Cystitis in women: treatment, symptoms and causes. Recommendations of a gynecologist.

Causes of frequent cystitis in women

Cystitis does not seem to be too serious a disease. However, only those who have never encountered it or are sick for the first time think so. The fact is that in approximately half of women who have had cystitis, the disease recurs within six months, that is, it recurs.

When the symptoms of cystitis (frequent urge to urinate, acute pain and pain in the lower abdomen, blood in the urine, fever) are repeated regularly, the disease turns into both a physical and psychological problem. And in order to solve it, it is important to understand what the causes of frequent cystitis in women are.

Causes of the disease

Cystitis in women usually occurs due to the entry into the urethra of an aggressive conditionally pathogenic pathogen, as well as ascending sexually transmitted infections: chlamydia, ureaplasma (Ureaplasma), fungal infections of the genus Candida, etc. A short and wide urinary channel is often vulnerable to such infections. The occurrence of cystitis in women can also occur due to the movement of pathogens through the bloodstream. This path of disease development is called hematogenous.

Another variant of infection is the entry of bacteria into the bladder due to pathologies of the kidneys and ureters. Typically, this development of events can be observed with pyelonephritis.

Causes of cystitis

It should be noted that a less common, but still occurring variant of the development of the disease, provoked by anomalies in the development of the urinary system. Cystitis can also be caused by a decrease in the contractility of the bladder muscles.

It is also worth highlighting cystitis during menopause during atrophic processes in the mucosa.

Signs of infection may appear especially active in the presence of predisposing factors. These include:

Sedentary work. Sitting for more than three hours at a time causes urine to stagnate, leading to possible bladder infection. Therefore, if your work involves sitting in one place for a long time, you need to get up every hour and do a short warm-up every three hours.
Constipation.
Presence of sand and stones in the bladder.
Tight underwear that can disrupt normal blood circulation in the pelvic organs.
Frequent hypothermia of the body.
Lower back injuries, spinal cord injuries.
Early onset of sexual activity.
Metabolic disorders, hormonal changes in the body (for example, menopause or pregnancy). During hormonal surges, the body's immune system may malfunction. Please note: when carrying a child, the expectant mother is at particular risk in case of infection and development of cystitis. Therefore, during pregnancy, it is necessary to carefully monitor your own health and consult a doctor at the first signs of illness.
Diabetes mellitus (Diabetes mellitus).
Therapy with immunosuppressive drugs.
Oncological diseases.
Unbalanced and irregular diet: abuse of spicy and fried foods, alcohol.
Improper hygiene procedures (in particular, improper washing in the direction from the anus to the vagina).
The chance of bladder infection is high if personal hygiene is not carefully observed (wearing the same pad or tampon for a long time during menstruation, untimely change of underwear, constant use of panty liners).
Stress, chronic lack of sleep, which has a serious impact on the immune system.
A general decrease in immunity caused by the presence of a chronic source of inflammation in the body (stomatitis, caries, rhinitis, tonsillitis). As a result, this can lead to disruption of the sterility of the urethra

Separately, it is worth highlighting such a form of inflammation of the bladder as interstitial cystitis, which is a consequence of serious disorders in the functioning of the immune system and is a severe chronic disease.

Complications

Chronic cystitis can affect most of the bladder mucosa. In the affected areas, due to a decrease in the elasticity of the epithelium in the patient, swelling and thickening can be detected by diagnostic methods. A progressive disease can lead to a number of complications that can even threaten the health of internal systems and organs:

in more cases, patients with advanced disease develop pyelonephritis or renal failure;
with organic changes in the tissues of the bladder, its walls may burst and peritonitis may develop;
periodic inflammatory process can cause adhesions;
many suffer from urethritis;
all kinds of tumor processes appear in the body;
ulcers may appear on the walls of the bladder and bleeding may occur;
a frequent complication is the appearance of urolithiasis;
due to muscle damage and loss of tissue tone of the bladder, bladder dysfunction occurs, and the patient exhibits urinary incontinence;
Long-term and acute illness can reduce reproductive function, up to the complete loss of the ability to bear children.

