Cervical cystitis during pregnancy. Pregnancy and cystitis: what drugs and medicines to drink during pregnancy from cystitis. Treatment of cystitis in the later stages

Cystitis is an inflammation of the inner (mucosal) lining of the bladder. Cystitis can be both an independent disease and a complication of a number of conditions, most often diseases. genitourinary system. In the vast majority of cases, cystitis is caused by bacteria.

Cystitis is the most common disease of the urinary system. The occurrence of cystitis is the most frequent occasion visits to the urologist, especially among women!

Cystitis occurs in all age and gender groups, however, the incidence of cystitis in females is much higher than that in men: according to statistics, women suffer from cystitis 3-6 times more often. This is due to the peculiarities of the anatomy of the lower urinary tract and the less extended urethra in women, which contributes to the penetration of bacteria into the lumen of the bladder in an ascending way.

Among certain population groups, women of reproductive age are most susceptible to cystitis, leading an active sexual life. With age, the incidence of inflammation of the bladder becomes much less, and after 70 years it can be found with equal probability in both men and women. In addition, comorbid conditions and diseases also affect the incidence of cystitis, namely:

1. Diabetes.
2. Congenital anomalies in the structure of the urinary system.
3. Immunodeficiency.
4. Pregnancy.

Cystitis among the population is considered to be a kind of fast-flowing disease that does not leave any consequences, the treatment of which does not present any particular difficulties. In fact, in addition to extremely unpleasant symptoms that reduce the quality of life, cystitis can lead to a number of adverse consequences and complications. In itself, the presence of inflammation of the bladder is a sign of a violation. defense mechanisms body from the introduction of infection: in fact, in a healthy person, the urinary system is sterile. Repeated cases of cystitis lead to structural restructuring of the bladder and ureters, which can subsequently be accompanied by the development of ascending uroinfection, such as pyelonephritis, and this is an extremely dangerous condition. In addition, the relationship between the frequency of inflammation of the bladder and the likelihood of developing cancer of this organ has now been proven!

The pathogenesis of cystitis

There are a lot of known causal factors for the development of cystitis, and in principle they can be divided into two large groups: infectious and non-infectious (see table).

infectious factors	Non-infectious factors
bacteria	Chemical substances
Viruses	hypothermia
Mushrooms	Allergy
Chlamydia and mycoplasma	Endocrine-metabolic disorders
Mycobacterium tuberculosis	Radiation therapy
Poor treponema However, despite a variety of factors, main reason development of cystitis are bacteria living in nearby organs: the rectum, vagina, large intestine, and also on the skin. Thus, the body's own flora - E. coli, Proteus or Klebsiella - is the most likely culprit in cystitis. According to what scenario does the disease develop? The bladder is a hollow organ that communicates with the external environment through the urethra, or urethra. It is through the urethra in the vast majority of cases that microorganisms enter the bladder. Because women have a shorter urethra than men, they are much more likely to get a bladder infection. However, acute cystitis does not occur in every woman. It's all about what's normal inner surface urethra has a very good resistance to bacteria. Substances released by epithelial cells, called glycosaminoglycans (GAGs), prevent microorganisms from attaching to the walls of the urethra, and without fixing, microbes are not able to divide and multiply. Thus, bacteria must overcome this protective barrier in order to enter the urethra. This is possible in the following cases: The hormonal background of a woman is changed, as a result of which thinning, wilting of the mucous membrane of the urethra and a decrease in its protective properties are observed. A similar mechanism underlies the so-called. postmenopausal cystitis - a chronic inflammation of the bladder that occurs in menopause and is difficult to treat. In the vagina, which is located in close proximity to the outer part of the urethra, an unusual microflora may develop. Normally, in women, vaginal microorganisms have a pronounced protective effect and do not allow the development of other, pathogenic microbes around them. However, in order for the species composition of the flora to be maintained at a satisfactory level, a good general state organism, which creates conditions for the normal functioning of this very flora. In some cases, this balance is disturbed. The most common reasons for this are: In women, the occurrence of cystitis in the vast majority of cases is associated with inflammation of the cervix or bacterial vaginosis! Separately, cystitis of pregnant women should be considered, the clinic and treatment of which has its own distinctive features. Cystitis of pregnant women About two out of a hundred pregnant women suffer from cystitis, which can be regarded as a fairly common occurrence. In this category of women, cystitis is a multifactorial disease, in the development of which the following are important: Hormonal reorganization. Mechanical compression of the pelvic vessels by the growing uterus. Systemic circulatory disorders. In general, the mechanism for the development of cystitis in pregnant women is as follows: the growing pregnant uterus presses on the bladder in such a way that the normal evacuation of urine from the bladder is disturbed; in addition, blood stasis occurs, which together sharply reduces protective properties epithelium of the urethra and contributes to the development of infection. The hormonal background in pregnant women leads to the formation of soft tissue edema (which is visible to the naked eye and is one of the signs of pregnancy), including in the pelvic area. This maintains disturbed circulation throughout pregnancy. In addition, during pregnancy, there is a violation of another phenomenon: the closure of the ureters at the time of urination. Normally, when a person attempts to urinate, the ureters contract in the part in which they communicate with the bladder. This prevents backflow of urine and infection of the kidneys. In pregnant women, due to mechanical reasons (compression of the bladder by the uterus), compression of the ureters does not occur. Therefore, urine infected with various pathogens can rise up the ureters to the kidney itself. In pregnant women, the development of cystitis is dangerous due to the addition of pyelonephritis, so cystitis must be eliminated in a timely manner! Video - Cystitis during early and late pregnancy Clinical manifestations of cystitis in pregnant women In general, the clinic of cystitis in pregnant women does not differ from that in non-pregnant women and consists of the following symptoms: Painful urination (dysuria). The pain is of a burning character. The appearance of blood in the last portion of urine (it can be colored brown) - the so-called. terminal hematuria. Frequent urination (pollakiuria). Persistent desire to urinate, even with an empty bladder. This symptom testifies to the developed inflammation in the area of ​​the cystic sphincter. Urination at night (nocturia). This symptom complex is characteristic of any cystitis during its height. Confirmation of the diagnosis is a general urine test, which reveals a large number of leukocytes (pyuria), mucus, bacteria, altered and unchanged erythrocytes, as well as epithelial cells. However, given the high likelihood of developing pyelonephritis during pregnancy, the current strategy for the treatment of pregnant women involves early diagnosis of the development of urinary tract infection, even before the development clinical symptoms. To do this, all women during pregnancy should regularly take a urine test to detect bacteria in it (bacteriuria). If a pregnant woman has bacteriuria in the amount of more than 10 5 pathogens (even in the absence of clinical manifestations of urinary tract infections), this condition is subject to mandatory treatment! Asymptomatic bacteriuria in pregnant women turns into pyelonephritis with a frequency of 20 to 40%, and pyelonephritis, unlike cystitis, can threaten the health of both the mother and the child and requires hospitalization in a therapeutic hospital. This is why early diagnosis of asymptomatic bacteriuria is so important. Treatment of cystitis in pregnant women If we are talking about cystitis of bacterial origin, then antibiotics are the basis for the treatment of this disease. At the same time, the treatment of cystitis in pregnant women has a number of features: The minimum duration of treatment for acute cystitis, according to modern recommendations should be 7 days. Asymptomatic bacteriuria also requires active antibiotic therapy lasting 3-5 days. It is necessary to take into account the negative impact of the drugs used on the fetus.

