They must be taken into account when managing pregnant women. So, at I-II degree of risk, pregnancy can be prolonged, but at III degree (creatinine> 265 μmol / l, glomerular filtration rate < 30 ml / min), pregnancy should be terminated.

Prevention of UTIs in pregnant women should include sanitation of the vagina in case of violation of its microflora and other sources of infection (teeth, pharynx, etc.), normalization of bowel function, optimal water regime.

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Marina Kolesnik,
photo of the author

What not to do with cystitis in early pregnancy

1. Take antibiotics unless prescribed by a doctor. Self-medication can lead to the development of fetal abnormalities. It is especially forbidden to take tetracycline, ofloxacin, norfloxacin, aminoglycosides.

2. Carrying out instillations. This procedure, during which an antibacterial drug is injected into the bladder, can cause an early miscarriage.

3. You can not take non-steroidal anti-inflammatory drugs. This refers to the intake of nimesil, diclofenac, analgin, etc. Otherwise, the unborn child may experience severe pathologies.

4. Do not carry out physiotherapy procedures, so as not to provoke a miscarriage.

5. Do not take a hot bath, do not visit the sauna, bath. Avoid overheating to avoid uterine hypertonicity.

How does cystitis manifest during pregnancy

The inflammatory process in the bladder in a pregnant woman is manifested:

• Frequent urination. This symptom does not always signal the appearance of cystitis. This is normal during pregnancy.

• The appearance of itching and burning in the urethra. An increase in these symptoms is observed after urine has begun to stand out.

• There is always a feeling that the bladder has not completely emptied.

• False claims appear. The pregnant woman is in dire need of going to the toilet, but there is no urine output.

• The stomach hurts, heaviness is felt in the lower part of the abdomen.

• The color of the urine changes. It is cloudy, reddish in color. This is due to blood impurities.

• After emptying the bladder, urine still leaks. The spread of the inflammatory process occurred on the sphincter. In this case, there was a violation of its functioning.

• A woman observes that a purulent and mucous secretion has begun to be released from the urethra.

• body intoxication. General weakness appears, the head often hurts, body temperature rises, there is no appetite.

Features of the treatment of cystitis in the later stages

Treatment of the disease in the third trimester of pregnancy is very similar to early treatment. However, there is a decrease in the risk of developing pathologies in the unborn child if the gestational age is more than 24 weeks.

At this time, the formation of the main organs, tissues and systems has already taken place. They just mature and develop. But at this stage of pregnancy, the likelihood of developing cystitis increases, which is dangerous for both the child and the pregnant woman with its complications.

Those medicines and procedures that were prohibited at an early date may be prescribed at a later date. It must be remembered that only the attending physician can prescribe this. It takes into account all the risks of treatment for the expectant mother and her child.

Exemplary regimen for the treatment of disease in late pregnancy

1. Appointment of antibiotic therapy. They can prescribe amoxicillin, suprax, monural. If the disease is more severe, the doctor prescribes penicillins, macrolipids, and other cephalosporins.

2. Instillation is carried out. During the procedure, an antibacterial and anti-inflammatory drug is injected into the bladder. This method can be carried out only in late pregnancy and only in the chronic form of the disease. The procedure is carried out in a hospital.

3. Herbal preparations (canephron, urolesan, cystone) are prescribed.

4. Treatment with antispasmodics.

5. Use of physiotherapy. Pregnant women may be prescribed electrophoresis or galvanophoresis with no-shpa or papaverine, calcium chloride, acetylsalicylic acid, antiseptic and antibiotic. These methods are indicated up to 34 weeks of pregnancy. Physiotherapy is in most cases prescribed for chronic cystitis. Contraindication is increased uterine tone, bleeding, preeclampsia, etc.

6. The use of immunostimulating drugs (flavozid or viferon).

It should be remembered that any therapeutic measures should be prescribed exclusively by a qualified and experienced specialist. With any attempt at self-treatment, the most deplorable consequences for the unborn child can occur.

