm the pain.
You can buy strips at a pharmacy that allow you to carry out a test that allows you to confirm the presence of bacteria and white blood cells in the urine. If the test result is positive, the person should consult a doctor to prescribe the use of antibiotics .

3. Finally, you can complement traditional therapy ( antibiotics ) with herbal remedies. Drink, for example, several times a day, cranberry juice .

Definition

Acute uncomplicated cystitis is an inflammation and infection of the bladder. It is an infection of the urine in the bladder. The word cystitis comes from the ancient Greek cysto- which means “bladder” and ite “inflammation”.

Bladder
The bladder is a hollow organ that can hold 600 to 1000 ml of fluid. The bladder serves to store the urine produced by the kidneys.

 

 

 

It is an infectious disease caused mainly by bacteria (about 70 to 90% of cases are caused by enterobacteria, of the Escherichia coli type) that rise in the urinary tract to the bladder. Bacteria can attach to the bladder walls and multiply.

Cystitis is often caused by contamination of fecal matter.

Epidemiology

– Cystitis is much more frequent in women than in men, this is largely due to anatomical differences, men have a longer urethra, allowing better protection. On average, the urethra of women measures 4 cm, while men have an average of 20 cm of urethra. The likelihood that bacteria will travel up the urethra and into the bladder in a man is much lower.

In addition, the female urethra is very close to the anus, another factor that explains the higher incidence of cystitis in women.

However, an American study published at the end of 2013 showed that men have a higher risk of being hospitalized in cases of cystitis. According to the researchers, it is mainly elderly men who are admitted to the hospital for antibiotic treatment.

In women, the risk of suffering from cystitis or urinary tract infection is 8 times greater than in men. Some sources even mention a 10 to 20 times greater risk in adulthood.

– 10% to 20% of women are affected by cystitis each year, which makes it one of the main causes of medical consultation.

– It is estimated that 40% to 60% of women suffer from cystitis or urinary tract infection at least once in their lives.

– We emphasize that 10% of women who have had cystitis may suffer from recurrences (more than 4 cystitis per year), in which case it is absolutely necessary to consult a doctor.

Older Women:
– Cystitis is common in older women, it occurs in 10% of women aged 65 and over and 30% of women aged 85 and over2.

See also: interstitial cystitis

Causes

Cystitis is usually caused by bacteria that rise in the urinary tract, therefore, some situations may be favorable to its development, such as:

– poor hygiene of private parts (there may be contamination by bacteria from feces).

– sexual relations

– malformations of the urinary tract

– urinary stones (urinary lithiasis)

– diabetes (type I or II)

– urinary probes such as a catheter. Due to the catheters frequently used in hospitals, the number of people affected by cystitis in hospitals is high.

– pregnancy (there may be compression of the fetus on the bladder, which prevents its complete emptying).

– constipation  (constipation)

– menopause  (between 50 and 60 years, the risk of developing recurrent cystitis is relatively high), the fall in hormones in this period reduces the level of protection of the bladder. In addition, there is a change in the vaginal pH during menopause, which favors the entry of Escherichia coli (bacteria). A basic or acidic pH prevents unwanted bacteria from entering the vagina.

– herpes genital

– spermicides, for example, found in condoms. They increase the risk of urinary tract infections.

– cases of cystitis in the family (genetic predisposition).

Mechanism of attachment of E. coli to the urinary tract
– A Swiss study published in March 2016 in the journal Nature Communications helped to better understand how E. coli bacteria remain attached to the urinary tract. This binding occurs through proteins called FimH, located along the appendages or filaments of E.Coli bacteria (see photo below). The FimH protein binds to sugars in the cells of the urinary tract, when there is a flow of urine the bacteria remain trapped. Once the flow of urine slows down, bacteria sometimes “swim upstream” and can then travel up the urinary tract and into the bladder. This study was carried out in partnership by the University of Basel and ETH Zurich, two leading Swiss institutions.