Symptoms and signs of cystitis

How does cystitis manifest?

The symptoms of cystitis are very characteristic and allow you to immediately make a correct diagnosis. First of all, this is a frequent urge to urinate (the patient visits the toilet up to several times per hour) and the manifestation of pain at the end of the process of emptying the bladder. Also, the most striking symptoms include:

feeling of fullness of the bladder even after urination;
blood or pus in the urine;
urine with cystitis in women acquires a more pungent odor;
cloudy urine and the presence of flakes in it;
pain in the lower abdomen;
when the infection spreads, including to the upper parts of the urinary system, pain in the kidneys and lower back is possible;
quite rare, but difficulty in holding urine does occur

Video about bladder inflammation

Infectious disease doctor Vladimir Nikiforov talks about bladder inflammation. Source - Live Healthy!

If you discover these symptoms, you need to consult a doctor for diagnosis and further treatment, since the advanced form of the disease is fraught with a number of complications.

Expert opinion

Symptoms of cystitis cause a woman not only physical, but also psychological discomfort, leaving an imprint on her personal and social life. Therefore, it is necessary to react to the appearance of the first signs of the disease as early as possible and begin therapy.

Obstetrician-gynecologist of the highest category Oksana Anatolyevna Gartleb

If the inflammation caused by infection spreads to the muscle layer of the bladder, the appearance of interstitial cystitis, which was already mentioned above, may occur. In this case, urine penetrates the walls of the organ, as well as its reflux into the ureters.

symptoms of cystitis in women

If untreated and if the infection spreads vertically, kidney disease-pyelonephritis (Pyelonephritis) may develop.

Types of cystitis

It is necessary to distinguish between types of disease that differ in the method of occurrence, course, morphological changes and nature of spread.

All types of cystitis are divided according to the nature of the course into acute and chronic. We will consider both options for the course of the disease.

Acute cystitis

Against the background of the manifestation of the symptoms described above, acute cystitis gives low-grade fever and general malaise. The blood vessels of the bladder dilate, which leads to swelling of the walls of the organ. In this case, pinpoint hemorrhages and hyperemia (Hyperaemia) are observed. During the acute phase of the disease, the mucous and submucous membranes of the bladder usually suffer, and their epithelium is torn away in places, and blood may appear in the urine. The color of urine in the hemorrhagic form of the disease can vary from light pink to cloudy brown.

Chronic cystitis

When the disease enters the chronic phase, inflammation expands and moves from the mucous and submucous membranes to the muscular layer of the bladder. In this case, the color of the mucous membrane acquires a whitish or grayish tint. If the disease is not treated for a long period of time, sclerotic processes appear in the organ, due to which its volume may decrease.

In the chronic form, all the previously mentioned signs can be “blurred” and not clearly expressed, which makes diagnosis difficult. If chronic cystitis is suspected, it is necessary to rely on data from the anamnesis, macro- and microscopy of urine, cystoscopy, and bacteriological examination. Particularly important when identifying chronic cystitis is a parallel gynecological examination, since often it is genital infections that cause the appearance of chronic forms of cystitis.

Acute and chronic cystitis: which doctor should I contact?

Standard tests for diagnosing cystitis in older women, mature women and girls are a general urine test, urine culture to identify pathological flora (bacteriuria), Nechiporenko analysis. As additional measures, modern clinics often offer ultrasound of the bladder and kidneys, cystoscopy, and screening for STIs. In some cases, the doctor may order urine collection for analysis not using the standard method, but using a catheter. This may be necessary to prevent vaginal discharge from entering the urine.

Classification

Cystitis is classified depending on its pathogenesis:

Primary. In the absence of other diseases of the urinary system.
Secondary. Occurs against the background of chronic infections in the urinary tract, urolithiasis, hydronephrosis, congenital anomaly, tumor growth.

