Cystitis during pregnancy

definition

A bladder infection belongs to the group of lower urinary tract infections. At a young age and in middle age, it occurs much more frequently in women than in men. This is because the urethra in women is significantly shorter and the bacteria can get into the bladder more easily from the outside. For pregnant women, the risk of developing a bladder infection is even higher than for non-pregnant women. 4-7% of women suffer from cystitis at least once during pregnancy. During pregnancy, different rules apply to drug treatment than to non-pregnant women, as untreated bladder infections can pose risks to the unborn child.

causes

A bladder infection is caused by bacteria that enter the urinary bladder from outside via the urethra. There they then trigger an inflammatory reaction. In women this happens much more often than in men because the woman's urethra is only about 5 cm long. The bacteria get into the bladder more quickly than in men. The reason for the accumulation during pregnancy is anatomical in nature: During pregnancy, hormonal changes lead to a decrease peristalsis (Movement of the muscles) the ureter. In addition, the right ureter is being compressed by the uterus, which is getting bigger and bigger. Both of these lead to a slight reduction in the flow of urine, the bacteria are less easy to flush out and an inflammatory reaction occurs more quickly.

The pathogens that cause a bladder infection originate in the majority of cases from the intestinal flora. The main causes of an infection can be found in incorrect intimate hygiene. For example, if after going to the toilet, instead of wiping from front to back, but from back to front, germs from the anus area get to the vagina and can there via the urethra to the bladder. Using a washcloth to clean the vagina and anus can also lead to contamination.

Other causes for the development of a bladder infection are certain sexual practices, for example anal intercourse, which is performed directly before vaginal intercourse. Some women are also very sensitive to sexual intercourse with a new partner and develop a cystitis shortly afterwards. One speaks of a Honeymoon cystitis. In addition to pregnancy, risk factors for developing a bladder infection are kidney stones, diabetes mellitus and permanent bladder catheters.

Also read our article: What are the typical causes of a urinary tract infection?

What are the first signs of a cystitis?

The first signs of a cystitis differ from woman to woman. Some women initially complain that they have to go to the toilet significantly more often than usual, so there is an increased urge to urinate. Others notice a slight pulling in the lower abdomen at first, which occurs mainly during urination. Sometimes the urine turns red at first, although this rarely occurs with a pure cystitis. Symptoms of a bladder infection can also be a feeling of malaise and fatigue.

Read about this too Urinary tract infection

Symptoms

Cystitis is associated with relatively typical symptoms. There is severe burning and drawing in the urethra area with each urination. In addition, the women affected feel a very frequent need to urinate. When they then go to the bathroom, however, there is hardly any urine. One speaks of a in technical jargon Pollakiuria. Occasionally, in the context of a bladder infection, the urine turns red due to blood (Hematuria). One then speaks of one hemorrhagic cystitis (bloody cystitis).

Pain

Very typical of a cystitis is the burning pain that occurs while urinating. In addition, pulling pelvic pain can also occur. These, too, are primarily related to urination.

diagnosis

The diagnosis of cystitis is primarily made through a urine test. However, the attending physician will take a brief medical history beforehand. He may ask what symptoms exist and when they first appeared. He will ask if there were any symptoms of this kind during pregnancy. He will also inquire about the progress of the pregnancy and possibly try to find out what could have been the cause of the cystitis. Inquiries can also be made about previous pregnancies.

This will be followed by a physical exam with the focus on the lower abdomen. Then the urine test takes place. Midstream urine must be given for this. This means that some urine is left first before the remaining urine is collected in a container. The urine is then examined either using a urine strip test or in a laboratory. The strip test shows roughly whether there is an inflammatory reaction in the urine. However, he cannot say exactly how high the number of inflammatory cells is and what type of bacteria it is.

The urine test in the laboratory (urine status) can provide more precise information about the number of inflammatory cells in the urine (Leukocytes) do. In the case of pregnant women, a urine culture is also usually created. The urine is examined more closely so that the triggering bacteria can be identified. However, the evaluation of such a urine culture takes a few days.

