Magazine 15 June 2021

Cystitis in Pregnancy

  1. Causes of cystitis in pregnancy
  2. Asymptomatic bacteriuria in pregnancy
  3. Risks
  4. Symptoms
  5. Treatment and prevention
  6. Summary

Dear reader and mom-to-be,

If you are here, it is likely that one or more episodes of cystitis are ruining what should be a magical time for you: pregnancy!
I have written this short guide to help you better understand the phenomenon and dynamics of cystitis in pregnancy.

The urinary tract is a breeding ground for unwanted guests: bacteria.
During pregnancy, their reproduction is very rapid in those areas of the urinary tract that are compressed by the expanding uterus. In fact, the urinary tract under pressure is partially blocked, making the passage of urine difficult, if not impossible. Urine left “trapped” can cause infection.
The combination of urinary tract compression and muscle relaxation caused by the hormonal changes associated with pregnancy make it easier for intestinal bacteria to enter the urinary track and grow more florid.
In 5-10% of cases, the resulting urinary infection is asymptomatic.

 

Causes of Cystitis in Pregnancy

Cystitis is a common phenomenon in pregnancy for a variety of reasons.

  • Physical changes
    Hormonal changes resulting from pregnancy make it easier for pathogens to pass through the urinary tract.
    In fact, the increased production of progesterone causes a reduction in the tonicity of the muscles throughout the urinary tract, slowing urinary flow. This increased progesterone production also increases the amount of glucose, which is a nutrient source for pathogenic bacteria.
    The lower urinary flow along with the aforementioned substances in the urine create the perfect environment for bacteria to reproduce.
  • Gut bacteria
    Bacteria that causes cystitis in pregnancy can come from different areas of the body. The most common invader is E. coli, originating in the intestines. Because the urethra (the channel from which urine comes out) in women is very close to the rectum, these bacteria can easily travel up from the entrance of the urethra into the bladder. This phenomenon in turn causes constipation, a common problem during pregnancy. Irregularity in intestinal transit increases the amount of intestinal bacteria present in the rectal area, increasing the risk of urinary tract infection.
  • Sexual intercourse
    During pregnancy, sexual activity is healthy (unless otherwise indicated by your specialist). However, there is one downside to intercourse: it can lead to the development of episodes of cystitis. In fact, mechanical movements can transfer bacteria close to the vagina into the urethra. To prevent this from happening, it is essential to urinate both before and after sexual intercourse and to rinse the intimate area thoroughly.
  • Group B Streptococcus
    This type of bacteria, commonly found in the intestinal tract, can cause cystitis during pregnancy. The doctor will subject the woman to a test that detects the presence of Streptococcus infections, an essential examination to avoid transmission to the baby during delivery.

There are some risk factors that can increase the onset of cystitis during pregnancy which, if present, it is important to discuss with your gynecologist:

  • A history of recurrent cystitis during a woman’s lifetime.
  • Maternal diabetes.
  • Obesity.
  • Sickle Cell Disease.
  • Previous urinary tract surgery.
  • Damage to the nerves that control the bladder.

Asymptomatic bacteriuria in pregnancy.

asymptomatic bacteriuria is caused by the presence of colonies of pathogenic bacteria in the urinary tract, with the absence of particular symptoms. The term asymptomatic bacteriuria refers, therefore, to the presence of a high number of bacteria in the urine.
Despite the absence of symptoms, this condition should not be underestimated as it is a precursor of the so-called pyelonephritis, an infection of the kidneys.

The only way to diagnose asymptomatic bacteriuria is with a positive urine test.
Usually, already in the early stages of pregnancy it is the doctor’s advice to prescribe a urine culture to identify the presence of any bacteria and their type.

 

Cystitis in Pregnancy: What Are the Risks?

Cystitis is the second most common condition that affects a pregnant woman, after anemia.
When the main symptoms of cystitis are noticed, the infection can be stopped and treated. Sometimes, however, urinary tract infections don’t give off any signals. In the absence of symptoms, they spread easily.

Asymptomatic bacteriuria, if left untreated, can negativelym impact the mother’s well-being and the health of the fetus. Problems at the level of the fetus could develop where the urinary tract infection results in pyelonephritis.
Premature birth and/or an underweight fetus are two of the major complications.

Symptoms of Cystitis in Pregnancy

As already mentioned, cystitis in pregnancy is not always accompanied by the manifestation of symptoms or signs that can alert us to the fact that something is not going well.
However, when present, the most glaring symptoms are:

  • Burning during urination.
  • Turbid urine.
  • Increased frequency of urination.
  • Strong urinary urgency, even for small amounts of urine.
  • Bad smell.
  • Pain in the lower abdomen and lumbar region.
  • Fever.
  • Nausea.
  • Painful sexual intercourse.

Cystitis in Pregnancy: Treatment and Prevention

In order to treat cystitis in pregnancy, it is important to know both the type of bacteria and its root causes. Once you become aware of this information, doctors can easily prescribe you with antibiotics that are suitable to be taken during pregnancy.

There are also natural remedies such as pure d-mannose. It is a naturally extracted sugar whose external conformation is compatible with that of most of the bacteria that cause cystitis, such as Escherichia Coli. This compatibility causes the bacteria to “cling” to the d-mannose, and be excreted via urine. Pure d-mannose is a mild ingredient, making it a suitable treatment for cystitis even during pregnancy.

At the end of the chosen therapy, an additional urine culture can confirm that the bacterial load has indeed decreased. In case of asymptomatic bacteriuria, periodic screening up to delivery can avert the possibility of re-infection.

Prevention of cystitis in pregnancy is essential for the well-being of the mother and the fetus. It is not possible, in fact, to exclude the possibility of being a victim of cystitis, but a few small measures will bring the odds back in favour of the mother and her baby.

Effective strategies to prevent cystitis in pregnancy include the following:

  • Keeping adequately hydrated by drinking at least 8 glasses of water a day.
  • Emptying your bladder whenever you feel the need.
  • Emptying the bladder before and after intercourse.
  • Avoiding vaginal douches, powders and products with artificial fragrances, which could cause irritation in the urethral area, already very vulnerable.
  • Avoiding tight clothing.
  • Preferring cotton underwear. This will help keep your intimate areas dry, as bacteria thrive in moist environments.
  • Eating clean, healthy foods. To keep your resistance to urinary tract infections high, it is important to eat a healthy diet and stay active. As in the normal prevention of cystitis, it is essential to reduce the consumption of refined sugars and carbohydrates, saturated fats, carbonated, sugary or caffeinated drinks, sausages and processed foods. Increasing your fiber intake combats constipation, which is a typical risk factor for cystitis in pregnancy.

If you have further questions, you can contact me on the chat on our Facebook page or via e-mail.

 

A hug,

 

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Summary

  • In gravidanza i cambiamenti ormonali contribuiscono al rilassamento della muscolatura del tratto urinario, rendendolo più suscettibile allo sviluppo di infezioni come la cistite
  • The pressure exerted by the expanding uterus on the bladder makes it difficult to completely empty the urinary tract, increasing the likelihood of pathogen proliferation.
  • In 5-10% of cases of cystitis in pregnancy, this is not accompanied by the manifestation of symptoms. This is asymptomatic bacteriuria
  • Failure to treat asymptomatic bacteriuria could lead to kidney infection and negatively impact the health of the fetus.
  • Periodic screening, through urine culture, is essential throughout the course of pregnancy to track the possible presence of bacteria, especially when there are no symptoms present.
  • Il trattamento della cistite in gravidanza può prevedere l’uso di sostanze completamente naturali e innocue per la salute del feto, come il d-mannosio puro.

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