Depending on the area of distribution, the disease is:

Total. With inflammation of the entire inner surface of the bladder.
Trigonite. The process applies only to the area of the anatomical triangle.
Cervical. There is local inflammation of the entire lower part.

From the source of origin of cystitis it is divided:

Infectious. More often as a result of poor genital hygiene or hypothermia.
Chemical. As a result of treatment with certain medications.
Thermal. As a result of flushing the bladder with hot liquid.
Traumatic. As a result of injuries to the genitourinary organs.
Ray. Occurs when organs are irradiated.
Postoperative. Consequences of organ surgery.
Viral. As a result of the disease, the infection penetrates the internal organs, mainly the kidneys, and from there enters the urinary tract.
Parasitic. Damage by parasites.

In addition, acute and chronic cystitis are distinguished. The acute form of the disease is characterized by a sudden onset with pronounced pain symptoms when urinating. In this case, the person experiences additional itching and burning, and sometimes an increase in body temperature. Chronic cystitis is usually detected by laboratory methods. The patient may have no complaints at all, and outwardly he may look completely healthy. But laboratory blood tests can detect an infection in the lower urinary tract. Chronic cystitis tends to worsen at an unexpected moment and show signs of an acute form of the disease.

Treatment of cystitis

Treatment of acute cystitis is based on antibacterial drugs. Due to the fact that such drugs are excreted by the kidneys, it is very easy to achieve the required concentration of the antibiotic in the bladder, so the effect of treatment appears as quickly as possible. There are two important factors to consider:

The doctor should prescribe antibiotics after receiving urine culture results, which will determine the sensitivity of the pathogen to the chosen drug.

Even after the condition has been alleviated, the prescribed course of antibiotics must be taken to the end, which will avoid relapse and the disease becoming chronic.

The following are used as auxiliary measures for the treatment of cystitis:

drugs to relieve bladder spasms, general anti-inflammatory drugs;
physiotherapy;
ozone therapy;
acupuncture.

To treat chronic cystitis, local administration of drugs that prevent the proliferation of pathogenic microorganisms can also be used. Restoring gel “Gynocomfort” with tea tree essential oil can be used as an adjuvant. This product was developed by specialists of the pharmaceutical company VERTEX, passed clinical studies at the Department of Dermatovenereology with the clinic of St. Petersburg State Medical University and has the necessary documents and quality certificates. The gel is recommended for eliminating vaginal discomfort, normalizing microflora and restoring the vaginal mucosa after infectious and inflammatory diseases and in the period after treatment with antibiotics.

Types of treatment and its features

Of course, it is best to consult a doctor for diagnosis and treatment of cystitis. It is especially important not to self-medicate during pregnancy.

Treatment of cystitis is almost always accompanied by antibacterial therapy and will be more effective if the doctor selects a specific antibiotic and other medications based on test results and other diagnostics.

In more advanced forms of cystitis, medications may be needed to strengthen blood vessels (Venarus, Detralex), as well as to compensate for the lack of iron, hemoglobin, etc.

In some cases, more often with chronic cystitis, recurrent cystitis, leukoplakia of the bladder, interstitial cystitis or oncology, the doctor may recommend a course of bladder instillations (administration of the drug through a catheter directly into the bladder). This will allow the medicine to be delivered as quickly as possible and in a more concentrated dose directly to the site of inflammation.

It is important to follow recommendations regarding diet and drinking, even if the doctor does not mention it.

Acute cystitis

It is worth noting that the treatment of acute cystitis always involves bed rest. Treating the inflammatory process in the bladder “on the run” without issuing a sick leave, especially in the cold season, means risking the possible transition of the disease to a chronic form. The disease is always accompanied by severe stress for the body, which requires rest and rest. At the same time, ignoring the disease and postponing a visit to the doctor can “result” in pyelonephritis, the treatment of which will require constant medical supervision.

