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Female cystitis and urinary tract infections

Female cystitis and urinary tract infections: definitions
Cystitis is inflammation of the bladder, usually caused by bacteria, more rarely by viruses, fungi, or parasites. Some, very few, are associated with autoimmune diseases.

Cystitis is common in women, whose anatomy promotes retrograde bacterial colonization of the bladder by microbes in the digestive tract (anus).

Cystitis are called "acute simple" when patients have only signs of sudden onset bladder. They are called complicated lorsqu' existent signs of severity or complications.

Acute cystitis are called recurrent when it suffers three or more times in a year when lists two other episodes in the last 6 months, or the last episode was in less than 3 months.

The interstitial cystitis is inflammation of the bladder wall sustainable by cellular alteration and degradation of local protection, unspecified causes.

Cystitis to "clear urine" is inflammation without infection. They could represent four cystitis in ten medical consultation city (Study BaCyst, National Days of Infectious Diseases, 2011).

Risks and origins of cystitis and urinary tract infections
Very few epidemiological data for a condition that according to specialists affect one in two women in his life (College teachers in nephrology, 2011). Cystitis is the second location infectious in general medicine, after respiratory infections.

Their impact on quality of life is clear because of the pain, especially if they are repeated infections. Their frequency increases with genital activity, they may inhibit sexual life considerably.

Infectious cystitis may be complicated by the infection spreading to the kidneys, pyelonephritis, followed by passage into the blood (septicemia). Pyelonephritis causes fever (38-39 ° C), chills, back pain sharp side of the affected kidney. Untreated pyelonephritis carries a risk of permanent damage to the affected kidney. This is a medical emergency.

Cystitis in men is in itself a complicated cystitis because its anatomy is normally prevent infection.

Cystitis in pregnant women and menopausal women is complicated office. It requires prompt medical care.

Other factors of gravity to talk about complicated cystitis are:

- Early relapse within 7 days after treatment of a previous cystitis and frequent recurrences;
- The presence of visible blood in the urine (other diagnoses imperative to mention);
- Abnormalities of the urinary tract (ureteral reflux, etc.).
- Promoting diseases associated infection (diabetes, cancer, immunodeficiency, liver disease);
- Calculations in the bladder or kidneys.

Causes and mechanisms of urinary tract infections and cystitis
The female perineum full of digestive bacteria (anal), vaginal and skin because it is close to various meatus (exit holes) of the bowel, vagina and urethra (duct emptying of the bladder) .

On behalf of friction (clothing, masturbation, toilet, coitus), these bacteria colonize more or less completely the urethra to the bladder. Cystitis are much more common in women and girls because of their short urethra, as boys.

All equipment is a urinary door inevitable infections: survey indwelling urinary catheter ...

At menopause, estrogen deprivation causes a drop in the defenses of the bladder, which promotes the development of infections. During pregnancy, it is the influx of hormones that promote the contrary: there is 1-2% of pregnant women cystitis (Association of Urology, recommendations Acute cystitis, 2008).

Bacteria that have extensions adhesives (pili) can stick and colonize the bladder wall. Especially due to Escherichia coli (80% infectious cystitis, Association of Urology - Urinary Tract Infections, 2008), this colonization promotes sustainable recurrence at the slightest drop "shape" or general bladder.

The lifestyle is essential. Some habits are bad: refrain from emptying the bladder often and long, drinking too little and not washing her bladder frequently, wiping from back to front, making a perineal toilet too far or negligent endure chronic constipation, especially forget to empty her bladder right after intercourse. Genital fondling and penetration are a source of local bacterial seeding important.

Symptoms and signs of urinary tract infections and cystitis
Urinary frequency, urinary urgency, painful urination, burning on urination, no fever, no symptoms 4 weeks before this episode, and no other symptoms.

Pain during urination (micturition pain) and frequent urination (pollakiuria) even when the bladder is empty signs are very suggestive. Burning while urinating is also characteristic, especially if it continues after the end of voiding.

But the pain (cystalgia) may be missing or very small: 4-6% of bladder infections are asymptomatic (without perceptible signs) from the professional recommendations of the Association of Urology (Acute cystitis, 2008). It is then important to note if the urine smells bad, if it is cloudy (pus), which are signs of confirmation.

The absence of fever and signs of lumbar or elsewhere (outside of the bladder) to limit the diagnosis of bladder infection.

More and more women in recurrent acute cystitis are prescribed by the general practitioner or specialist urine dipsticks. These strips are soaked in testing urine to confirm or not the presence of pus and / or blood.

