Not only cystitis: pain when urinating

It is generally accepted that pain during urination is a reliable sign of cystitis. However, the “nuisance” can only be associated with inflammation of the lower urinary tract, and owes its origin to a specific flora. It is often not possible to identify such pathogens with a general urine test. And treatment with popular antibiotics, in most cases, does not help.

Cystitis or urethritis
“Urinary” infections can be “based” at any level of the urinary system.

The defeat of only the urethra is called “urethritis” and can be caused by:

specific microflora = bacteria and sexually transmitted viruses (gonococci, herpes, ureaplasma, mycoplasma, trichomanada and chlamydia);
opportunistic microflora = Escherichia coli, entero-, staphylo- and streptococci, as well as fungi of the genus Candida, which are “known inhabitants” of the intestines, skin and respiratory tract.
Inflammation can also be caused by injury to the urinary tract, the influence of toxic and physical factors (radiation, burns, and so on). Although, admittedly, such situations are still rare.

The main signs of urethritis are:

burning,
pain,
itching
and discharge from the urethra,
and in some cases – an increase in body temperature up to 38.0-39.0 degrees.
At the same time, an increase in urination or a feeling of an overflowing bladder, characteristic of cystitis, does not occur with isolated urethritis.

Inflammation of the bladder often has a “classical” bacterial nature and is provoked by representatives of opportunistic microflora.

The latter can enter the urinary tract both “from the outside” and “from the inside”, migrating from the intestine along the lymphatic tract.

Such “microbial travel” is facilitated by:

a sedentary and sedentary lifestyle, which creates conditions for lymph stagnation in the pelvic organs and the migration of pathogens;
dysbiosis of the intestines and genital tract;
systemic and / or local decrease in immunity, provoking prolonged sluggish inflammation and chronicity of the process.
By the way, the diagnosis of “chronic recurrent cystitis” is eligible already in the case of 2 exacerbations within six months, or 3 – in just a year. In this case, the risk of bacterial complications “to the kidneys” and adjacent organs increases significantly. And treatment, in most cases, becomes interdisciplinary (with the participation of doctors of different specialties).

Diagnostics
1. Having already become “classic”, the general analysis of urine is the first line of diagnosis. The speed of its implementation and a fairly wide range of indicators serve as a rationale for prescribing treatment in the shortest possible time.

However, this treatment is empirical.

Until the results of a microbiological study are obtained, it is not possible to assess the quality, quantity and sensitivity of bacteria to antibiotics. This means that the antibiotic is prescribed “blindly” based on the spectrum of action of the drug, and may not be effective against microflora in a particular case.

2. To increase the “efficiency” of treatment, you can find out the nature of the pathogen.

This requires:

conduct a urine culture test to determine antibiotic susceptibility
and take a swab from the urethra for STI pathogens (PCR-6).
Material from a smear, unlike inoculation, allows you to isolate intracellular and “capricious” microorganisms (ureaplasma, mycoplasma, chlamydia, Trichomonas and others), as well as viruses. And sowing, in turn, gives an idea of ​​the sensitivity of the opportunistic flora.

Both the one and the other analysis separately does not allow you to get the most complete picture. While together they cover a much wider range of possible pathogens.

3. Of course, do not forget about the systemic reaction of the body to inflammation, which can be assessed in a general blood test with a leukocyte formula. And the shift in the formula towards neutrophils or lymphocytes serves as an indication of the bacterial or viral nature of the infection, respectively.

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