More information about drug treatment of cystitis in women: drugs

Some of these medications are usually prescribed to relieve symptoms and treat cystitis in women:

"Monural". This drug has an antibacterial effect on most gram-positive bacteria. The main active ingredient of the drug is fosfomycin. "Monural" is prescribed starting from the age of five, and is contraindicated in cases of severe renal failure.

Furagin. An antimicrobial drug that is well tolerated by patients. It effectively fights the action of many harmful microorganisms, including staphylococci and E. coli. Please note that Furagin has contraindications, including pregnancy and renal failure.

Antibiotics and quinolones. These medications for cystitis in women have a wide spectrum of action, so they are prescribed not only for the treatment of cystitis and effectively fight a number of STIs, streptococci, and staphylococci. Use only after prior consultation with a doctor.

Monurel. This remedy is usually prescribed as a preventive measure (especially in the case of frequent exacerbations of the disease). The main active ingredient is cranberry extract, which suppresses the action of microbes in the walls of the bladder.

Cyston. Belongs to the category of herbal preparations. The composition includes a complex of ten plants (didimocarpus cauliflower, membranous rash, madder cordifolia, saxifraga reed and others) that help relieve inflammation during female cystitis. Has antispasmodic and diuretic effects.

Cardiologist German Gandelman on the causes of female cystitis. Source - cystis.ru

Treatment of cystitis at home

Treating cystitis at home can be very effective. Of course, home treatments do not exclude visiting a doctor and the need for tests, but they will help relieve unpleasant symptoms and pain.

Bearberry decoction shows excellent effectiveness, which is confirmed by experienced nephrologists. This herb has a diuretic effect and effectively removes “bad” flora from the bladder.

Cranberry juice is also recommended for use, which, due to its acidic environment, prevents the proliferation of microorganisms. At the first manifestations of cystitis symptoms, you can take a decoction of lingonberries, bear's ear, and half-palm.

Therapeutic diet

In order to relieve inflammation as quickly as possible, it is recommended to drink plenty of fluids: the minimum volume of liquid consumed should be 1.5 liters per day.

It is also necessary to follow a diet.

Nutrition for cystitis has a number of restrictions. Eliminating hot and spicy foods will promote recovery and help avoid a recurrence of the situation. During the treatment period, it is necessary to completely avoid alcohol. This applies to all alcohol-containing drinks.

If you notice painful and frequent urination, blood, flakes or pus in your urine, do not rush to panic. Indeed, according to statistics, female cystitis is a very common phenomenon.

The main thing is not to delay and consult a doctor in time.
Sources:

ISSUES OF DIFFERENTIAL DIAGNOSIS AND TREATMENT TACTICS OF ACUTE UNCOMPLICATED CYSTITIS IN WOMEN IN PRIMARY CARE. Akilov F.A., Arustamov D.L., Alidzhanov Zh.F., Rakhmonov O.M., Mirkhamidov D.Kh. // Bulletin of emergency medicine. – 2011. – No. 1. – P.106-110.
CURRENT ASPECTS OF PHARMACOTHERAPY OF CHRONIC CYSTITIS IN THE ACUTE STAGE IN WOMEN. Kurnosova N.V., Kuzmenko A.V., Kuzmenko V.V. // Saratov Scientific and Medical Journal. – 2010. – No. 3. – pp. 705-708.
Diagnosis and treatment of interstitial cystitis. Zaitsev A.V. // Author's abstract. dis. Dr. med. Sci. M. - 1999. P. 38.
Results of studying the prevalence of antibiotic resistance among pathogens of community-acquired urinary tract infections. Sidorenko S.V., Ivanov D.V. // Antibiotics and chemotherapy. - 2005. No. 5091. - P. 3-10.
Uncomplicated and complicated urinary tract infections. Principles of antibacterial therapy. Lopatkin N.A.. Derevyanko I.I. // Russian medical journal. - 1997. - T. 5, No. 24. P. 1579-1589.
https://www.pubfacts.com/detail/23276554/Treatment-of-interstitial-cystitis-in-women
https://www.researchgate.net/publication/44614433_Bacterial_cystitis_in_women/link/0c960517f54b1f402…
https://www.aafp.org/afp/2009/0315/p503.html
https://www.healthline.com/health/cystitis