How dangerous is cystitis to the baby?

Untreated cystitis during pregnancy carries several risks. The main risk for the expectant mother is that the bladder infection will spread. The bacteria can ascend into the kidneys and trigger an inflammation of the renal pelvis. This is a serious clinical picture that is often associated with a very high fever, chills and a significantly reduced general condition. Hospital treatment may be necessary, especially for pregnant women. Timely antibiotic therapy usually prevents such a complicating course. If the bladder infection is left untreated, the main risk for the child is an increased likelihood of premature birth. Premature birth itself is fraught with numerous risks and generally requires close care and treatment on a special ward in the hospital.

therapy

Cystitis during pregnancy is somewhat different in therapeutic aspects from cystitis in a non-pregnant woman. This has to do with the fact that cystitis is always considered complicated in pregnant women. Therapeutically, this means that every urinary tract infection in the pregnant woman must be treated. This also applies to cases in which a routine examination reveals a urinary tract infection although the woman concerned has no symptoms at all (asymptomatic bacteriuria). Therefore, according to the guidelines for preventive examinations during pregnancy, a urine status is carried out monthly. If a bladder infection is found, antibiotic treatment must be initiated. If the symptoms are very severe at the beginning, additional mild pain relievers such as paracetamol (possible during the entire pregnancy) or ibuprofen (only in the first 6 months) can be administered.

Read more on the topic: Bacteria in the urine - how dangerous is it?

Which antibiotics are allowed?

Special care must be taken during pregnancy as there are certain medications that the pregnant woman must not take. This is related to the fact that certain medicines can have a harmful effect on the unborn child. They are called teratogenic, that is, teratogenic. Numerous antibiotics should not be used during pregnancy, either because they have not been adequately researched with regard to their use in pregnancy, or because there are indications of a teratogenic effect. The antibiotics of choice for cystitis in the non-pregnant woman are Fosfomycin or Nitrofurantoin. Nitrofurantoin however, should not be used during pregnancy. In terms of Fosfomycin there is currently no completely uniform opinion. Some authors see this antibiotic as the drug of first choice, others call it only a drug of the second choice in pregnancy, meaning that it should only be used if something speaks against the use of the first choice drug. The drugs of first choice include: antibiotics from the group of Penicillins like for example Amoxicillin or Ampicillin and antibiotics from the group of Cephalosporins such as Cefuroxime or Cefixime.

Read more on the topic: Antibiotics in Pregnancy

Home remedies for a cystitis during pregnancy

There are several home remedies that can help relieve symptoms of cystitis. First of all, it is important to drink enough. If there is no illness that prohibits this, such as severe heart failure (heart failure), you should drink at least two liters a day during cystitis. There are numerous bladder-and-kidney teas (such as Indian bladder and kidney tea) that are said to have an additional mild anti-inflammatory effect. These can be tried out. However, water or other teas are said to be equally effective. The aim is to flush the pathogens out of the urinary tract. In addition to drinking enough, a warm hot water bottle that is placed on the lower abdomen or a bathtub often provides relief. Otherwise, above all, adequate physical rest should be ensured. However, this does not mean complete bed rest. Quiet walks in the fresh air are almost always good for the body.

Read more about the topic here: Skin cream for a cystitis

Duration of a cystitis

The duration of a urinary tract infection varies from woman to woman. A urinary tract infection generally lasts about 1-2 weeks. However, this does not mean that the woman concerned will suffer from the typical symptoms for 2 weeks. After starting antibiotic therapy, the symptoms usually become significantly less after 1-3 days, and after about 1 week they should generally be completely gone at the latest. However, this does not mean that all pathogens have been eliminated from the urinary tract. By the way, bladder infections can occur again and again - to the chagrin of many women - one then speaks of recurrent urinary tract infections. There are some studies that suggest that regular intake of cranberry supplements, for example in juice or tablet form, reduces the risk of recurrent bladder infections. However, other studies could not prove any advantage of cranberry over placebo, so that there are no valid recommendations for this.