Types of cystitis during pregnancy

Cystitis in early pregnancy can have a different etiology. This means that there is no single method of treating pathology. Drawing up a treatment regimen and prescribing drugs depends on the results of the diagnosis. The disease may be:

• Hemorrhagic. The provoking factor is an infectious agent. They mean Escherichia or Pseudomonas aeruginosa, enterobacteria, streptococci. This is the most common form of cystitis. In such a situation, treatment with an antibacterial drug is necessary. The choice of the drug is carried out strictly by the attending physician, since the intake of certain drugs is prohibited in the first trimester of pregnancy.

• Interstitial. This type of cystitis is characterized by a non-infectious inflammatory process, that is, the cause of the disease is an allergen or medication. To eliminate this form of the disease, an antibiotic is not prescribed. For the treatment of interstitial cystitis, a pregnant woman is shown taking anti-inflammatory, sedative and analgesic drugs.

• Luchev. Refers to a rarer occurrence during pregnancy. This is explained by the fact that the conduct of radiation therapy to a woman is prohibited during the bearing of a child. For the treatment of this form of cystitis, antispasmodics, sedatives and drugs are prescribed that help accelerate regenerative processes.

• Sexual. An exacerbation of this form of cystitis during pregnancy occurs due to prior infection. Strengthening of the symptoms of the disease is observed after sexual intercourse, if there are no barrier means of protection. This can be easily explained. After intimacy, the microflora changes. If pathogenic or conditionally pathogenic microorganisms have entered the urethra, a woman will notice the appearance of signs of cystitis. Genital inflammation of the bladder needs to take antiseptics, sedatives, diuretics.

Why does cystitis appear

The development of cystitis during pregnancy occurs under the influence of several factors. An important point is the timely determination of the causes that led to the appearance of cystitis. This is necessary so that the doctor can prescribe effective treatment and draw up a list of medical recommendations that will help the pregnant woman avoid a relapse of the disease. Also, it helps to prevent the transition of the disease into a chronic form.

There are a number of factors that lead to cystitis:

• Promiscuous sexual intercourse. The likelihood of infection during sexual contact increases, since the urethra and vagina are located in close proximity. It should be borne in mind that the penetration of infection into the urinary tract can occur, both from the mucous membrane of the vagina and the external genital organ of a woman.

• Neglect of hygiene rules. It is necessary to wash the external genital organs daily, to wash after intimacy, to change underwear in a timely manner, to use daily pads. All this helps to reduce the likelihood of infection entering the urinary tract of a woman.

• Prolonged presence of dysbacteriosis or vaginal candidiasis. If the vaginal microflora is disturbed, pathogenic microorganisms multiply much faster. This can cause an inflammatory response.

• Impaired immunity. If immunity is lowered or allergic local pathologies are present, a significant decrease in the protective properties of the body occurs. As a result, pathogenic or opportunistic microorganisms enter the bladder without any obstacles.

• With infrequent urination. It is normal for a woman to empty her bladder at least 4 times a day. During pregnancy, this figure increases. There are various reasons why a timely trip to the toilet is not possible. And if it becomes regular, the structure of the urethra and the sphincter anatomically change. As a result of such changes, the normal emptying of the bladder is disrupted. In addition, if urine is in the bladder for a long time, optimal conditions are created for infectious development.

• With regular hypothermia. If the body of a pregnant woman is often supercooled, its local protective properties are weakened, as a result of this, the likelihood of unhindered penetration of the infection into the bladder increases. Damaging factors contribute to the development of an inflammatory reaction in the walls of the bladder, as a result - the appearance of signs of cystitis.

All causes of cystitis are divided into infectious and non-infectious. There are four routes of bladder infection:

1. Descending - the penetration of the infection occurs from the inflamed organ, that is, the kidney.

2. Ascending - the initial localization of the infection that has entered the bladder is the external environment.

3. Lymphogenic - lymphatic vessels are involved in the movement of the infection. Basically, the focus of infection in the inflamed genital organ.