Lower urinary tract infections in women are an urgent medical and social problem of modern outpatient urology, which is primarily due to their high prevalence in the female population [1-4]. According to statistics, every year about 15% of sexually active women suffer at least one episode of acute bacterial cystitis, and in general, throughout their lives, at least 60% of women have suffered from this disease at least once [1]. After acute bacterial cystitis, approximately 50% of women develop relapses of the disease within a year, which in 15-25% of cases progress to chronic recurrent bacterial cystitis (CRBC), which often acquires a very persistent clinical course and is characterized by insufficient effectiveness of pharmacotherapeutic measures, which is accompanied by often severe medical, social and psychological maladaptation and a sharp decrease in the quality of life of women [2-4].

HRBC: MODERN PROBLEMS OF ANTIMICROBIAL CHEMOTHERAPY AND WAYS TO SOLUTION THEM

Currently, almost all researchers and clinicians note the multifactorial nature of the phenomenon of decreased effectiveness of antibacterial therapy in CRBC:

Factors from microorganisms (the ability of bacteria to form biofilms (biofilms) in the mucous membrane of the bladder; mutations leading to increased expression of key antibiotic breakdown enzymes, which bacteria are able to transmit to subsequent generations of strains; structural modification of endo- and exotoxins synthesized by bacteria, etc.) [ 5,6].
Factors from the macroorganism (decrease in the mechanisms of natural and acquired immunological reactivity, both congenital in nature and acquired during life in connection with various diseases (for example, decrease in urothelial synthesis of secretory immunoglobulin IgA and protective glycosaminoglycans of the mucosa); increased level of allergic triggering of the population, which makes it is almost impossible to prescribe antibiotics in a number of cases; chronic diseases accompanied by the potential ability to change the metabolism of antibiotics in the body (diseases of the liver and gastrointestinal tract), etc.) [7,8].
Pharmacological factors (almost complete absence of synthesis of new effective classes of antibiotics over the past decades, limited mechanism of action of a number of antimicrobial chemotherapy drugs, uncontrolled and irrational prescription of antibiotics in clinical practice, use of low-quality generics, widespread prescription of veterinary antibiotics to animals, leading to subsequent sensitization of the human immune system when consumed meat of such animals, etc.) [9-11].

The global wave of antibiotic resistance in its various manifestations, which has swept the vast majority of countries in the world, including Russia, forces us today to actively seek ways to solve the problem of pharmacotherapy of infectious diseases, including CRBC in women. And if at present the possibilities of synthesizing new effective antibiotics to combat microorganisms remain limited, then, obviously, attention should be paid to the state of the second participant in the infectious-inflammatory process - a macroorganism that resists any pathogen, and the outcome of infectious inflammation does not depend on each of them separately, but is the result of their opposition and interaction, mediated by a huge number of mechanisms on both sides. This provision, in our opinion, is especially applicable to the bladder, which from a physiological point of view is not a simple “passive” reservoir for holding and evacuating urine, but is a hormone-dependent organ, all of whose structures are under powerful neuro-hormonal control [12]. The influence on the anatomical and functional state of the structural elements of the bladder, mediated primarily by sex steroid hormones, ensures almost all of its physiological functions: from storage-reservoir and evacuation to urothelial-protective, neuroendothelial (innervation and blood supply) and especially bactericidal functions, which in common provide the bladder urothelium with a known and fairly high level of natural antibacterial resistance [13,14].