A Danish study published in August 2016 in the scientific journal mBiOshowed that the E. coli bacterium manages to change its shape and become extremely long (a process known as “filamentation” in English, see the photo below), as a survival strategy. As a result, the bacteria improve their ability to attach to the bladder wall, causing their elimination in the urine to be reduced. Interviewed by Create health in August 2016, Prof. Møller-Jensen of the University of Southern Denmark, who led the study, says the E. coli bacteria is capable of stretching more than 100 times, which dramatically increases its adhesion to bladder cells. By blocking the formation of these filaments, the Danish professor says that it would be possible to increase bacterial elimination through the urine and thus limit cystitis, especially those that recur.
To read:Cause of cystitis, new mechanism

Groups of risk

All women can have cystitis, as they have a urinary tract that favors contamination by bacteria (anatomical difference), but:

– Mainly elderly women, as hormone production that has a protective effect decreases. As discussed in the section on epidemiology above, cystitis occurs in 10% of women age 65 and older and 30% of women age 85 and older.3 .
It’s important to know that we have a microbiome of normal, healthy bacteria that live throughout our bodies to help fight the bad bacteria that make us sick. This is also the case for the bladder and urinary tract, so as we age, these good bacteria can have a harder time fighting infections for a number of reasons. The hormone estrogen, in particular, helps keep good bacteria healthy and bad bacteria at bay.

– Young children (girls) who often still do not have good intimate hygiene (do not dry themselves properly, etc.).

Men are less affected by this problem, with the exception of those with prostate problems, who are more subject to cystitis.

Symptoms

– The person affected by cystitis has a constant urge to urinate. In some cases every 2 minutes.
– The volume of urine is generally insignificant (polyacyuria). It is not uncommon for the flow to be just a few drops.
– There is usually a lot of difficulty and pain (dysuria) when passing urine, due to a burning sensation.
– Pain can also be felt in the back region or in the lower part of the belly.
– Often, the urine emitted can have a bad smell.
– In case of cystitis it is possible to feel a persistent feeling of full bladder. Also, blood in the urine is usually the sign of cystitis.
– Urine may be cloudy. In fact, during cystitis the E.Coli bacteria travel up the urinary tract, attach themselves to the wall or inner surface of the bladder, grow and then cause inflammation. In response, the body rejects the outer layer of bladder cells and removes most of the bacteria in the urine. This results in cloudy urine, typical of a urinary tract infection such as cystitis.

Blood
Cystitis usually does not have serious consequences, but in certain cases it can have complications, such as the development of kidney infections. This symptom would be a consequence of our organism’s defense reaction. During cystitis, white blood cells are mobilized. This results in inflammation, which damages the urinary mucosa in particular. Small amounts of blood may pass through the urinary tract and end up in the urine, also called hematuria (blood in the urine).

Typically, cystitis does not present with a fever. This symptom usually characterizes pyelonephritis, a serious complication of cystitis.

Cystitis in the elderly and mental confusion
In older people (aged 80 or over), the classic symptoms of cystitis, such as the constant urge to urinate, may not exist, which greatly complicates the diagnosis. However, the elderly may have symptoms such as mental confusion, memory disorders, delusions or even hallucinations. Restlessness and vertigo are two other possible symptoms. Delusions may eventually be characterized by forgetting the names of the grandchildren, aggressiveness, strange behavior, etc. The origin of these delusions lies in a change in the immune system of the elderly.
Very often, these mental symptoms precede the typical symptoms of cystitis, such as pain or the frequent urge to urinate, and sometimes they can even be the only symptoms of cystitis in the elderly.
As with younger people, treatment consists of administering antibiotics to treat the infection. However, in case of asymptomatic bacteriuria (in English:  asymptomatic bacteriuria ), that is, without symptoms in the elderly, antibiotics should not be administered4 . It is not necessary and causes antibiotic resistance.

Diagnosis

The diagnosis of cystitis can be based on anamnesis (medical history) or sometimes on a urine test. This test is especially recommended in risky situations, for example in pregnant women.

Urinalysis Urinalysis
(urine sample) may include looking for nitrites. These are released by bacteria, especially E. coli, which cause cystitis in about 85% of cases. A high level of white blood cells (leukocytes) can also be found in the urine during cystitis, because the inflammation produces large amounts of white blood cells. Finally, blood in the urine, in some cases, also characterizes cystitis (read more about this in Symptoms, above).

In addition, the doctor may also order an ultrasound scan.

Diagnosis is always the doctor’s task, so only he will know how to decide the best diagnosis.

