Pain after sex: Why cystitis torments many women and how to beat it
Cystitis at least once in his life was in 60% of womenolder than adolescence, and every tenth woman over eighteen years of age it happens every year. After the first episode, 25-50% of cases of cystitis return within a year, and in 3-5% of women the infections will recur longer. Fortunately, most often acute infections of the lower urinary tract occur without complications and respond well to treatment without posing a threat to life. Nevertheless, this condition is extremely unpleasant. We understand why not everyone suffers with cystitis, why it comes back and what to do to get rid of it.
Burning and pain
Suspecting cystitis without the help of a doctor is easy: you can hardly confuse his symptoms with something. An unbearable desire to pee, an emergency search for the nearest toilet, a jerk into the stall, and a bladder that signaled that he needed to be emptied urgently produced a few drops of urine. The pain is such as if thousands of nails and pins aspire to the outside. The picture is complemented by a burning sensation with good urination, the continuation of false urges, a feeling of pressure in the lower abdomen, discomfort in the pelvic region. Visible changes in urine are sometimes added: it becomes reddish or turbid, acquires an atypical, pungent odor. The situation is frequent: there are 26 million such episodes per year in Russia, that is, more than 70,000 per day - and these are only cases in which women went to a doctor, in reality, the figure may be higher.
It is necessary to define the terms: in the English-language medical literature usually talk about urinary tract infections, and not about cystitis or urethritis separately. This is justified, since the symptoms of inflammation of the urethra (urethra) and the bladder are almost the same, and it is very difficult to catch the moment when urethritis becomes cystitis. Most often, inflammation does not spread above the bladder, so we can talk about lower urinary tract infection - in contrast to diseases of the upper part, in which inflammation covers the ureters and kidneys.
Microbes and Biofilm
The causative agent of acute cystitis in 70-90% of cases is Escherichia coli, in 5-15% - Staphylococcus aureus. Less commonly, an enterococcal infection, an extraordinary Proteus (the name of the microorganism Proteus mirabilis is translated from Latin), Klebsiella is detected. In theory, after treatment with properly selected antibiotics, the infection should recede, and the state should be normalized. But in practice, everything is much more complicated: many factors affect how cystitis happens and how quickly you can get rid of it.
Let's start with the bacteria: E. coli, it is Escherichia coli, in healthy people lives in the lower intestines. Due to continuous mutations, some strains of these bacteria have acquired lint or flagellum, allowing them to penetrate new habitats - in fact, these are proteins that can attach to the cells lining the urethra and bladder. In addition, the microorganism has learned to form a biofilm - a whole community of bacteria that is resistant to the effects of antibiotics and cells of the immune system.
Cystitis can also occur without a bacterial infection - in this case there is no sense in antibiotics. There is, for example, the so-called interstitial cystitis, the causes of which are still not completely clear. It is manifested by prolonged inflammation of the bladder and pelvic pain, affects mainly women, and the infection is not detected. Even cystitis can occur under the influence of chemicals - for example, in the composition of foam or bombs for baths, hygienic sprays or gels, spermicidal tablets or jellies. These substances trigger an allergic reaction in the urethra; inflammation of the urethra and then the bladder develops.
Sex is always a risk factor: 60% of all urinary tract infections occur after intercourse. With sex more than three times a week, the risk of urinary tract infection is three times higher than if there were no sex.
Sometimes cystitis occurs when you take certain medications, for example, to treat systemic lupus erythematosus or glomerulonephritis. Foreign body cystitis is an inflammation that develops, for example, because of an installed catheter. In general, good health, cystitis is unpleasant, but not dangerous, but during pregnancy, in women with diabetes or kidney stones, in the presence of anatomical anomalies or suppression of immune function, the disease is no longer considered harmless: inflammation can "rise" and cause kidney tissue damage.
And yet the most common case is the usual bacterial cystitis. It occurs in women more often than in men, due to the characteristics of the anatomy: a short and wide urethra facilitates easy penetration of infectious agents into the bladder. But there are other factors, because of which some women do not have cystitis at all, while others suffer from it all the time.
Honeymoon and Hormones
Contrary to the stable opinion, sitting in the cold does not cause cystitis, and the main predisposing factor is sexual activity. Acute inflammation of the bladder often occurs for the first time after the onset of sexual activity - even the term “honeymoon cystitis” was coined for this. Mechanical stimulation of the urethra, a change in the tone of the muscles of the pelvic floor, and blood stagnation in the lower third of the urethra become triggers, which increases the risk of injury to the urethra. Sometimes factors combine to reinforce each other’s influence.
Sex is always a risk factor: 60% of all urinary tract infections are postcoital, that is, occur after sexual intercourse. With sex more than three times a week, the risk of urinary tract infection is three times higher than if there was no sex. Using spermicides for contraception is also not the best option: their active ingredients reduce the number of beneficial lactobacilli and change the pH of the vagina, allowing bacteria to enter the urethra.
A significant role is played by the hormonal balance: there is evidence that in 10-15% of women cystitis occurs a week before menstruation. Due to changes in estrogen levels, a certain type of white blood cells (mast cells) in the bladder releases inflammatory substances. Estrogens also affect the formation of a protective layer of mucopolysaccharides on the surface of the epithelium, which prevents the attachment of bacteria; few estrogens - few substances to counteract the infection.