The dependence of the anatomical and functional state of the bladder urothelium in women on the level of sex hormones was established back in 1947 [15]. Further studies showed the key role of sex hormones (estrogens and progesterone) in ensuring the synthesis by the urothelium of protective mucopolysaccharides-glycosaminoglycans (hyaluronic acid and its sodium and zinc salts, chondroitin sulfate, glycoproteins, mucin), which make up the surface glycocalyx of the bladder mucosa - a powerful natural system antibacterial protection (anti-adhesive factor), the loss of which naturally increases the susceptibility of the urothelium to various adverse effects, including infectious agents. This is considered today as one of the key manifestations of urothelial dysfunction underlying the modern pathogenesis of CRBC and its relapses [16-19].

Works of recent decades indicate that CRBC is not so much an independent local infectious-inflammatory process in the bladder, but rather an infectious “tip of the iceberg” of systemic metabolic and hormonal mechanisms (systemic chronic cytokine inflammation, sympathetic autonomic hyperactivity, oxidative stress, decreased antioxidant and immunological reactivity of the body , neuroendothelial dysfunction, systemic hypoxia, etc.), inevitably affecting the key functions of the bladder, including bactericidal [20-22].

From the standpoint of a systematic approach to the problem of CRBC, it is also obvious that with the general ill health of a woman, the frequency of its relapses tends to increase, which may be due to the high frequency in the population of modern women of hormonal-metabolic systemic disorders (obesity, insulin resistance, dyslipidemia, arterial hypertension (endothelial dysfunction), type 2 diabetes mellitus, sarcopenia (deficiency in the quantity and quality of muscle mass), vitamin D deficiency, etc.). These changes tend toward rejuvenation and, taking into account the increase in the average life expectancy of women on Earth, will accompany her almost the entire second half of her life after menopause, steadily progressing simultaneously with the deterioration of the anatomical and functional state of the bladder with age (“aging of the bladder” , or “senile bladder”) [23, 24].

ENDOCRINE-AUTOCRINE-PARACRINE MODEL OF BLADDER REGULATION AS A PATHOGENETIC BASIS FOR CRBC CONTROL IN WOMEN

To date, a huge number of scientific clinical and experimental publications have been accumulated, allowing us to say that the bladder is a single functional system, all elements of which (urothelial cells, nerve endings, vessels, myocytes and myofibroblasts) are in constant active interaction aimed at maintaining physiological compliance of the organ in order to ensure its most optimal functions in constantly changing conditions of the external and internal environment. Urothelial and other bladder cells can be activated or blocked by various mechanisms, both systemic (endocrine) and local (autocrine or paracrine) [20].

Endocrine regulation of the bladder, like all other organs, is carried out by specialized substances of various natures - hormones synthesized in specialized endocrine glands and entering the cells of organs and tissues in which the corresponding receptors are expressed through the systemic bloodstream (regulation at a distance). Currently, the key role of sex hormones (estrogens, progesterone, androgens), vitamin D, insulin in ensuring metabolism and energy metabolism in all cells of the bladder has been proven (the expression of receptors for the corresponding hormones in the bladder has been established), and an important role in this has also been shown the process of sleep hormone (melatonin), growth hormone (somatotropin), which exerts its physiological effects through insulin-like growth factor-1 (IGF-1), as well as adipose tissue hormones (leptin, adiponectin, adipsin, resistin, desmin, etc.), which today it is considered as one of the most active endocrine organs [25-33].

Endocrine regulation of the bladder provides almost all of its functions, creating a “hormonal” springboard for the implementation of autocrine and paracrine regulation mechanisms inherent in cells, which also take place in the tissues of the bladder. With autocrine regulation, the cell is capable of independently synthesizing a local hormone (hormone-like substance) and at the same time has the corresponding receptors for it. In other words, the cell is both a hormone producer and a target cell. An example is endothelins produced by endothelial cells, including in the vessels of the bladder, which directly affect the function of these same endothelial cells [34]. Paracrine regulation is that biologically active substances (local hormones) secreted by producer cells spread into the tissue due to diffusion and act on neighboring target cells. This is how, for example, many mitogenic stimulants (polypeptide growth factors) act - epidermal growth factor (EGF), platelet growth factor (PGF), interleukin-2 (T-cell growth factor), nerve growth factor (NGF), etc. [34 ].