Pregnancy in a woman's life is often a long-awaited and exciting period of waiting for a baby. Usually it is associated with pleasant emotions, but sometimes they are disturbed by unpleasant sensations, one of which is cystitis.

Why does cystitis develop during early pregnancy?

Statistics show that every 10th woman experiences cystitis during pregnancy. cystitis during pregnancy early dates happens most often. It's all about the increased susceptibility of the body of a pregnant woman to various adverse factors, including infections. It happens by physiological reasons occurring in a woman's body during pregnancy:

1. To prevent immunological rejection of the embryo or the so-called immunosuppression, immunosuppression occurs in pregnant women.
2. The constantly growing uterus puts pressure on the bladder and on the pelvic organs, and accordingly, on the vessels that supply them with blood. The blood supply is disrupted, and any infection that enters the body does not meet with much resistance.
3. Progesterone, which is also called the "hormone of pregnancy", is able to reduce the tone of the bladder.

These factors impede the outflow of fluid from the bladder and lead to the fact that it is not completely emptied. Residual urine is an excellent breeding ground for bacteria. Their number is constantly increasing, and the inner walls of the bladder become inflamed. Develops cystitis during pregnancy.

Symptoms

Usually, those who have encountered this disease at least once will not confuse it with anything else. How to recognize cystitis during pregnancy? Symptoms of this infectious disease appear almost immediately:

• patients feel pulling pain lower abdomen;
• pain and burning are felt when urinating;
• there may be frequent false urge to urinate;
• urination frequent and in small portions;
• urine may be cloudy due to a large number leukocytes or bacteria, and sometimes there is a red tint, if red blood cells appear in it (blood in the urine);
• sometimes subfebrile temperature rises.

An experienced doctor can easily determine cystitis during pregnancy by the symptoms and test results. The symptoms of this disease are difficult to confuse with something else.

Diagnostics

After collecting an anamnesis and identifying symptoms that bother a woman, the doctor will prescribe a series of studies to clarify the diagnosis. This is a standard examination for suspected cystitis in early pregnancy:

• general urine analysis;
• urinalysis according to Nechiporenko;
• bacteriological in order to identify opportunistic microorganisms;
• general blood analysis;
• if necessary, ultrasound of the genitourinary organs is prescribed in order to detect concomitant diseases;
• cystoscopy and cystography allows you to identify the nature of the disease, as well as the degree of the inflammatory process and the presence of tumors in the bladder;
• DNA diagnosis of major infections can be assigned.

Cystitis during pregnancy sometimes occurs without any symptoms. It is for this reason that pregnant women need to give urine for analysis at each visit to their supervising doctor.

Treatment

Self-medication during pregnancy is strictly contraindicated. Even seemingly harmless alternative methods of treatment during pregnancy can lead to irreparable consequences. Some medicinal herbs should not be used for treatment during pregnancy, and thermal procedures (warming up) can provoke an early miscarriage or premature birth at a later time.

