Acute and recurrent cystitis. Which is?

What is it?cystitis

A acute cystitis (acute cystites), caused by bacteria and rarely by other microorganisms such as fungus and viruses. Cystitis is the infection more frequent urinary tract (ITU) and occurs more in women, especially in adulthood. In men, only among the elderly.

Usually the disease is caused by bacteria that colonize the vaginal introitus and the urethral meatus and manage to rise to the bladder. The bacterium Escherichia coli (E. E. coli coli), which has fimbriae to adhere to the urothelium (bladder epithelium), is the bacterium that causes the most urinary tract infection (ITU, 75-95% of cases).

Signals and symptons

The main complaints of women with acute cystitis are dysuria (burning to urinate), urgency (urgent urge to urinate), polyuria (urinating often, at all times and with little volume) and final hematuria (blood in the urine at the end of the period). urination). In addition, nicturia (waking up at night to urinate). Suprapubic pain and discomfort. Urine with cloudy appearance, with sediment and smelly.

If fever is not cystitis and yes, pyelonephritis

Acute cystitis does not cause fever and when it occurs (temperature greater than 37,70C), it's because it's happening ITU top (pyelonephritis, infection in the renal tubules). Pyelonephritis requires treatment with antibiotics urgently and sometimes for long duration. Therefore, these cases should be evaluated with imaging tests. THE ITU in adult women it usually occurs 2 to 3 days after intercourse. In children, under 1 year of age, they are usually due to congenital anomalies of the urinary tract and should be investigated with imaging tests. In menopausal women, on the other hand, it is caused by the fall of female hormones after the stop of menstruation. In addition, anatomical changes in the urinary tract may be occurring.

Diagnosis of cystitis

The diagnosis of UTI is made by collecting medium jet urine in the clinical analysis laboratory through the Urine test type I and culture with urine antibiogram. Culture of urine with more than 100.000 colonies / ml of bacteria are considered UTIs. On the other hand, symptomatic and cultured patients with fewer colonies / ml can be considered positive for treatment indication. Patients with repetitive UTI should be investigated with imaging exams. In this way, initially with ultrasound of the urinary tract and female pelvis.

Almost 20% of women who have a ITU will have another, and 30% will still have another. In this latter group, 80% will continue to have recurring ITU. Therefore, other tests, such as tomography for investigation of other findings seen or suspected by the USG, may be requested.

Clinical symptoms for more than 2-3 days

Patients with persistent clinical symptoms after 48 to 72 hours of antibiotic therapy adequate for ITU should undergo radiological evaluation of the upper urinary tract. Radiological evaluation is mandatory for patients with pyelonephritis (renal infection) who are severely ill, have a fever, are toxic, or have symptoms of renal colic or a history of renal calculi, diabetes, history of previous urologic surgery, immunosuppression, repeated episodes of pyelonephritis, or urosepsis.

Risk factors

In sexually active women, risk factors for UTIs include recent sexual activity, spermicide use, and a history of previous UTI. The familial predisposition for UTI can be caused by altered local defense factors. Therefore, it can occur due to the low production of local antibodies. The changes in the composition of the vaginal flora, with bacilli of Döderlein favors predisposition to cystitis.

Even more so, especially if these women are sexually active. Congenital anomalies, mainly because they cause urinary stasis, may predispose ITU and should be corrected surgically. Similarly, patients with functional bladder disorders (of neurological origin) may also be the cause of UTI.

Urinary incontinence

Patients with urinary incontinence, by keeping the genitalia moistened, urine being irritating to vaginal mucosa and skin, facilitating the microbial alteration of the vaginal flora and the occurrence of UTI. Your fix is ​​part of the ITU solution. Pregnant women are at increased risk of developing UTI. During pregnancy, the anatomical changes imposed by uterine growth during pregnancy compress the bladder and ureters. Thus, making it difficult to empty urine from the urinary tract, favoring ITU.