It is known that stimulation of receptors and membrane channels on urothelial cells can lead to the release of many mediators that regulate the functions of nerve endings and other types of cells in the bladder. On the other hand, urothelial cells themselves may be a target for mediators released by neurothelial, endothelial, or other cell types. The release of local mediators in the tissues of the bladder is carried out thanks to the adaptive interaction of the sympathetic and parasympathetic parts of the autonomic nervous system with the participation of systemic and local hormonal mechanisms (neuro-endocrine regulation), which allows the bladder, morphologically consisting of various types of cells, to work as a single functional cellular syncytium [20] (Fig. 1).

In this well-coordinated functional system, an important role is played by the endocrine component of the autonomic regulation of bladder functions, since hormones have both a direct effect on the anatomical and functional state of all structural elements of the bladder, and indirectly - by regulating the functional activity and expression of various receptors in the urothelium and neuro- muscle elements of the detrusor. The results of the studies show that sex hormones are capable of modulating the functions of the local neuroreceptor apparatus of the bladder in both men and women. Thus, it is known that in women, the effects of estrogen are realized through the modulation of the activity and expression of predominantly α-adrenergic receptors of the bladder vessels, and the effects of progesterone through the β-adrenergic receptors of the detrusor [35].

Rice. 1. Hypothetical model of interactions between urothelial cells (urothelium), afferent and efferent nerve endings (neurothelium), blood vessels (endothelium), smooth muscle cells and myofibroblasts of the bladder [20]. Conventional abbreviations: ATP adenosine triphosphate NR neurokinin receptor PG - prostaglandins ACH - acetylcholine NickRnicotinic receptor SP - substance P AdR - adrenergic receptor NO - nitric oxide TyrKR tyrosine kinase receptor with BR bradykinin receptor P2R - purinergic receptor with high affinity for NGF MR muscarinic receptor subtype 2 TPK transit ny receptor NEnorepinephrine P2X and P2Y – purinergic potential channels NGF – nerve growth factor receptors X and Y subtypes

Thus, sex steroid hormones play one of the most critical roles in the metabolism of the bladder, regulating almost all its functions, so it seems illogical and incorrect to consider various clinical variants of bladder diseases, including infectious and inflammatory ones, in isolation from its hormonal regulation .

Sex steroid hormones in women: synthesis and features of age dynamics. To date, medicine has developed an incorrect traditional understanding of sex hormones, according to which there are supposedly only “male” (androgens) or only “female” (estrogens, progesterone) sex hormones, the use of which is impractical, unacceptable and even dangerous in members of the opposite sex. However, from a biochemical point of view, this is incorrect, since all sex hormones are representatives of the same hormonal family - steroid hormones (which also includes glucocorticoids, mineralocorticoids and vitamin D) and have a single biochemical precursor (7-dihydrocholesterol) [35,36] ( Fig. 2).

Rice. 2. Scheme of synthesis and biotransformation of sex steroid hormones in men and women [35, 36]

In this regard, the traditional division of sex hormones into “female” and “male” should be considered erroneous and incorrect, since in order to ensure all physiological processes, both men and women need the presence of all three sex hormones in the body, as well as vitamin D in the corresponding physiological concentration needs of the body [36,37].

The results of modern research prove the important role of all three sex hormones in the regulation of various physiological processes in women (transcription, binding of metals and DNA, intracellular signal transmission, activation of genes for protein synthesis, carbohydrate and fat metabolism, functioning of cell mitochondria, etc.). These processes involve both estrogens (activation of estrogen receptors leads to modulation of the expression of about 600 genes), and progesterone (activation of progesterone receptors causes modulation of about 1800 genes), and androgens (activation of androgen receptors leads to changes in the expression of about 250 genes) [37] ( Fig. 3).