Traditional medicines intended for the treatment of cystitis should not be taken by pregnant women without control. Treat cystitis during early pregnancy (in the first trimester) medicines should be especially careful. Medicines can be taken only after consulting a doctor.

The main treatment even during pregnancy remains only the most sparing antibacterial and uroseptic drugs. Modern ones capable of treating cystitis during early pregnancy are, for example, the drugs Amoxiclav and Monural.

In some cases, drugs are applied topically, i.e. they are inserted through a catheter directly into the bladder. This method is called instillation, but in case of an acute inflammatory process it cannot be carried out. Instillations are carried out only in medical institutions.

After drug treatment has been carried out and all acute cystitis processes have been removed, a rehabilitation course can be carried out with safe herbal remedies of traditional medicine.

Folk remedies for cystitis

• good and safe folk remedy for the treatment of cystitis is cranberry juice;
• you can use an infusion of blackcurrant leaves;
• infusion of birch leaves;
• infusion medicinal collection from red rowan berries and with the addition of honey;
• with honey.

A good cure for cystitis in women during pregnancy is drugs that include herbal ingredients. In fact, these are the same herbal preparations, but in tablet form, for example, this medicine"Canephron". This drug has an antimicrobial, diuretic and antispasmodic effect and does not have a harmful effect on the fetus, therefore it is safe during pregnancy.

Prevention of cystitis

If a woman has already had cystitis at some time, and she is prone to relapses of this disease, then even before planning a pregnancy, it is advisable for her to undergo a complete medical examination and find out the cause of these relapses. Some gynecological diseases, such as chlamydia, mycoplasmosis and ureaplasmosis, can provoke the development of the disease. They must be treated before pregnancy.

Cystitis can be prevented by taking a large number liquids, especially fruit drinks and cranberry juice. Cranberries can increase the acidity of urine, and acidic environment kills bacteria and prevents infection.

Tight clothing can also trigger the development this disease. During pregnancy, it is better to wear comfortable underwear that will not interfere with normal blood circulation in the pelvic area.

Constipation can provoke cystitis. Fighting will help to avoid the occurrence of the disease. You need to drink enough fluids and eat plant foods rich in fiber.

How does cystitis affect the body of a future mother?

If cystitis is treated in time, then its consequences are reduced to nothing. But if the process accepted severe form, then the inflammation can rise higher, and then the infection affects the kidneys. Very dangerous complication is pyelonephritis. This is an inflammatory disease of the kidneys, which is purulent in nature, characterized by an increase in temperature to high numbers and severe pain in the kidney area. This condition requires immediate hospitalization.

Kidney damage can cause arterial hypertension, which in turn is dangerous. possible development pre-eclampsia and eclampsia - very dangerous state during pregnancy.

How does cystitis affect

The effect of cystitis on pregnancy can be quite detrimental. A strong inflammatory process can lead to a newborn's body weight deficit, because. the mother's body was depleted, and the child did not receive adequate nutrition. In severe cases, a neglected inflammatory process can lead to fetal death or developmental anomaly. Some experts argue that a bacterial infection provokes the development cerebral palsy The child has.

Untreated cystitis in the early stages can lead to miscarriage, and in the latter - to premature birth. Even if the birth takes place on time, passing through the birth canal, the child is able to swallow pathogens, which will lead to general intoxication of the baby.

The first time you need to see a doctor. Only a specialist can choose drugs that are allowed during pregnancy. Self-medication can also have a detrimental effect on the health of the unborn baby.

During pregnancy, every woman becomes vulnerable to many bacterial infections. The high risk of disease is due to reduced immunity. Before conception immune barrier rejected pathogens, but during pregnancy they easily enter the body through the respiratory system and gastrointestinal tract. The most common infectious disease that pregnant women become infected with is cystitis.

About 10% of pregnant girls become hostages of bacteriuria. Her insidiousness is based on an asymptomatic course. Pathology can negatively affect the formation and development of the fetus. Also, 20% of women in position show obvious problems in terms of the urological system, this is inflammation of the bladder membrane, in other words, cystitis. Among the complications of infection of the genitourinary system during pregnancy, the most common is pyelonephritis. According to statistics, this disease occurs in 2% of pregnant women. This explains the need for constant monitoring of the genitourinary system. That is why gynecologists insist on frequent urine tests for analysis. In the first and second trimesters twice a month, and in the third every 7-10 days.

Why are pregnant women at high risk of developing cystitis?

We have already mentioned the main reason, this is a decrease in immunity. In addition, pregnant women are exposed to impaired urine outflow due to the constantly growing uterus. Thus, there is stagnation of urine in the kidneys, which is extremely dangerous for women in position. Pregnant women who have had cystitis in childhood are 27% more likely to get it during gestation than women who have never experienced such a problem. If cystitis in childhood was complicated by pyelonephritis, then the risk of getting infections of the genitourinary system during pregnancy increases by 47%.

When is an examination by doctors of other specializations necessary?

During pregnancy, an indication for examination by a therapist and urologist can be any changes in urine tests, pain in the lower back and abdomen, changes in the color of urine. This leads to a high risk of miscarriage or premature birth due to acute cystitis.

Classifications of cystitis

This classification of cystitis was proposed by G.I. Goldin.

