Some of my patients in Milan and Florence complain about relapsing cystitis during their gynaecological visits. It is a very tedious and debilitating disorder that affects their quality of life, and there is not always an immediate solution.
It is estimated that 20–30% of adult women suffer from it, experiencing one or more acute episodes each year.
Its incidence increases with a woman’s age. There is an initial surge at the onset of sexual activity, followed by surges during pregnancies and with the advent of menopause and old age.
Sexual intercourse can facilitate bacterial ascension from the urethra to the bladder mechanically through microtrauma caused by insufficient lubrication and excessive contraction of the elevator muscle. The use of spermicidal creams can also alter the vaginal flora and pH, making the area more susceptible to bacterial colonisation.
Cystitis and pregnancy
As in menopause, pregnancy involves hormonal changes that affect the mucous membrane and vaginal environment. An increase in progesterone reduces the tone of the urethra and its ability to empty, while urine contains nutrients that can encourage the growth of bacteria. During pregnancy, it is important to be vigilant, as untreated urinary tract infections, which are often asymptomatic, can lead to serious complications for the mother and fetus.
Cystitis and menopause
On the other hand, oestrogen deficiency during the menopause affects vaginal flora and acidity (pH), leading to atrophy and dryness of the mucous membranes. Intestinal dysfunctions such as constipation also increase during this time, and uterine or bladder prolapse may lead to incomplete emptying of the bladder.
Other predisposing factors
Conditions that may increase the risk of relapsing cystitis include diabetes, urinary calculosis, multiple sclerosis and tetraplegia. Individuals who are immunosuppressed due to drug therapies or stress may also be more prone to this condition.
Your susceptibility to recurrent cystitis is correlated with the number and frequency of acute episodes you have experienced in the past. This is why it is important to inform your doctor of the number of cystitis episodes you have experienced in the last 12 months.
In a healthy body, the bladder and the upper urinary tract function in a sterile environment, i.e. free of bacteria. In contrast, the lower urinary tract (the urethra) contains a physiological bacterial colony that does not normally cause infection.
Urinary tract infections therefore occur when there is a disruption to the normal bacterial flora, which is often caused by germs spreading from the intestine to the vagina or ascending from the urethra to the bladder.
The most common pathogen is Escherichia coli (80% of cases), but others include Staphylococcus epidermidis, Staphylococcus aureus, Staphylococcus saprophiticus, faecal Streptococcus and other enterobacteria such as Proteus, Pseudomonas and Klebsiella. These types of bacteria are generally easily identified with a urinoculture.
Recurrence or re-infection?
Recurrence is defined as repeated infections caused by the same bacteria. However, re-infection is caused by a different germ.
To counteract repeated recurrence, it is advisable to address the underlying factors and take preventive measures through lifestyle and dietary changes. Antibiotic therapies such as ciprofloxacin are more effective in treating single acute episodes.
Symptoms of cystitis
Symptoms of cystitis may include pain and a burning sensation when urinating, as well as afterwards. Other symptoms may include a feeling of tightness and pressure in the lower abdomen, an urgent and frequent need to urinate (pollakiuria), and sometimes fever, chills or blood in the urine.
Cystitis can be confused with vaginitis, and the two conditions can occur together. Vaginitis can be recognised by abnormal vaginal discharge in terms of its consistency, colour and pain. Unlike cystitis, it does not cause pain when urinating or soreness above the pubic area.
A urine examination and culture analysis with bacterial colony count and antibiogram (testing for sensitivity to different antibiotics) is used to confirm the diagnosis and establish the correct therapy.
If there are recurrences, a culture examination of a vaginal swab may also be recommended. In some cases, when there is no bacterial proliferation, vaginitis itself can cause cystitis due to gynaecological infections, which are mainly caused by Trichomonas or Candida and, more rarely, by Neisseria gonorrhoeae or Chlamydia trachomatis.
Prevention and prophylaxis
In addition to the indicated antibiotic and anti-inflammatory drug therapies, sufferers of relapsing cystitis are advised to take the following measures for prevention and prophylaxis:
- Hydrate properly (drink at least two liters of water a day) to dilute the bacterial load in the bladder.
- Do not retain urine; urinate often and completely.
- Treat intestinal inflammation.
- Adopt a diet rich in vegetable fibres.
- Avoid simple sugars.
- Take live milk enzymes.
- Maintain the utmost hygiene of the external genitals.
- Urinate immediately after sexual intercourse.
- Have protected intercourse.
- Rest.
- Fight constipation and regularise your bowels.
- Wear undergarments made of natural, loose-fitting fabrics.
- Consider the presence of food intolerances (especially to gluten or lactose).
- Correct pelvic congestion and all situations that may hinder the complete emptying of the bladder.
- Maintain a healthy vaginal ecosystem to defend against the growth and spread of bacteria.
- Avoid using vaginal tampons during your period.
If you’d like to book a gynaecological consultation—online or in person—you can contact me here or book directly online.
I see patients weekly in my clinics in Milan and Florence and am always available to support you in choosing the best path for your health and comfort.
* Photo by Susan Cipriano on Pixabay