This confirms the diagnosis or not probable bacterial cystitis at home for women prone to recidivism. Allowing self-medication according to the protocol of the treating physician.

Not to be confused with anything?
Vaginal genital infection, a digestive disorder may be low. Signs of cystitis are fully recognized by women who have already made.

If signs persist, in the absence of overt infection, it must evoke a bladder pathology: polyp, calculus, cancer ...
How to prevent bacterial cystitis women?
"You must drink at least 2 liters per day, empty your bladder often and urinate after intercourse to avoid germs at the perineum and the vagina back into the bladder.

These guidelines apply during the treatment, but also prevention to prevent recurrence, "advises Dr. Jean-Pierre Mignard (Hospital of St Brieuc).

The complete perineal hygiene tips: never hold long to empty her bladder, wipe from front to back after a bowel movement, perineal regular toilet without excess, fight against constipation.

Depending on the individual and the circumstances of occurrence, it may be prudent to avoid foods that inflame the bladder, urine and can affect the growth of bacteria: seafood, white wine, champagne, spices ...

A spa targeted three consecutive years, good results against recurrences, accompanying hygiene measures. This avoids the prescription of antibiotics continuously for several months.

Cranberry (cranberry) has demonstrated its anti-bacterial effect against preventive cystitis by inhibiting bacterial adhesion (Escherichia coli) in the bladder wall. Recognized in 2004 by FSSA (Agency for Food Safety), it is consumed as juice or tablets. His prescription is useful, but its daily amount is not fixed (the Association of Urology - Acute cystitis, 2008).

Aromatherapy and herbal prescriptions exist, they are not validated by clinical studies, but can give good results in experienced hands.

 As should you consult?
Although bacterial cystitis in their infancy may disappear by drinking at least 3 liters of water a day to wash the bladder, it is medically necessary to treat the signs as soon as unchanged last more than 48 hours.
According to the study BaCyst (JNI 2011) in the city, 43% of urine samples during a symptomatic cystitis are sterile. These cystitis "clear urine" are inflammatory. Inclusion and adhesion of bacteria to the bladder wall are probably involved because their antibiotic treatment frequently gives good results ... A balance is needed to make sense of things and push if need exploration.
Symptoms of pyelonephritis (fever, chills, back pain with or without urinary pain) require urgent consultation.

How to prepare for the consultation?
It is important to remember personal history of urinary tract infections, diseases during (vaginal infection, transient immunosuppression or not).

Clarify the circumstances of painful urination (urinating on) is also very important: sex, stress, lack of abundant drink during exercise (during moving for example) ...

It is very important to report any self-medication exactly business: antibiotics on hand, phytotherapy, aromatherapy, etc..

Keeping a voiding diary is very useful to the physician to assess the tendency to relapse and risk factors: it is downloaded from the website of the Association of Urology (see links).

What is the doctor?
It examines the patient and verifies the absence of aggravating factors, and complications.

In case of acute cystitis simple, no further examination is necessary, apart from a urine test strips diagnostic by the firm.

In case of complicated cystitis or signs bastards, a urinalysis (urine culture) with susceptibility testing is necessary to know the bacterium in question and choose the antibiotic to which the bacteria is sensitive.

If recurrences are frequent, a urological assessment (cystoscopy, MRI ...) and urodynamic by a specialist is desirable to eliminate a curable cause (an abnormality of the urinary tract, kidney).

In cases of pyelonephritis likely a urinary tract ultrasound checks the status of the kidneys. Sometimes, hospitalization may be necessary in high-risk situations extension infectious or severe renal impairment or in patients with fragile carrying multiresistant bacteria.

For cystitis in young women and in nonpregnant professional recommendations (Association of Urology, 2008), the doctor prescribed a short course of antibiotics: a single dose or in 3 days (more efficient) by Fosfomycin trometamol, or fluoroquinolones or cotrimoxazole). Other antibiotics require longer treatment durations (5-7 days) at the discretion of the physician.

Leaching of the bladder by at least 2 liters daily drink (water, tea) is essential, as well as the establishment of a healthy urination.

Analgesic treatment may be necessary in cases of severe pain.
Recurrent cystitis in menopausal women are constrained by prescribing estrogen (vaginal suppositories) that restores the local tissue quality.
Pyelonephritis application targeted antibiotic therapy and prolonged from 10 to 15 days and a subsequent biological monitoring to check kidney function.

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