Complications

Cystitis usually does not bring complications. However, in some cases, if not properly treated, it can allow bacteria to rise in the kidney region, thus causing nephritis or pyelonephritis. Elderly and immunocompromised people are at greater risk of developing complications.
This type of complication is very problematic and can endanger the kidney (risk of kidney failure, with dialysis), if in doubt about cystitis, always consult a doctor.

A poorly treated cystitis can also lead to septicemia.

When to see a doctor?

– It is absolutely necessary to consult a doctor in the following cases: if there is blood in the urine, severe pain (e.g. in the back) high fever , if the cystitis remains painful and/or accompanied by fever for three days, if it occurs in men ( risk of prostate hypertrophy ), children or pregnant women. In case of recurrent cystitis it is also important to consult a doctor. It is normal for women to develop one or two urinary tract infections each year like cystitis. But when they appear more often, or when they appear in men, they can be cause for concern.

Warning, non-exhaustive list, for any suspicious symptoms, consult a doctor.

Treatments

antibiotics

The doctor, after making a diagnosis and ruling out the risk of complications, usually prescribes antibiotics. Norfloxacin or other molecules in the quinolone family are sometimes prescribed for a short period of time (as a single dose or for more than 3 days). But because of the increase in cases of resistance, other classes of antibiotics are always more prescribed, such as amoxicillin or, mainly, fosfomycin and nitrofurantoin (always the first choice, read more below). Antibiotics are available only with a prescription.

Fosfomycin may have some advantages over other antibiotics:
– A single fosfomycin-based pill can usually cure cystitis.

– Resistance rate would be lower than for other antibiotics (compared to quinolones).

– Fosfomycin has fewer side effects, such as diarrhea or nausea.

– The action of this antibiotic is more specific: in fact, fosmycin will prevent the bacteria (responsible for cystitis) from attaching to the bladder walls.

However, a Swiss study published in 2018 showed that nitrofurantoin was significantly more effective against cystitis than fosfomycin. In this study conducted by the University of Geneva, 513 women aged between 18 and 101 years, residing in Switzerland, Israel or Poland, were randomly assigned to fosfomycin treatment or nitrofurantoin treatment. The researchers performed bacterial controls on the participants before taking the drug, at 14 days and 28 days after treatment to observe the eradication of infectious bacteria. Scientists found that 70% of participants responded positively to the use of nitrofurantoin and 74% of bacteria definitely disappeared, compared to a success rate of just 58% to 63% of bacteria eradicated in women treated with fosfomycin. This study was published online May 1, 2018 in the scientific journalJAMA (10.1001/jama.2018.3627).

It is recommended to avoid quinolones, due to increased resistance.

Review of fluoroquinolones
Fluoroquinolones, used in the past against cystitis and urinary infections, have been increasingly discouraged since the 2010s due to potential side effects, sometimes serious, especially on muscles and joints, tendons and neurological. Since 2016, the FDA (United States drug regulatory agency) advises against the use of fluoroquinolones against simple urinary tract infections (e.g. simple cystitis)5

Because of the increase in quinolone-resistant bacteria, other types of antibiotics are often used against cystitis (eg cefuroxime and cotrimoxazole), European and American specialists have proposed since 2011 recommendations to avoid the use of quinolones in the case of uncomplicated infections of the lower urinary tract (UTI), i.e. in women with acute urinary cystitis without known pathology, outside pregnancy and without fever, as revealed by the Swiss reference site Pharmavista.net in June 2011.

The University Hospital of Geneva (HUG) in Switzerland offers the following treatment for uncomplicated UTI in women (no fever, not pregnant and no urinary tract malformation)

– 1st choice: nitrofurantoin 100 mg capsule, three times a day, for 5 days

– 2nd choice: fosfomycin 3 g in a single dose

Attention, as with all treatments with antibiotics, respect the duration of the treatment, that is, even if you no longer have the symptoms or pain associated with cystitis, do not suspend the prescribed therapy, follow the medical instructions until the end (finish the pill box), otherwise you are increasing antibiotic resistance.

In severe cases of cystitis or urinary tract infection, the duration of low-dose antibiotic therapy can last up to 5 years.

However, since 2019, the Swiss Society of Infectious Diseases recommends one or the other molecule (nitrofurantoin or fosfomycin) as the first choice, without priority. Recommended treatment varies slightly by HUG, ie nitrofurantoin 100 mg twice daily for 5 days or fosfomycin 3 g as a single dose.