It is estimated that 4% to 10% of pregnant women develop UTIs. Therefore, it is approximately double the number found in non-pregnant women of the same age. In severe cases, UTIs in a pregnant woman can lead to miscarriage and premature delivery.

ITU in childhood

Women who have had an ICU during childhood are twice as likely to develop an infection during pregnancy than women who did not.

Poor intimate hygiene can be a cause of contamination of the vaginal introitus and may be the reason for UTI. Deficiencies of the immunoglobulins secreted by the female genitalia may predispose to UTI. Associated systemic diseases, such as diabetes mellitus, should be compensated for to correct metabolic changes. Thus, these diseases may leave the body fragile in its systemic defenses, predisposing to UTI. Antibiotic treatments of other infectious diseases may alter the genital microflora by corroborating ITU.

Treatment of cystitis

Treatment of acute cystitis should be done with antibiotics for 3 days and preference should be given to the use of bacteriostats as they do not affect the flora of other parts of the body (such as the nasal or intestinal). These remedies are absorbed through the digestive tract and are eliminated promptly by urine. In this way, maintaining high concentrations of the drug in the bladder causes death of the bacteria.

The specific treatment of each case should be based on the cause that is predisposing to ITU. If vaginal changes occur, they should be treated, whether they cause vaginal discharge or dryness of the vagina. The latter is caused by hormone deficiency. Thus, its correction may be the principle of therapeutic success. The recolonization of bacilli of Döderlein normalizes the vaginal flora and fights invasion by intestinal bacteria.

Sometimes the cause of ITU is an important proctological abnormality (anus and rectum diseases) and should be treated primarily. The identification of the clinical situation of the patient is fundamental for the therapeutic planning.

Prevention of cystitis

Some women, with Repeat ITU, should receive a dose of bacteriostatic daily or after sexual intercourse. These women should be instructed to urinate after intercourse to expel the bacteria that ascended the bladder. In this way, the goal is to decrease the population of invading bacteria. Thus, it can give advantage to the body's defenses. For the same reason, generous hydration can help eliminate bacteria from the urinary tract.

Bacterial reservoirs in the bladder

The use of spermicides may predispose to recurrent UTIs. Patients with a reservoir of bacteria, as in women with urinary stasis (cystocele, neurological functional bladder disorders). In addition, diverticula (saculations that store urine) in the urethra and bladder should be left untreated for resolution. Treatment can be clinical or surgical. Urinary stasis is the cause of repetitive UTIs. Patients with urinary incontinence should be treated for resolution of their primary cause.

Normalization of vaginal flora

Normalization of the vaginal flora is part of the treatment of UTI, whether in the pre-menopausal or postmenopausal phase. Sometimes, local hormone replacement can solve the problem. Thus, treatment is instituted indefinitely in postmenopausal women.

Intimate hygiene of the genitals should not be performed after urinating or evacuating with showers, antiseptic soaps or hygienic tissues, as they may alter the microflora and vaginal pH. Try to urinate when you feel a full bladder. Therefore, chronic retention of urine may even cause neurological problems of the bladder. Keeping the bladder empty can help prevent ITU.

Local hygiene care

Exchange frequent and careful absorbents with tight clothing and lingerie made from synthetic materials, as they hinder perspiration and maintain local moisture as facilitators of bacterial proliferation, especially in a tropical country. Personal hygiene should always be done from front to back.

The use of cranberry juice seems to have some protective effect because it produces substance that in the urine prevents the bacterial fimbriae from attaching to the urothelium.

As can be seen, many are the causes and etiopathogenesis (as they happen) of the cystitis, and these should be treated so that the urinary tract is preserved in its integrity. Thus, poor treatment may predispose to complications in the evolution of one of the most frequent diseases observed in women during their lifetime.

However, if you would like to know more about this and other diseases of the genitourinary tract, access our content area for patients to understand and gain knowledge. Culture always makes a difference. You will be surprised! In it you can choose the subject you are interested to know. Select what you are looking for.

Reference

https://www.auanet.org/guidelines/recurrent-uti

EnglishPortuguese
× How can I help you?