A. Primary cystitis

1. Acute cystitis

- infectious (specific and non-specific);
- chemical;
- thermal;
- toxic;
- medicinal;
- alimentary;
- neurogenic.

B. Secondary cystitis

1. Bubble origin:

- with stones and foreign bodies;
- in case of injuries and wounds;
- with tumors;
- with developmental anomalies;
- after bladder surgery.

2. Extravesical origin:

- with prostate adenoma;
- in diseases and injuries of the spine;
- with strictures of the urethra;
- during pregnancy, childbirth and postpartum;
- in diseases of the pelvic organs.

The essence of the danger of cystitis for a pregnant woman and fetus

Any infection of the genitourinary system during pregnancy can provoke serious consequences, including:

Intrauterine fetal death;

Childbirth ahead of time;

The baby was underweight at birth;

Anemia in a pregnant woman;

Arterial hypertension in pregnancy.

Scientific evidence suggests that past infections during pregnancy can cause development of cerebral palsy(infantile cerebral palsy) and delayed psychomotor development during puberty.

Causes of cystitis during pregnancy

Cystitis is divided into: infectious and non-infectious.

Non-infectious cystitis develops when:

The presence of urinary stones, which can provoke damage to the mucous membrane;

Due to irritation of the mucous membrane by chemicals present in the urine;

Reactions to certain types of drugs.

Non-infectious cystitis tends to "reincarnate" when an infection is attached to the initial process of inflammation.

Infectious cystitis is more common, among the pathogens are:

coli (80%);
- Klebsiella (3.7%);
- staphylococcus (5%);
- streptococcus (2.5%);
- Enterococcus (2.2%);
- Proteus vulgaris (8.2%);
- causative agents of gas gangrene (extremely rare).

Often cystitis develops against the background of STIs (sexually transmitted infections):

Chlamydia;
- gonorrhea;
- ureplasmosis;
- mycoplasmosis.

Tuberculosis microbacteria and treponema are also noted among the causative agents of cystitis (infectious). Cases of infection of the bladder during the catheterization procedure are common. Pregnant women and women who have recently given birth are at risk, during this period the tone of the bladder walls is greatly weakened.

Pathogenesis

Ways of transmission of the pathogen:

Ascending;
- descending;
- lymphonic;
- hematogenous;
- contact.

An infectious agent enters the bladder of a pregnant woman from the urination canal. The physiological structure of the female body provides for a wide and short urination channel, which is located close to the anus. Bacteria enter the urethra, most often from the vagina. Normal female microflora consists of lactobacilli (Dederlein sticks), bifidobacteria in small quantities and other types of microorganisms. The norm provides for the balance of all bacteria. Their number is controlled by each other. Bacteria provide colonization resistance. In this ideal balance, disturbances can sometimes occur - dysbacteriosis.

There are many reasons for this phenomenon, consider the most compelling:

stressful conditions;
- changes in the hormonal background;
- pregnancy;
- hypothermia.

Dysbacteriosis is explained by the growth of bacteria of some species and their inhibition of others. Among the harmful bacteria that provoke dysbacteriosis, there are: gardnerella, fungi of the genus Candida and others. Such microorganisms have pathogenic activity. Often, vaginal dysbacteriosis is provoked by an intestinal imbalance of bacteria. Human physiology is designed in such a way that it is difficult for any kind of infection to invade the body and infect healthy organs. Exactly the same with bladder, its mucous membrane is dense, able to resist infections and the only pathogen alone is not enough for the progress of cystitis.

Here, some provocateurs play a separate role, namely:

hypothermia;
overwork, hypovitaminosis;
neglect of personal hygiene;
conducting a promiscuous sexual life;
immunodeficiency;
transferred surgical interventions;
hormonal problems, etc.

The pathogenesis of complications of gestation

In pregnant women, cystitis can occur as a result of hormonal imbalances, namely the growth of progesterone, which helps to weaken the smooth uterine muscles and other muscle tissues, including the bladder. If there is no pathogen, then complications should not be feared, but with bacterial vaginosis and urogenital infections, reduced tone and favorable conditions (humidity and temperature of 37 ° C) can provoke inflammatory processes. If a woman has chronic cystitis, then the risk of repeated relapse during pregnancy is very high. Changed background of hormone levels, weakened immune barrier, changes in microflora - these factors create excellent conditions to exacerbate existing diseases, even if they for a long time were in remission. Physiological changes the structure of certain parts of the urination system (relaxation of the smooth muscles of the bladder, an increase in its volume and insufficient bowel movements, physiological hydronephrosis of pregnant women, physiological hydroureter of pregnant women), as well as significant changes in the composition of urine (exceeding pH, glucosuria) are associated with the influence of some mechanisms:

The pressure of the growing uterus;
increased estrogen, progesterone, PG-E2 and hCG;
hypertrophy of the muscular longitudinal bundles of the lower ureters.
These complex changes affect the possibility of recurrence of cystitis in women in position.

Cystitis as a consequence of labor

This trouble occurs due to some moments of the course of the birth process, as well as when E. coli enters the cavity of the bladder or staphylococcus / streptococcus (very rarely). Here are the factors that provoke the disease:

Urinary retention in the cavity of the bladder;
change in the mucous membrane;
protracted natural childbirth;
injury received in birth process.