What exactly you should not do - so it is to enter into the search engine line "popular methods of treatment of cystitis." Despite the fact that some of these methods helped women a hundred or more years ago, they have not yet been studied and are sometimes dangerous.
Another risk factor is a violation of the vaginal ecosystem; For example, taking antibiotics can cause the growth of fungi and the appearance of thrush, and after using antifungal drugs, a newly shifted balance can provoke repeated cystitis. Sometimes it is caused by a candida fungus that causes thrush. In addition, stress increases the vulnerability to inflammation of the bladder; Emotional stress activates the production of one of the hormones of the hypothalamus (corticoliberin) and the release of biologically active substances responsible for inflammation. It is proven that stress increases the susceptibility to inflammation of the bladder.
Another important point - congenital anatomical anomalies. If the exit from the urethra is low, that is, close to the vagina, during sex, the urethra may gape and become the entrance gate for bacteria. A similar situation occurs with increased mobility of the urethra, when it is displaced to the vagina at certain positions of the body. Finally, hereditary influences resistance to cystitis. The urinary tract is lined from the inside by a layer of cells that produce protective substances (proteoglycans and glycosaminoglycans) that interfere with cell penetration. If there is a genetic defect in the synthesis of these substances, the bacteria penetrate into the tissue faster and provoke inflammation.
Antibiotics and kegel exercises
The most common cause of cystitis is a bacterial infection, and to cure it, you need to destroy the pathogens. Ideally, it is necessary to pass urine for planting on a nutrient medium and determine the sensitivity of the pathogen to antibiotics - this will help to understand exactly which bacteria were the cause and which antibiotic is needed. True, with the classic picture of cystitis, treatment is often prescribed without tests. The Russian Society of Urology believes that the right choice is a single dose of three grams of fosfomycin trometamol (this drug is sold in a single-dose package). In principle, this option can be chosen if the cystitis is found where it is not possible to get to the doctor quickly - but after returning it is better to appear to a specialist.
The American Urological Association has issued recommendations to help the doctor find the right antibiotic, the dose and duration of therapy. On some points, these recommendations differ slightly from European ones, but in general they are similar. If the inflammation recurs, long-term antibiotic therapy can be recommended, up to six months or even up to a year - of course, only a specialist who can take into account various factors can do this treatment. And if cystitis occurs after sexual intercourse, then prophylactic antibiotics for two hours after sex can be the best tactic - this is more gentle with respect to the intestinal microflora and vagina than long prophylactic antibiotics.
Sometimes there is an inexplicable situation: the symptoms of cystitis are, the urine is sterile according to the results of the analysis, but the course of antibiotics helps a lot. A possible answer is that there are bacteria, but they are not enough to form a visible colony.
In addition to antibiotics, the doctor may recommend normalizing the tone of the pelvic floor muscles (Kegel exercises are suitable for this) and determining the level of estrogen: if it is low, the doctor may prescribe a replacement therapy. Since spermicides are also known as provoking cystitis, it may be necessary to change the contraceptive method to prevent recurring inflammation. Also at the reception, the gynecologist can determine the location of the urethra and give recommendations on what positions to avoid during sex so as not to injure her. In severe anomalies, if other options do not help get rid of cystitis, an operation is performed - surgical movement of the urethra to its typical place.
Cranberry and new methods
There is no definitive evidence on the effectiveness of cranberry juice for the prevention of recurrent infections. Cranberry components have been reported to disrupt the attachment of Escherichia coli to the cells lining the bladder; however, the dosages of juice in this study were quite large and even caused nausea in many participants. Another method with insufficient evidence is the advice to urinate immediately after sex in order to mechanically wash bacteria from the urethra. Although it is impossible to say exactly how effective it is, this method is exactly safe and simple, so it is not necessary to ignore it with a tendency towards cystitis.
D-mannose can be attributed to the new means of preventing cystitis - the ability to prevent relapses has been demonstrated for this substance if taken on a six-month course. D-mannose is found in citrus fruits and acts like cranberry flavonoids - disrupting the attachment of bacteria to urinary tract cells. While there is no large clinical studies on this topic, and D-mannose is used in veterinary medicine to help cats, horses and dogs, and people are offered in the form of dietary supplements. Perhaps, after a more thorough examination, it will be registered as a medicine.
Red flags and folk methods
It is worth knowing about the warning signs, when it is not worthwhile to delay a visit to a specialist (urologist or nephrologist). This is urine staining in red color, pain in the back or on the sides of the abdomen, high fever, nausea or vomiting. Such symptoms may indicate more serious problems - for example, pyelonephritis.
What exactly you should not do - so it is to enter into the search engine line "popular methods of treatment of cystitis." Despite the fact that some of these methods helped women a hundred or more years ago, they have not yet been studied and are sometimes dangerous. For example, the advice to sit on a bucket with a red-hot brick or make steam baths with the addition of alcohol can lead to serious burns of the delicate mucous membranes of the genitals. Acceptance of "healing" herbs can also be dangerous: plants do contain active ingredients, but their dose cannot be controlled, so side effects can be unpredictable.
Photo: Vitalii Raichenko - stock.adobe.com, fotofabrika - stock.adobe.com, Svetlana Nikolaeva - stock.adobe.com