Note on antibiotics against cystitis

– The rate of resistance to the antibiotic trimethopine can be greater than 20% in certain countries. Fluoroquinolones can also generate resistance, so in the case of complicated cystitis, it is preferable to take other antibiotics such as fosfomycin, mecilinam and/or nitrofurantoin (Source: Tribune Médicale, June 2009, Switzerland).

– In severe cases or when there is resistance to oral antibiotics, the doctor may give intravenous antibiotics.

– Ciprofloxacin is another antibiotic, among others such as nitrofurantoin or fosfomycin indicated for cystitis, but it should be preserved and used only during severe infections. Indeed, ciprofloxacin, a new generation antibiotic, has been overused, especially in the 2000s, and has led to cases of resistance. In 2018, the University of Geneva estimated in a press release published in May 2018 that up to 20% of the bacterial population was resistant to ciprofloxacin.

– In 2018 and according to the University of Geneva, the most prescribed antibiotic against cystitis, at least in Switzerland, was fosfomycin. The reason is that taking fosfomycin to fight cystitis is very simple, just take a pack of this antibiotic at once. Nitrofurantoin, another antibiotic also indicated for cystitis, is prescribed 3 times less in Switzerland than fosfomycin. The main reason is that taking nitrofurantoin is more complicated, 1 tablet 3 times a day for 5 days, than fosfomycin (1 single dose).

Anti-pain – Anti-inflammatory

Against the pain of cystitis, you can also take anti-inflammatory drugs ( ibuprofen ,…).

Antispasmodic

Against spasms, it is also possible to take an antispasmodic, which should be used at the first symptoms of cystitis.

Cystitis vaccine?

So far there are no vaccines available against cystitis, but according to some studies it will be possible in the long term to develop a vaccine (with E.Coli) against this and other urinary infections. Laboratory tests carried out on rats have obtained good results, but it is still necessary to wait a few years for these to be carried out on people.

Menopause and cystitis (urinary infections)

After menopause , some doctors prescribe estrogens (eg vaginally) to prevent the risk of urinary tract infections in women.

Treatment of recurrent cystitis

If more than 3 episodes of cystitis occur per year, it is called recurrent cystitis.

Antibiotics
To treat recurrent cystitis, the doctor may, for example, prescribe a low dosage of antibiotics to be taken daily for between 6 and 12 months.
Some doctors, especially American ones, recommend taking an antibiotic pill or capsule after each act of intercourse. This approach does not increase cases of antibiotic resistance as well as vaginal mycoses.

Mannose, a natural remedy in case of recurrent cystitis
Mannose is an interesting alternative for replacing the antibiotics used in the treatment of uncomplicated recurrent cystitis, as it binds to the FimH protein of E.Coli bacteria (see Causes, below, to better understand the FimH protein and its role in cystitis). Mannose is a simple sugar, which can be purchased at a pharmacy, for example, in the form of D-mannose. The use of D-mannose for 6 months is recommended for long-term prevention. The dosage indicated for the prevention of cystitis is 2 g a day, simply dissolved in a glass of water.
Mannose acts as a natural antagonist of the FimH protein. A Croatian research dated 2014 carried out with more than 300 women (here the link to learn more about the study) showed that mannose was as effective as antibiotics in preventing recurrent urinary tract infections. Mannose causes fewer side effects than antibiotics, although there is eventually a side effect with this sugar:  diarrhea .

Herbal medicine

There are numerous plants that help prevent and treat cystitis.
However, these plants must be used under the prescription of a specialist (pharmacist, doctor) who will indicate which is the most suitable, depending on the symptoms , frequency and duration of cystitis.
In cases of bacterial infection, doctors usually prescribe   antibiotics quite frequently. We emphasize that the role of berry plants ( cranberry , cranberry) in the prevention of recurrent cystitis is very positive.
You will find below the plants most used in the treatment and prevention of cystitis.

Plants used in the prevention of cystitis:

– Red cranberry  ( blueberry ), used in juices.

– Cranberry , used in juices or in capsules.

Plants used in the treatment of cystitis:

–  Birch , used in teas or capsules.

–  Heather ( Erica cinera ), used in capsules

–  Nettle , used in teas or capsules.