In progress labor activity the movement of the child through the birth canal provokes inhibition of the blood circulation of the organs in the small pelvis. This often causes an exacerbation of cystitis. The rules for conducting labor activities provide for mandatory catheterization of women immediately after the birth of the baby. This is because a full bladder prevents increased postpartum uterine contraction. This rule can cause the penetration of an infectious agent into the cavity of the bladder. An additional motive for the development of cystitis is poor-quality emptying and stagnation of urine. Some women in labor in the first days after childbirth may not have the urge to urinate, this is due to squeezing nerve endings. Therefore, newly-made mothers need to write regularly, after 1.5–2 hours. Mothers often forget about important rule. As a result, a lot of urine accumulates and this can cause the development of cystitis.

Symptoms of cystitis in pregnant women

There are chronic and acute cystitis. Acute cystitis often progresses immediately after the influence of a provocative factor, for example, hypothermia. Among the main symptoms of acute cystitis are:

Frequent urge to urinate, but the urine itself is excreted in minimal quantities;
pain and cramps in the lower abdomen;
pyuria (urine with purulent impurities).

Sometimes the pain does not subside for a long time. The most severe discomfort occurs during urination and at the end of this process. It happens that the patient is unable to hold back urine at the next desire to write. It happens that acute cystitis proceeds without much severity. In such cases, patients are accompanied only by a feeling of fullness in the lower abdomen, moderate pollakiuria ( frequent urination) and slight pain at the end of the urination process. It happens that mild symptoms of acute cystitis last no more than two days and go away on their own without any treatment. However, in most cases, acute cystitis lasts from 6 days to two weeks, even if treatment was started in a timely manner. A longer period of disease may indicate an additional disease that provides favorable, supportive conditions for the inflammatory process. In such situations, the patient needs further examination.

For a complex course of acute cystitis, symptoms are characteristic:

Heat;
- intoxication
- oliguria.

IN similar cases the duration of the course of the disease increases and may be complicated serious condition. Complicated types of acute cystitis are characterized by an increase in body temperature, intoxication, and oliguria. If the patient feels a sharp, piercing pain at the end of the process of urination, then most likely the inflamed focus is localized on the neck of the bladder. Powerful pain is associated with convulsive contractions of the sphincter of the bladder. The patient needs constant emptying of the bladder, so the pain is constantly present. In addition to leukocyturia, during the period of acute cystitis, bloody impurities in the urine may be added. Hematuria is observed at the end of the urination process. This phenomenon is explained by the fact that the inflamed membrane of the bladder neck, as well as the Lieto triangle, is injured at the end of urination. Postpartum cystitis is accompanied by urinary retention, the initial portion has a cloudy appearance, there is pain at the end of urination. Chronic cystitis is different from acute. The diversity lies both in the clinical picture and in the method of therapy. Chronic cystitis is completely determined by the state of health of the patient and the etiological factor. The symptomatology of chronic cystitis is similar to acute, the difference is only in a less pronounced manifestation.

In the chronic form, 2 scenarios of the course of the disease can be expected:

1. A continuous process with regular complaints of pain discomfort and changes in the patient's urine (bacteriuria, leukocyturia).

2. Alternating remission ( total absence painful symptoms) and relapse (period of exacerbation, with symptoms as in acute cystitis).

Complications of gestation

Inflammation of the bladder, accompanied by an infection, can cause fetal fading, miscarriage, as well as the birth of a premature baby;

Infection inside the bladder can provoke acute pyelonephritis with a further complicated course if the infection goes through the ureters to the kidneys.

Anamnesis. Diagnosis of cystitis during pregnancy

Anamnesis plays a colossal role in acute inflammation and its further increase. Just like with the previously present inflammation and the development of acute cystitis into a chronic type.

Physical examination:

Palpation examination;
- percussion (tapping).

Laboratory samples:

Urinalysis (general);
- blood test (clinical);
- urinalysis according to Nechiporenko;
- Zimnitsky's test;
- examination of urine for the presence of harmful bacteria;
- analysis of the vaginal microflora for dysbacteriosis;
- PCR analysis for STI pathogens (Trichomonas, gonococci, chlamydia);
- determination of the level of glucose in the blood serum.

Instrumental examination:

Ultrasound of the bladder, kidneys and organs in the small pelvis;
- cystoscopy;
- catheterization (diagnosis and treatment);
- biopsy of the bladder.

Cystoscopy is not provided for acute cystitis, so as not to exacerbate it even more. In chronic cystitis, cystoscopy makes it possible to detect hyperemia, swelling, bleeding, thickening and violation of the mucosa, areas with ulcers and fibro-purulent films.

Differential Diagnosis

Acute cystitis differentiates with renal diseases, cystalgia, urolithiasis, urethritis and other diseases of the genitourinary organs of a woman. If there are stones in the bladder cavity, then the symptoms are very similar to cystitis. Manifestation pain syndrome in the presence of stones increases when walking, running or shaking crossings. The pain radiates to the vagina. Attached is a violation of urination, in the form frequent calls especially when moving. During rest and in the supine position, the pain tends to subside.

