Cystitis prefers Women

Cystitis, bladder pain and urine infections are very common in women. What is the reason? how to treat and prevent these problems?

The bladder is a median and distensible organ where urine gathers before its release outside the body trough

cystitis and bladder pain

Bladder inflammation (cystitis) is very common in women.

urination. Cystitis means inflammation of the bladder and it is usually caused by a urine infection. Typical symptoms are pain when you pass urine, and frequent urination.

It is possible to distinguish between acute form, when symptoms arise unexpected, and chronic forms, when they last in time. As you will see, the problem is quite common in women.

PREVALENCE (Epidemiology)

Cystitis is so common in women to become a characteristic disease and to affect about 20-30% of them every year. Practically, a 50% of women experience at least one episode of cystitis in their lifetime. Its incidence tends to increase with age: rare before puberty, increases with the beginning of sexual activity and after menopause.

The reason for this higher preference for women appears to be linked to the particular anatomical shape of their lower urinary tract. The shortness of female urethra (the structure that connects the bladder to the outside), and its proximity to vagina and rectum seems to predispose to a more easy contamination of urine by bacterial, fungi and viruses. We will discuss in this article the most frequent Cystitis. Rarer infectious cystitis (by drugs, radiation therapy, interstitial) will not be discussed.

Predisposing or triggering factors (CAUSES)

Among the most frequently pathogens cause are counted mainly Escherichia coli (Gram Negative that normally dwells in the intestines) but also Proteus, Klebsiella, Pseudomonas, Staphylococcus Aureus.

Many are those conditions considered related to the cystitis onset. Among these we include:

 poor hygiene (importance was also given to the way in which it is made ​​cleansing of the external genitalia and peri-anal region)

 genetic factors (higher bacterial adhesion to cells of the lower urinary tract lining)

 alterations of pelvic pavement static (prolapse of utero-vaginal and bladder conditions)

 inflammatory conditions of vulva and vagina (contamination, alteration of local ecosystem)

 reduced immunity

 diabetes

 hormonal factors (estrogen deficiency)

 sexual intercourse (in some women closely linked to the onset of cystitis through microtraumas and easier contamination of the urethra)

SYMPTOMS

The onset of cystitis is characterized by a burning sensation and a difficulty in urination, a burdensome feeling (weight) and pain in the suprapubic region, perception of incomplete bladder emptying and a more frequent needs (with stimulus sometimes imperious) to urinate. Sometimes there may be blood in the urine (hemorrhagic cystitis).

DIAGNOSIS

The diagnosis is not in the scope of this discussion. We can say, however, that Cystitis is almost always easy to diagnose. More attention require chronic and relapsing forms.

 

THERAPY

Although therapy is not the scope of this discussion task because is under family doctor responsability, it is still a medical therapy that is often prescribed in an empirical way (particularly in acute forms) or on information derived from culture tests (resistant forms, chronic and recurring). Surgery is useful when it is found a a prolapsed bladder condition that prevent a complete emptying of the bladder favoring the accumulation of urine and bacteria. Even hormonal therapies (by local, general or vagina) may be useful when it is identified the main responsibility of a dystrophic condition of the mucous membranes resulting from hypoestrogenism.

PARTICULAR SITUATIONS

Menopause: the estrogen deficiency increases the bladder and urethral mucosa vulnerability;

Pregnancy: the progressive growth of the uterus displaces and compresses the bladder and could create problems in its regular emptying. Secretion of progesterone also leads to an alteration (relaxation) of the pelvic support structures tone. This facilitate urinary infections and therefore episodes of cystitis in pregnancy. It should be emphasized that the inflammation (infection) of urinary tract during pregnancy are particularly dangerous and therefore requires special attention.

The honeymoon cystitis is a form of cystitis described after frequent and close sexual intercourse (once typical of young newly married couples) probably favored by microtraumatic factors and especially by bacterial contamination of urinary meatus and then of lower urinary tract.

The role of the Gynecologist

Vagina, vulva, sexual activity, ovarian hormonal changes and pelvic static changes play an important role in this disease and may become the cause of its chronicity. It is important to treat well and prevent vulvovaginal inflammation, also including changes in the local ecosystem which are possibly present. The role of the gynecologist is very important, especially for that forms that show a recurring tendency.

 

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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