4. Hematogenous - the spread of infection occurs through the bloodstream from a distant purulent focus.

Non-infectious causes of cystitis:

• An allergic reaction, which manifests itself in the form of an inflammatory process of the mucous membrane of the bladder.

• Disturbed work of the immune system, nervous system.

• If the lower abdomen or pubis is undergoing radiation therapy.

There are factors in the presence of which increases the likelihood of developing cystitis. This happens when:

• regular hypothermia of the body.

• Constant use of tight underwear.

• Non-compliance with hygiene rules.

• Chronic disease of one or another internal organ.

• Overwork, hypovitaminosis.

• Impaired emptying of the bladder.

• Reduced protective functions of the body.

• The presence of a foreign body that is located in the bladder.

Despite the fact that the most common cause of cystitis is a bacterial infection, the inflammatory process in the bladder can begin due to some non-infectious factors.

Under the influence of certain drugs, especially chemotherapy drugs, an inflammatory process in the bladder can begin. The cause of drug cystitis is the excretion of the decay products of medicines from the body.

With prolonged use of the catheter, there is an increase in susceptibility to bacterial infection. As a result, the likelihood of an inflammatory process increases. This is called foreign body cystitis.

Some women may be hypersensitive to a particular substance found in personal care or household products. They mean bath foam, feminine hygiene spray, spermicidal gel. In some situations, the inflammatory process is a consequence of the reaction of the body - allergies.

Diagnostic measures

If any signs of cystitis appear, a woman should immediately consult a doctor. At the appointment, the patient is asked about how long ago she noticed the onset of symptoms, whether this happened before, and also what diseases were previously transferred and are present now. The patient must truthfully answer the questions. Otherwise, the doctor will not get a complete picture of what is happening to her.

To detect cystitis, the doctor sends for a laboratory examination. It consists in the delivery of a general analysis of blood and urine. Thanks to such studies, it is possible to detect inflammation, the level of leukocytes and the immature form of neutrophils, the level of erythrocyte sedimentation rate. In addition, protein in the urine, bacteria are detected. If the result of a general urinalysis showed that the content of leukocytes is increased, the patient is prescribed a urine test according to Nechiporenko.

Conducting such a urine test will help determine what was the causative agent of the disease. As a result, more effective treatment is prescribed. With this method of examination, an antibiogram can be performed and the sensitivity of the pathogen to various types of antibacterial drugs can be determined.

Also, special test strips are used, thanks to which nitrites and leukocytes are determined. Such special strips give a reaction if the products of the activity of pathogenic microorganisms are present in the urine.

Ultrasound examination of the bladder helps to exclude stones in the organ, and also, the doctor assesses the condition of the upper urinary tract and the organs adjacent to the bladder. Ultrasound will allow to exclude a volumetric neoplasm.

How to prevent the development of cystitis

There are a number of recommendations, subject to which the likelihood of developing the disease decreases.

1. It is necessary to wash every day once a day. For these purposes, use soap, preferably for children. It does not contain fragrances and dyes.

2. Carefully monitor that the sexual partner observes the basic rules of personal hygiene. He must wash the external genitalia every day.

3. Before and after sexual intercourse, you should thoroughly wash yourself. Use soap. This rule must be respected by both sexual partners.

4. With stomatitis, tonsillitis, oral candidiasis and other infections, it is not recommended to have oral sex. This rule is easy to explain - with saliva, the infection is transmitted to the external genital organs, and then to the urethra.

5. Always dress for the weather. Hypothermia can cause chronic recurrent cystitis. It should be noted that cystitis is not the most terrible pathology that hypothermia can cause. In addition to cystitis, an inflammatory process develops in nearby organs, which can provoke a miscarriage.

6. Keep track of the state of your own immunity. If a woman often has a cold, it can be judged that the work of the immune system is reduced. To restore it, you need to contact a qualified specialist.

7. Try as much as possible not to hold back urination. With prolonged retention of urine in the bladder, an infection develops.

8. Drink enough fluids.

9. A man should change his underwear every day.

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