Magazine 15 June 2021

Bladder: how do you defend against cystitis?

  1. Internal defenses: the immune system of the urinary tract
  2. The innate immune system in the bladder
  3. The adaptive immune system in the bladder
  4. External defenses: other systems of defense against cystitis


Can the bladder defend itself from bacteria that cause cystitis? Is there an immune system in the bladder? Why does cystitis keep coming back? Perhaps there are not enough barriers to prevent bacteria from passing into the bladder?

It’s no secret. We talk about cystitis all the time, a lot.

In most cases, the formula cystitis stands for burning, pain, and discomfort, whereas antibiotic stands for immediately feeling better.
Isn’t it?

What about the poor bladder?

I can guarantee that many people don’t even know that cystitis is a bladder problem, and it’s a shame.

Today I’m happy to introduce you to the amazing world of the bladder’s internal and external defense mechanisms.

And I’m doing it ESPECIALLY because this way I’ll also be able to answer one of the most popular questions of all time: why does cystitis keep coming back?

P.S: if you don’t have time to waste, you can always contact me right away and tell me about your cystitis.

Let’s get started!

The bladder is constantly exposed to the threat of microorganisms inhabiting the not far away gastrointestinal tract. The urinary tract can resist the potential infection generated by the passage of these microorganisms from the intestine into the bladder.

However, this resistance cannot always be taken for granted, mainly ascribed to the innate immune system. This is that area of the immune system that, when faced with a threat, immediately recognizes a danger and generates a very fast immune response when faced with a threat.

This response, however, is not specific. Therefore, it does not adapt to the type of pathogen threatening our bladder.
In addition, the innate immune system does not develop a memory.

That this is a problem?

Let’s find out right now


Internal defenses: the immune system of the urinary tract

Let’s take a small step back and focus, for a moment, on the urinary tract.

The urinary tract includes the kidneys, ureters, bladder, and urethra: all mostly sterile organs.

Protection from pathogens is operated by:

  1. soluble factors present in urine;
  2. anatomical barriers;
  3. a lining of epithelial cells and other cells of the immune system.

The bladder, specifically, stores urine for considerable time and urine, as we know, is the ideal environment for bacterial reproduction.

It follows that the immune system of the bladder plays a crucial role in hindering the emergence of infections and, therefore, cystitis.


The innate immune system in the bladder

The innate immune system of the bladder, which, as we have said, provides an immediate but “generic” response to hazards, relies on:

  • Epithelial cells

It is the first line of defense against pathogens. These cells encapsulate a large number of soluble compounds, from pro-inflammatory substances to antibacterial agents.

One of the many functions of these compounds is, for example, to inhibit the reproduction of pathogenic bacteria in the urine through the elimination of important growth factors. Or, a substance called uromodulin prevents bacteria from interacting with the inner wall of the bladder while causing them to be aggregate and be excreted through the urine.

GAGs (Glycosaminoglycans), present in free form in urine, have a similar function. They attach themselves to the “paws” of the bacteria and then accompany them on their way out through urination. GAGs are also an integral part of the inner wall of the bladder(urothelium) with the function of making it waterproof.

Given this dual functionality, GAGs have been selected among our Dimann Daily’s main ingredients, because they support the repair of the urothelium after the painful acute phase of bacterial (and not) cystitis.

  • Neutrophils

Neutrophils are the first immune cells to be brought into play in the event of a bacterial infection.

Their fundamental role is to facilitate the reduction of the bacterial load.
The number of neutrophils involved in the battle is directly proportional to the number of bacteria present in the urinary tract.

  • Macrophages

Macrophages reside in the submucosa of the urinary tract. These cells modulate the activity of other immune cells and dictate the timing and intensity of the inflammatory response.
The purpose of macrophages is to ensure the effective removal of bacteria from the urinary tract, minimizing bacterial infection’s harmful inflammation.

  • Mast cells

Mast cells are in the deepest areas of the inner wall of the bladder, near the blood vessels and the lymphatic system.

Mast cells have a pro-inflammatory function at the onset of bacterial infection.

Why would our immune system cause inflammation?

You need to know that inflammation is part of the defense mechanism.
Inflammation causes those symptoms that signal that something is wrong and cause us to take action to fix the problem.

Think about it: how much trouble would we be in if there was no way to realize that our body was fighting a danger?

As the infection progresses, however, mast cells switch to producing inflammatory substances.

In summary, innate immune cells in the bladder provide a rapid and robust immune response.

Warning: here’s the bad news.

Sometimes, the innate immune response is interrupted prematurely, leaving room for residual bacteria to reproduce. This abnormality can potentially lead to the development of recurrent or, at worst, chronic cystitis.

Once the infection becomes more frequent, the architecture and cellular composition of the bladder is substantially affected, predisposing it to further infection.


The adaptive immune system in the bladder

Suppose the innate immune system has a broad-spectrum action in case of infections in the bladder, In that case, the so-called adaptive immune system inexplicably acts in a limited form in our bladder.

As the name suggests, the adaptive immune system adapts its response throughout the infection, improving, as it goes, its knowledge of the pathogen. Unlike the innate immune system, the adaptive immune system develops a memory that will allow, in the future, a more immediate and efficient response against pathogens fought in the past.

This apparent defect in the bladders’s adaptive immune response may be one of the main reasons for the remarkable prevalence of recurrent cystitis.

Science believes that the reason for the limited adaptive immune response in the bladder is due to two main factors:

  1. On the one hand, the need to avoid that every time the bladder stores urine, harmful substances can automatically lead to an activation of the immune system;
  2. The need to facilitate the healing of the inner bladder wall the following infection by limiting inflammation processes.


External defenses: other systems of defense against cystitis

Are there other defense mechanisms against potential bladder infections? Absolutely!

A few aspects might seem disconnected to you but can play a key role in safeguarding your bladder.

If you have already read other articles written by me, you will have noticed that when talking about cystitis, I often refer to the vaginal environment as well.
Pubic hair and female genitalia are the first barriers that bacteria have to pass along their way.

The vaginal environment is typically acidic, ideal for the reproduction of vaginal bacterial flora, but a dangerous condition for pathogenic bacteria that often cannot survive there.

Great, isn’t it? 😉

In addition, to ensure that the vaginal mucous membranes remain a strong and hostile environment for bacterial reproduction, estrogen(female hormones par excellence) is a panacea.
That’s why, with menopause and the sharp drop in estrogen hormones that come with it, susceptibility to cystitis and other intimate infections increases.

Finally him, the intestines.
It is now undoubtedly true that the majority of cystitis results from intestinal problems.
A healthy gut is the best protective barrier to fight cystitis.

Shall we conclude? I want to give you a few tips to boost your outer defenses 😉

  • Choose your intimate cleanser carefully to avoid “changing” our vaginal environment. Prefer detergents that are odorless, free of antibacterial substances and perhaps enriched with lactobacilli. Avoid too frequent intimate hygiene and remember that the vagina is self-cleaning! (Yes, you read that right).
  • Keep your vaginal and intestinal flora healthy by taking probiotics.
    I recommend our Dimann Flor because it is based on lactobacilli specially selected for those who often suffer from cystitis or vaginal infections.
  • If your cystitis keeps coming back and the bacteria responsible is intestinal bacteria, investigate the condition of your intestines with the help of your doctor or a gastroenterologist.
  • Feel free to ask me a question or ask for clarification!


A hug!


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