–  Horsetail , used in teas or capsules.

–  Uva-ursi , used in teas or capsules.

Homemade medicine

Here are the home remedies advised in the treatment or prevention of cystitis:

– Cider vinegar (prevention)

– Infusion against cystitis

– Horsetail infusion

– Water with lemon rich in bicarbonates. Add a little lemon juice to mineral water, if possible, rich in bicarbonates. Bicarbonates make it possible to alkalize the urine, and lemon juice acts as an antibacterial agent.

therapy tips

– Drink plenty of fluids: 1.5 to 2 liters of water per day, as, as with colds, this resource allows the dilution and elimination of infectious germs. This effect is particularly useful in the area of ​​the urinary tract and bladder. Avoid drinking sodas or other fizzy drinks, and prefer water, cranberry juice or herbal teas against cystitis. Try to empty your bladder completely and often.
It is important to drink very quickly about 1 liter of fluids in 1 hour (eg 3 drinks of 3.3 dl every 20 minutes). The objective is to dilute the germs, including in the bladder and to facilitate their exit from the urinary tract. Drinking heavily is scientifically proven to be a very effective measure, either in preventing recurrent cystitis or as a therapeutic measure. Also don’t drink too much, but until you are no longer thirsty.

– You can apply a thermal bag to the lower part of the belly to relieve the pain of cystitis.

Prevention

– Drink plenty of fluids (at least 1 liter a day). To prevent recurrent cystitis, try juices (250 ml a day) of berry plants (cranberry, cranberry) as these are quite effective. Try to empty your bladder completely and often.

– Fight against fatigue and stress, as both can be responsible for the appearance of cystitis, through the weakening of the immune system. You can take fortifiers and vitamins to strengthen the immune system.

– Increase your immune defenses, through the sauna, for example, and a healthy diet, made up of fruits that are rich in vitamins (avoid citrus fruits) or probiotics (yoghurt, lactobacilli, …).
You can also take medicines based on echinacea, vitamin C or immunostimulating medicines based on extracts of germs, such as E.Coli bacteria, to strengthen the immune system.

– Wear warm clothes in winter, avoid very tight, short or synthetic underwear (give preference to cotton garments). Young women should be careful with the fashion for showing their bellies in winter, as the cold weakens the immune system, thus increasing the risk of getting cystitis.

– Regularly change your underwear to prevent the appearance of infectious agents.

– Treat and prevent any constipation problem as soon as possible, as this can favor intestinal fermentation which, in turn, can lead to the spread of bacteria towards the urinary tract.

– Urinate whenever you feel like it, it is not advisable to “hold the pee”, because in this case the germs can proliferate more easily.

– Have good intimate hygiene. The use of very strong soaps or cosmetics can favor the entry of infectious agents.

– In some women, after the first sexual intercourse, there may be remnants of the hymen, which prevent a good evacuation of urine and can cause cystitis. Because of this, some women manage to observe a reduction and even interruption of cystitis after the birth of their first child. For this, the delivery must be normal, as this will help to evacuate the remnants of the hymen in a natural way. In some cases, the doctor may propose surgery to remove these remains.

– Respect hygiene advice in the bathroom, women should clean themselves from front to back, towards the anus, to avoid contamination of the urinary tract by fecal infectious agents.

– Sexual intercourse can sometimes favor the appearance of cystitis, so it is advisable to drink before intercourse and urinate (empty your bladder) soon after, as this allows the elimination of certain germs that can cause cystitis.

– Avoid jacuzzis (they can be infected with numerous germs)

– If you are in menopause, you should know that symptomatic vaginal dryness during menopause can favor urinary infections. Talk to your doctor to act preventively, if applicable.

– Avoid the use of external pads, especially among women with recurrent cystitis. Prefer the internals.

– In case of recurrent cystitis, acupuncture can be an effective alternative medicine. The action of acupuncture is based on stimulating the immune system and strengthening certain organs of the urinary tract (bladder, for example). Consult your acupuncturist about the recommended number of sessions. According to a Norwegian study, two sessions per month for a month reduced the number of cystitis in the six months following the acupuncture sessions.

– Do not use spermicides, especially in condoms or diaphragms. These chemicals increase the risk of cystitis and urinary tract infections in general.

– In case of recurrent cystitis, take more showers than baths.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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