In the presence of cystalgia, changes in the bladder are not observed. No pyuria. But despite this, the pain can be enough a strong character. Thus, the diagnosis is made on the basis of the patient's complaints, if there is no pyuria, bacteriuria, and due to the absence of changes in the lining of the bladder mucosa that are indicative of cystitis.

Cystitis can be a symptom of acute pyelonephritis. Acute pyelonephritis has a number characteristic symptoms, but the main symptom is considered to be a body temperature of 38-39 ° C and severe chills. Also, patients report pain in the lumbar region, nausea and vomiting. Acute pyelonephritis is very dangerous, and even more so for a pregnant woman, so the disease requires inpatient treatment. With urethritis, the patient has pain when urinating, and a purulent mass is released from the urethra. Urethritis can be in combination with bartholinitis and cervicitis.

The most common causative agents of urethritis are:

Urogenital microplasmosis;
- chlamydia;
- gonorrhea.

Vulvovaginitis is characterized by discomfort in the vulva, it increases with the emission of urine. Also noted purulent discharge from the vaginal opening.

Among the frequent provocateurs of vulvovaginitis note:

Microplasmosis urogenital;
- Chlamydia urogenital;
- genital herpes.

Treatment of cystitis during pregnancy

For the treatment of cystitis during pregnancy, prescribe:

Amoxicillin (dose 250-500 mg, break 8 hours for 3 days);

Clavulanic acid together with amoxicillin (dose 375–625 mg, break 8–12 hours);

Cefuroxime (dose 250–500 mg, break 10 hours) duration of treatment 3 days;

Ceftibuten (dose 400 mg per day);

Cephalexin (dose 250-500 mg at 6 hour intervals) duration of treatment up to 3 days;

Nitrofurantoin (dose 100 mg at 6 hourly intervals). Continue treatment for no more than three days.

Maintenance Therapy:

Nitrofurantoin (100 mg dose) at bedtime;
- amoxicillin (250 mg) before going to bed;
- cephalexin (250 mg) at night;
- fosfomycin (dosage 3.0 g) the duration of the treatment course is 7-10 days.

A topical treatment that has an antimicrobial effect is also prescribed. Therapy with herbal uroseptics, lasting 7 days:

Kanefron three doses per day, 2 tablets;
- phytolysin three doses per day orally, 1 tsp;
- a decoction of herbs with a diuretic effect, half a glass 3 times a day. At the same time, treatment of bacterial vaginosis and STIs is prescribed.

Treatment of cystitis with folk remedies

For the treatment of cystitis, a pregnant woman can use infusions and decoctions of herbs after consulting a doctor.

Herbs are brewed in the evening and insist all night. As a rule, 0.5 liters. boiling water is required
2-3 tbsp. l. mixtures of herbs. The prepared infusion is drunk during the day. The course is 3-6 weeks.

In chronic cystitis, herbal treatment should be continued for several years. Fees should be alternated and take a break every two months. Urine control during treatment is required.

1 fee

Take 5 parts of bearberry leaves, 3 parts of birch buds and 5 parts of horsetail herb. Take 2-3 weeks.

2 collection

Take 2 parts of calamus root, 4 parts of black elderberry flowers, 5 parts of St.

3 collection

Take 5 parts of Veronica officinalis herb, 5 parts of wild rosemary shoots, 5 parts of St. John's wort, 3 parts corn silk, 2 parts flax seeds, 3 parts peppermint leaves, 3 parts Scotch pine buds, 4 parts horsetail herb.

4 collection

Take 5 parts of parsley herb, 5 parts of knotweed herb, 7 parts of oregano herb, 3 parts of St. western, 1 part eucalyptus leaves.

5 collection for alkaline urine

Take 2 tbsp. l. bearberry leaves and pour 0.5 l. boiling water, let stand and drink the resulting infusion throughout the day. The course is 7-10 days.

Preventive measures and prognosis regarding complications

Prevention in order to prevent the aggravation of the disease is to follow the rules of personal hygiene, the correct treatment of acute cystitis, the prevention of hypothermia, the observance of asepsis during endovesical studies and catheterization of the bladder, as well as the timely and accurate diagnosis of diseases of the genitourinary system with further optimal correction of the condition.

Features of the treatment of complications

Gestation in the first half of pregnancy is fraught with the risk of fetal fading and abortion. Then classical therapy is carried out.

Indications for appointment:

bacteriuria;
- leukocyturia;
- hematuria.

The main treatment is determined solely by the doctor. Local therapy is provided, infusion of antimicrobial solutions into the bladder. At the same time, treatment of STIs and bacterial vaginosis is prescribed.

The effectiveness of therapeutic therapy is evaluated according to the following criteria:

Clinical symptoms disappear;

Urinalysis is normal.

Making a medical decision regarding the timing and method of delivery

If diseases are diagnosed in time and effective treatment occurs, then the birth process takes place according to due date. For caesarean section, only gynecological indications are necessary.

Important for a patient with chronic cystitis

Before pregnancy or immediately after conception, you should consult your doctor about chronic ailments, including tooth decay and tonsillitis. Chronic infections can serve as provocateurs to excite inflammation in the bladder and other organs. If there is bacterial vaginosis, it is advisable to carry it out medical therapy even before pregnancy.