Rice. 3. Percentage of genes of the main functional categories upon activation of various steroid receptors in women [37]

Activation of vitamin D receptors leads to modulation of the expression of at least 300 genes (according to other sources, up to 2000 genes), which is a reflection of the extreme physiological importance of the constancy of vitamin D balance in the body, since this vitamin, being essentially an active steroid hormone, regulates at least 3% of the human genome, including genes for the insulin receptor, glucose metabolism and steroidogenesis [38-40]. With age, the level of all three sex hormones and vitamin D in representatives of both sexes decreases, which coincides with the onset of the formation and progression of most age-associated diseases, including the urogenital tract [41]. Therefore, previously urologically healthy women with age may manifest various symptoms of dysfunction of the genitourinary system, which were not present at a younger age (stress urinary incontinence, overactive bladder, nocturia, recurrent inflammatory diseases of the bladder, etc.) [42-44 ].

Previously, it was traditionally believed that various urogenital disorders in women are associated only with estrogen deficiency, and in this regard they are classified as medium-term manifestations of the menopausal syndrome, which develop shortly after its early manifestations (hot flashes and vasomotor disorders) [45]. However, this point of view has now been radically revised, and the modern concept of endocrinology in women is that they (like men) require the effects of all three sex hormones, the levels of which gradually decrease with aging [41]. At the same time, the earliest hormonal deficiency in women today is considered to be progesterone deficiency, which can be observed already at the age of 35, and then the level of androgens in women begins to decrease, which leads to an almost twofold decrease by the age of 40 compared to the age of 20 [41 ,46]. Beginning at 40–45 years of age, when most women enter their menopausal transition, and until menopause at an average age of 51 years, women begin to experience a decrease in estrogen synthesis, which manifests itself in various manifestations of estrogen deficiency (menopausal syndrome) [47,48].

Moreover, in each time period, as the synthesis and effects of the corresponding sex hormone decrease, one can observe various clinical manifestations of the lower urinary tract, the anatomy of which in women differs from the male anatomy (short and wide urethra, proximity of the vagina and urethra to a potential source of infection - the anus etc.), therefore, the key factors of natural antibacterial protection in women are the normal biocenosis of the vagina (maintaining an acidic bactericidal pH of vaginal secretions) and the active synthesis by the mucous membranes of the genital and lower urinary tract of various biological secretions with local protective factors (mucin, lysozyme, IgA , IgS, mucopolysaccharides, glycosaminoglycans, etc.), which are generally considered to be hormone-dependent processes [49-51]. This position is confirmed by the fact widely known in classical urogynecology, according to which there is a reliable connection between the frequency and severity of disorders of the hormonal-synthetic function of the ovaries, on the one hand, and disorders of the bladder functions in women, on the other hand [52, 53].

CONCLUSION

In modern conditions of increasing antibiotic resistance of most uropathogens that cause chronic recurrent lower urinary tract infections in women, there remains a very limited number of antimicrobial chemotherapy drugs to effectively solve the problem of CRBC. However, clinical practice shows that even their rational use according to indications does not allow effective sanitation of the bladder in many patients and successfully reducing the frequency of recurrence of CRBC. The role of a microorganism in the pathogenesis of any infectious-inflammatory process is undoubted, but today more attention should be paid to the second side of the interaction within the framework of chronic recurrent infectious inflammation, namely the state of the macroorganism. The female bladder is a hormone-dependent organ, and normal cellular hormone levels appear to be one of the key conditions necessary for all physiological functions of the bladder, including its natural antibacterial function. The modern endocrine-autocrine-paracrine theory of regulation of bladder functions allows us to consider CRBC as a kind of infectious-bacterial “tip of the iceberg” of hormonal bladder disease in women. Timely and effective management of endocrinological mechanisms regulating bladder functions in women can become one of the most effective pharmacotherapeutic options in the treatment and prevention of any lower urinary tract infections in women, including CRBC.

LITERATURE

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Interstitial cystitis (Painful Bladder Syndrome, Sensitive Bladder Syndrome)

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Complications

Symptoms and signs of cystitis

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Acute cystitis

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