• Chronic cystitis is called a chronic inflammation that develops in the wall of the bladder.

• It is a clinical syndrome characterized mainly but not only, by a group of symptoms like (pain urinating, ie pain during urination), urinary frequency, urinary urgency, suprapubic pain (pain in the bladder) which can occur together or separately, They vary in intensity, with periods of remissions and exacerbations.

• Causative factors causing inflammation are various infectious microorganisms, the main ones are: Escherichia coli (found at levels above 60%), Proteus, Klebsiella, Enterococci, Streptococci group B, and some experts microorganisms with particular potential sexual transmission than others, such as Chlamydia, Ureoplasma, Mycoplasma, Gardnerella vaginalis. The aforementioned infectious microorganisms, are in several cases simultaneously found and in vaginal fluid’s crops, regardless of whether or not there are symptoms in the vagina, which confirms the close urethral-bladder relation to the vagina and the other genitalia (cervix, uterus, trumpets, etc.) and the need to confront the infection (chronic cystitis) in the urogenital system of women overall.

Figure 1: General representation of the female urogenital system where the close relationship between urinary (urethra – bladder) is shown with the genital tract (vagina – uterus – fallopian tubes).

Enhancers or deterrents for the infections and especially for chronic cystitis.

• Microbes primarily enter the ascending tract (ie. Through the urethra) and are in many cases similar to those kinds of microbial colonies present in the intestine, in the country or perineal and vaginal fluids. To create inflammation the presence only of the microbial agent is not enough, but because of a variety of reasons, microbes suddenly express intense virulence properties that allow the attachment and penetration in areas with easy access to the bladder such as the urethra or the vagina.

• Protective mechanisms against chronic cystitis are:

• The quality of urination, that is a very good urinating where urine leaves no residue, is an important factor which prevents a possible infection. Otherwise, such as when there are dysfunctions of the bladder-urethral mechanism, urethral stricture or urethral prolapse, changing conditions the of urination mechanism are created and infections are favoured.

• The existence of defensive cell lines along the urethra, intercept and capture incoming microorganisms. In cases where we have injuries or inflammations in the urethra, it is understood that the cellular factors are doubtful.

• Also the vaginal pituitary and perineal area have microorganisms such as galaktovakkiloi and acidic microenvironment, as defensive mechanisms, preventing the easy attachment of germs. If there are situations that will change the microenvironment of the vagina or perineal area (such as fungal infections, the use of various antibiotics, drug paraphernalia or other medicines and cases of vaginal atrophy), the resistance is reduced locally and there are conditions created which will favor the infections (such as chronic cystitis).

Figure 2: In the picture above is shown the migration way of bacteria from the intestine and the perineal area to the vaginal cavity and bladder. It is also shown the direct anatomical relationship of the vaginal cavity to the bladder, which justifies the fact that when the one cavity is infected, the infection is quite easily expanded in the other too.

Predisposing factors of chronic cystitis include:

• The length of the female urethra of 4 cm. (Unlike men who are 15 cm.).
• The vaginal contraceptive diaphragms (for younger women).
• Frequent sexual intercourse, especially when not taken precautions.
• Allowing and easy use of antimicrobial drugs which have the side effect of reduction or destruction of the normal flora resulting in changing microenvironment vaginal or perineal area.
• Nutrition with excessive consumption of alcohol and sugary foods.
• Hormonal abnormalities such as the drop in estrogen may lead to changes in the homeostasis of tissues of the vagina, urethra and bladder. The tissues of organs become thinner, weaker and lose the protective layer of the grease that is installed like a dryness. These changes increase the risk of infection or relapse of the inflammation. Also during pregnancy the changes that occur in the urinary tract, increase the proportion of infections (such as chronic cystitis).
• For women with more than two births or women at a slightly older age or after menopause, problems such as urinary incontinence, cystocele, atrophic vaginitis and urinary tract infections from the history, lead to increased installation possibilities of such a disease (such as chronic cystitis).

What one can do to reduce the chances of infection or minimize recurrences:

Perhaps some tips offer a little help, so we’ll mention a few things which are related to some precautionary measures in particular:

• Hygiene . There is no evidence that an inadequate hygiene can lead to inflammation of the bladder. Instead I would say that some women who cleaned with particular thoroughness the area around the anus and the vagina, probably lead to minor injuries in the region, encouraging microbes to dock better in injured skin. Excessive cleaning or vaginal showers bring about changes in the balance of the normal flora of microbes and reduce the layer of protective mucus, so as to allow the bacteria to thrive. A smooth approach to the rules of hygiene, is a gentle daily wash with soap and water and a soft sponge on anal areas, in the perineum and around the vagina, avoiding abrasions in the skin and the mucous membranes by the use of hard sponges or other instruments.

• Cleaning the anus after defecation. A gentle and proper wiping of the anus after the defecation, in the direction opposite to the vagina and urethra is enough, although a gentle wash of the area immediately after the sweep is suggested.

• Sufficient fluid intake. Drinking more liquids on a daily basis to a more frequent urination in the sense that the bladder is cleaned from germs better, is not something that has been proved to be correct and that brings some good results in preventing infection of the bladder. In a few cases, taking on a greater quantity of liquid, is shown to alleviate the symptoms, but in some other highly stringent conditions can simply increase the number of painful urination.

• Urinating after sexual intercourse. A short urination after sexual intercourse may reduce to some extent the likelihood of microbial adhesion to the mucosa of the urethra and bladder.

• Prevention of vaginal dryness. Particularly during the sexual activity, the use of a formulation for the lubrication of the vaginal mucosa, reduces the chances of minor injuries and therefore the transmission and the installation and infectious bacteria.      – Underwear. Cotton underwear which is comfortable and changed daily seems to help. Instead formfitting and tight pants, creates heat, sweating and low ventilation areas of the genitals, which are friendly conditions for the germs.

Conclusively for chronic cystitis:

This disease’s progression occurs as highly disturbing the quality of our everyday life and quite difficult to treat. The detailed assessment (of chronic cystitis) with the necessary clinical and laboratory testing and user experience of the urologist in a significant number of similar situations, makes them a highly treatable disease, with cure rates above 90%. The patient should always follow certain rules such as:

• To know the parameters of the disease, so to follow the instructions under the responsibility of the physician.
• To follow with great attention the dietary changes necessary for ultimate success in treatment.
• The radical treatment of the disease (chronic cystitis) will test in numerous occasions the patience of the patient, particularly if treatment last longer than planned, however, the progressive in one extent relieve of discomfort and the improvement of objective findings in the treatment, should be the weapons of patience and perseverance to the end result.

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