Postpartum prevention of cystitis

Prevention of cystitis should be taken into account by the doctor during the birth process, which is characterized by the provision of maximum assistance to the woman in labor. After childbirth, it is imperative to avoid urinary retention. During catheterization, asepsis must be observed. IN postpartum period it is necessary to abandon sour, fried, spicy foods, spices and exclude alcohol. Such rules are recommended not only for the prevention of cystitis, but also for normal breastfeeding. Watch the frequency of the stool, in every possible way preventing constipation. The retention of feces in the intestines provokes a violation of the blood supply to the organs in the small pelvis, which can lead to cystitis. It is important to avoid hypothermia even in the warm season.

cystitis during pregnancy

Inflammation of the genitourinary system is very common in women. It is widely believed that cystitis is a non-serious disease, like a runny nose. When he appears, he is treated on his own, and then forgotten for a while. Through certain period the disease returns, because it has already passed into a chronic form.

This disease should not be underestimated. Especially dangerous is cystitis in the early stages of pregnancy, when the fetus is forming. In the second and third trimesters, due to inflammation, there are risks of intrauterine infection of the child and premature birth.

What is cystitis and what are its symptoms?

Cystitis is an inflammatory process in the bladder that disrupts its normal functioning. It mainly affects women because of their physiological characteristics- The urethra is shorter and wider than in men, which is why pathogens can easily enter the bladder.

The disease can occur in acute and chronic forms. If acute cystitis is not cured, it will turn into chronic, which is characterized by the frequency of attacks. Only after a complete cure of cystitis can pregnancy be planned.

Some women first experience this unpleasant disease during the period of bearing a child. It poses a threat not only to the mother, but also to the baby. That is why, having discovered the first signs of acute cystitis during pregnancy, you should urgently consult a specialist and begin treatment.

Signs of acute cystitis during pregnancy:

• frequent urination (up to several times per hour) with small amounts of urine;
• pain and pain when urinating;
• a false feeling that the bladder has not emptied;
• pain in the lower abdomen;
• cloudy urine, the presence of blood or pus in it;
• hyperthermia;
• fever.

An increase in body temperature to high values suggests that urgent treatment is needed, since the inflammation has turned into a dangerous form. signs chronic cystitis identical to the sharp current. Only the intensity of their manifestation differs. Pain during urination is not so pronounced, and discomfort in the urethra may be present all the time.

Causes of cystitis during pregnancy

The causative agents of the disease are Escherichia coli, staphylococci, chlamydia and fungi. Changes during pregnancy hormonal background, which cannot but affect the microflora of the mucous membranes. This also applies to the genitals, from where the infection occurs.

The provoking factors for the occurrence of pathology are:

• reduced immunity, in which pathogenic microbes easily enter the body;
• prolonged stay in the cold - it is important to keep the legs, lower back, kidney area warm;
• taking certain medications that, when excreted through the bladder, irritate its mucosa, causing inflammation;
• allergic reaction to drugs intimate hygiene, condoms, food, etc.;
• warming procedures in a sauna, bath or bath contribute to a change in the composition of the microflora of the genital organs;
• non-compliance with daily hygiene;
• other diseases of the genitourinary system, which are subsequently joined by cystitis.

In the first months of pregnancy, a woman experiences a physiological decrease in immune forces. This is necessary so that the body does not reject the embryo, which consists not only of maternal cells, but of their alien paternal ones. Decreased immunity is often the cause of the development of cystitis and other ailments in pregnant women.

Progesterone, which is produced in the body of a pregnant woman, helps to relax muscles, including the bladder. As a result, pathogenic microorganisms penetrate the genital organs, and inflammation begins.

IN last trimester Pregnancy women are even more prone to developing cystitis. This is due to the fact that the uterus presses hard on the bladder, and urine can stagnate in it.

Why is cystitis dangerous for the fetus and women in an “interesting position”?

Timely and adequate treatment of cystitis during pregnancy avoids severe complications. If untreated, cystitis during pregnancy can pass to the kidneys, causing pyelonephritis. This disease is dangerous for all categories of patients, especially for pregnant women. The body temperature rises to critical values, and severe pain appears in the kidney area. Pyelonephritis is treated exclusively in a hospital.

Subsequently, violations of the kidneys threaten such complications of pregnancy as preeclampsia and eclampsia (complicated toxicosis on later dates). These diseases occur in pregnant women and pose a serious danger to them. Arterial pressure reaches high marks and threatens not only the health, but also the life of the patient. Convulsions may occur, contributing to the death of the fetus and the occurrence of serious injuries in the mother.

The fight against inflammation leads to the fact that the child does not receive enough necessary substances, he has a low body weight. Cystitis provokes intrauterine infection child. What will be the consequences of infection, it is difficult to predict.

Any infection is a risk factor for miscarriage early in pregnancy. In the 2nd and 3rd trimesters, preterm labor may occur. That is why at the first signs of cystitis, you should immediately consult a doctor. If the course of the disease is neglected, the body temperature has risen, you need to go to the hospital. In no case should you let the disease take its course, self-medicate and practice the use folk methods therapy. During pregnancy, such actions will have sad consequences.

