Bacterial cystitis: where do germs come from?

A frequently asked question when we talk about recurrent bacterial cystitis and even more so when the urine test reveals different germs or, on the contrary, always the same bacteria, is: “How can I catch them?”. This question is further legitimized by the fact that, most of the time, bacteria identified with the urine test originate in the intestine, suggesting a “self-contamination”.

This article proposes to dissect the different modes of bladder infection which are three:

1. ascending cystitis

The commensal germs of the digestive tract permanently colonize the perineum in a physiological and more intense way (they are more numerous and varied) after the evacuation.

This perineal presence is normally regulated thanks to:

– a “safe distance” between the anus and the urinary meatus (several cm, a very large distance to be covered by bacteria with a size of a few micrometers)

– the presence of a balanced and competent vulvovaginal flora that intervenes and is responsible for “blocking” bacteria that may try to reach the urinary meatus

– an intimate toilet not too aggressive after defecating to eliminate potentially pathogenic germs (peri-anal washing with adapted intimate care + abundant rinsing)

– another intimate toilet equally delicate for the external genitals in certain circumstances (menopause, chronic urogynecological disorders, after intercourse, etc.)

Regarding this last point of prevention, it is important to understand that a simple cleaning or “rinsing” (because the use of water alone cannot be classified as “washing”) of the perineal area after defecating is insufficient. In fact, cleaning the feces with toilet paper does not eliminate bacteria that massively colonize the perineum at the time of defecation. This is the reason why it is necessary to use, on this occasion, an adequate intimate soap to wash the perineum and eliminate the excess of bacteria produced during the expulsion of feces.

This intimate toilet, after defecation, is not “culturally” part of the hygiene habits of most countries (for example, those without bidets); however, it is still a “good” habit that it would be advisable to teach all children (especially little girls) for optimal prevention of urogenital infections.

Similarly, vulva and external genitals “rinsing” is usually sufficient for a no menopausal woman without specific uro-gynecological disorders, but becomes insufficient in case of uro-genital problem (in this case, it is necessary a specific intimate toilet).

When the germs manage to pass these “defense lines”, they reach the urinary meatus and then arrive to the bladder -> this is what it is called ascending cystitis.

Therefore, it should be noted that this typology of cystitis only happens in the presence of certain predisposing and/or precipitating factors:

– modified anatomy of perineum (for example, after a complicated delivery, an episiotomy, etc.)

– vulvovaginal atrophy (menopause)

– vulvovaginal dryness (contraception, menstrual cycle, premenopause or menopause)

– vaginal dysbiosis

– recent and/or repetitive use of antibiotics

– inadequate intimate hygiene

– sexual intercourse

– very tight clothing

– synthetic underwear, thongs

– excessive friction, prolonged sitting position

2. migration cystitis

In some cases, the lining of the intestine (colon) has a porosity (permeability). In other words, the junctions between the cells that make up the intestinal lining widen, creating enough “cracks” (we’re talking about a few micrometers here) for bacteria that physiologically colonize the intestine to come out and contaminate the bladder – > in this case, we talk about migration cystitis.

It is important to specify that this intestinal permeability is often (more than half of the cases) caused by inflammation of the digestive system (particularly the colon). So it is advisable to look for its origin:

– food imbalance

– alimentary intolerance

– transtit disorders

– certain medications intake

– laxative abuse

– insufficient physical activity

– insufficient hydration

Identifying the “root” of the problem is the key to implement all the measures to solve it -> resolution of porosity = migration stopping = no cystitis

3. cystitis and biofilm

In this case, the infection is not due to the “entry” of germs into the bladder but to the “release” of bacterial colonies by a deposit that is already present in the bladder.

Several articles in this blog investigate about biofilm.

Of course, depending on the type of urinary tract contamination responsible for cystitis (when identifiable), which can be one or multiple and differ from one subject to another, the preventive care strategy varies to best adapt to the need to cope with a bacterial attack:

– ascending cystitis

– migration cystitis

– biofilm and cystitis

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