Diagnosis of cystitis in pregnant women

During pregnancy, a woman regularly gives a general urine test. If she visits a doctor on time, identifying cystitis at an early stage is not difficult. Changes in urine parameters (elevated leukocytes, impurities of blood and pus, protein, bacteria) will alert the gynecologist leading the pregnancy, and he will prescribe additional examinations.

The diagnosis of "cystitis" during pregnancy is made on the basis of the patient's complaints and the results of laboratory tests:

• complete blood count (elevated ESR);
• urinalysis according to Nechiporenko;
• bacterial culture of urine to determine the type of pathogen;
• vaginal smear.

If necessary, an ultrasound of the bladder and kidneys, cytoscopy will be prescribed. Then the pregnant woman goes to narrow specialist(urologist) or to the hospital.

A woman should be given Special attention the correctness of the collection of material for the study. You need to collect only the average portion of the morning urine. Before analysis, it is necessary to thoroughly wash, and then collect the urine in a sterile jar. It is better to purchase a container for analysis at a pharmacy.

Biomaterial cannot be collected the night before, the maximum storage time does not exceed 2 hours. It is best to send the analyzes to the laboratory immediately after collection.

Features of the treatment of cystitis during childbearing

Many medications are contraindicated for pregnant women. This is due to the fact that the chemicals in their composition are teratogenic in nature, i.e. may harm the fetus. You should be especially careful in the first months, because it is at this time that all organs and systems of the baby are laid. When choosing therapeutic methods, the specialist must take into account the duration of pregnancy and concomitant diseases of the woman.

Be sure to drink plenty of water, which will help the body quickly remove pathogenic microbes from the bladder. The total amount of fluid consumed should be at least 2.5 liters per day. It is better to use a simple drinking or mineral water recommended by the doctor.

At high blood pressure drink plenty of fluids with caution. It is necessary to limit salt intake so that water does not linger in the tissues. You should definitely discuss this issue with your doctor and follow all his appointments.

Particular attention is paid to the diet for cystitis. Some foods can provoke irritation of the mucous membrane, it is better to exclude them from the diet (spicy spices, seasonings, mustard, garlic, onions, smoked foods, mushrooms). The ban is imposed on strong tea, coffee, sweet soda. The menu necessarily includes diuretic products (watermelons, melons, cucumbers). Meat consumption should be limited until the symptoms of cystitis disappear.

Many physiotherapy procedures are contraindicated for pregnant women. For cystitis, the doctor will recommend only warm compresses and electrophoresis.

Antibacterial drugs

First of all, antibacterial drugs are prescribed, because bacteria are often the source of the disease. Many antibiotics are prohibited for use during pregnancy, others can be drunk with caution. The decision to prescribe certain drugs should be made only by a doctor. He will assess the likely harm and benefit to the expectant mother and child.

More often, experts opt for drugs such as Amoxiclav and Monural. They have fewer contraindications and side effects, they can be taken during childbearing. At the same time, the drugs are quite effective, they quickly remove pain. Antibiotic therapy continues for up to 2 weeks, and symptoms disappear a week after the start of treatment.

A trusted remedy for cystitis is Furadonin. However, drinking it before childbirth is contraindicated. In the last months of pregnancy, Furadonin can provoke anemia in a child.

If the condition of a woman is severe, she is placed in a hospital, bladder instillation can be used. Usually, the procedure is indicated for the chronic course of the disease. In this case, the drug is injected into the affected organ through a catheter.

Herbal medicines

In addition to antibiotic therapy, the doctor will prescribe medication, the action of which is aimed at the complete excretion of urine. Such herbal preparations include Kanefron in the form of tablets. It is shown to women in position, does not negative impact on their condition and development of the fetus.

Kanefron causes a diuretic effect, relieves spasms, inflammation and pain. It has an antimicrobial effect, enhances the effectiveness of antibiotics. The drug is approved for use even in early pregnancy. After a few doses, the patient will feel significant relief, and unpleasant symptoms will be lost.

Folk remedies

Alternative methods can be used in pregnant women only after agreement with the attending physician. He may approve some prescriptions as an addition to the main therapy. Self-medicate, use exclusively herbal remedies it is impossible - it is fraught with serious complications for the expectant mother and child.

Herbal preparations can provide positive action on the bladder. It is allowed to use plantain, chamomile, bearberry, marshmallow, St.

Dill gives a good anti-inflammatory and antibacterial effect. In addition, it has a diuretic effect, which is necessary for cystitis. Has a similar effect lingonberry leaf, a decoction of it can be drunk during pregnancy. Subsequently, herbal infusions are used to prevent the recurrence of cystitis.

Followers of traditional medicine should still pay attention to natural pharmaceutical products, in which the components are selected in such a way as to exclude harmful effect on a child. You should not experiment and make your own herbal preparations, because some of them can provoke an allergy or a miscarriage.

Prevention of cystitis during pregnancy

Pregnant women should know and follow the rules for the prevention of cystitis:

• Carry out daily hygiene procedures of the genital organs. Need to use special means for intimate hygiene and warm water. In this case, it is better to take a shower rather than a bath.
• Wear underwear made from natural fabrics. Synthetic shorts can provoke the active reproduction of harmful bacteria in the urinary organs.
• Avoid hypothermia. Do not stay in the cold for a long time or swim in cool water. Be sure to dress for the weather, the pelvic area should be warm.