诊断

如果您有膀胱炎的症状,请尽快咨询医生。除了讨论您的体征和症状以及病史之外,您的医生还可能建议您进行某些检查,例如:

  • 尿检。如果医生怀疑是膀胱感染,可能会要求您进行尿液采样以确定您的尿液中是否存在细菌、血液或脓液。如果存在,医生可能会要求进行尿细菌培养。
  • 膀胱镜检查。在这项检查过程中,医生会将一个膀胱镜,也就是一根装有灯和摄像头的细管),经由尿道插入膀胱,以查看尿路是否有疾病迹象。

    医生还可能利用膀胱镜取出一小部分组织样本(活检),进行化验分析。但如果您是第一次出现膀胱炎的体征或症状,很可能不需要进行这项检查。

  • 影像学检查。通常不需要进行影像学检查,但是在某些情况下,尤其是在没有发现感染迹象的情况下,影像学检查可能会有所帮助。例如,X 线或超声波检查可能会帮助您的医生发现膀胱炎症的其他潜在原因,例如肿瘤或结构异常。

治疗

细菌感染引起的膀胱炎一般使用抗生素治疗。非感染性膀胱炎的治疗取决于基础病因。

治疗细菌性膀胱炎

抗生素是细菌性膀胱炎的一线疗法。所用的药物以及用药时长取决于您的总体健康状况和尿液中发现的细菌情况。

  • 首次感染。症状往往可在接受抗生素治疗一天左右得到显著改善。但是,根据感染的严重程度,您可能需要使用抗生素三天到一周。

    无论治疗持续多长时间,都应按医生的处方完成抗生素疗程,以确保感染痊愈。

  • 反复感染。如果您反复出现尿路感染,医生可能会建议长期接受抗生素治疗,或者将您转诊给专门治疗尿路疾病的医生(泌尿科医生或肾病科医生)进行评估,以确定泌尿系统异常是否可能导致这些感染。对于有些女性,性交后服用一剂抗生素可能会有帮助。
  • 医院获得性感染。医院获得性膀胱感染的治疗难度可能很大,因为在医院中发现的细菌往往对用于治疗社区获得性膀胱感染的常见抗生素类型具有耐受性。为此,可能需要不同类型的抗生素和不同的治疗途径。

绝经后的女性可能特别容易患上膀胱炎。作为治疗方案的一部分,医生可能会推荐阴道雌激素软膏,前提是您能够使用这种药物而不会增加其他健康问题的风险。

治疗间质性膀胱炎

对于间质性膀胱炎,导致发炎的原因尚不确定,因此没有哪一种治疗方法对每种情况都产生最佳疗效。用于缓解间质性膀胱炎的体征和症状的疗法包括:

  • 口服或直接置入膀胱的药物
  • 推拿膀胱以改善症状的医疗程序,例如借助水或气体拉伸膀胱(膀胱膨胀)或外科手术
  • 神经刺激,它利用轻微的电脉冲缓解盆腔痛,有时候还可以缓解尿频

治疗其他形式的非感染性膀胱炎

如果您对泡沫剂或杀精剂等产品中的某些化学物质过敏,避免使用这些产品可能有助于缓解症状,并预防膀胱炎再次发作。

对于因化疗或放射疗法的并发症而产生的膀胱炎,治疗重点在于疼痛管理,通常会使用药物和水分冲出膀胱刺激物。

Treating bacterial cystitis

Antibiotics are the first line of treatment for cystitis caused by bacteria. Which drugs are used and for how long depends on your overall health and the bacteria found in the urine.

  • First-time infection. Symptoms often improve a lot within the first few days of taking antibiotics. But you'll likely need to take antibiotics for three days to a week, depending on how severe your infection is.

    Take the pills exactly as directed by your provider. Don't stop the pills early, even if you're feeling better. This helps make sure that the infection is completely gone.

  • Repeat infection. If you have recurrent UTIs, your provider may have you take antibiotics for a longer period of time. You may also be referred to a doctor who specializes in urinary tract disorders (urologist or nephrologist). A specialist can check for any urologic problems that may be causing the infections. In some cases, taking a single dose of an antibiotic after sex may be helpful for repeat infections.
  • Hospital-acquired infection. Hospital-acquired bladder infections can be a challenge to treat. That's because bacteria found in hospitals are often resistant to the common types of antibiotics used to treat community-acquired bladder infections. Different types of antibiotics and different treatment approaches may be needed.

Women who have gone through menopause may be particularly at risk of cystitis. As a part of treatment, your provider may give you a vaginal estrogen cream. But vaginal estrogen is recommended only if you're able to use this medicine without increasing your risk of other health problems.

Treating interstitial cystitis

There's no single treatment that works best for someone with interstitial cystitis. The cause of inflammation is uncertain. To relieve symptoms, you might need medication given as a pill you take by mouth. Medicine can also be placed directly into the bladder through a tube. Or you might have a procedure called nerve stimulation. This uses mild electrical pulses to relieve pelvic pain and urinary frequency.

Surgery is a last resort option, to be considered only when other treatments fail. Surgery might not work to relieve pain and other symptoms.

Treating other forms of noninfectious cystitis

Some people are sensitive to chemicals in products such as bubble bath or spermicide. Avoiding these products may help ease symptoms and prevent more episodes of cystitis. Drinking plenty of fluids also helps to flush out substances that may be irritating the bladder.

For cystitis that develops as a complication of chemotherapy or radiation therapy, treatment focuses on managing pain by taking medicine.

生活方式与家庭疗法

膀胱炎可能令您很痛苦,但您可以采取措施来缓解不适:

  • 使用加热垫。放在您的小腹上的加热垫可以减轻膀胱压力或疼痛的感觉。
  • 保持水分充足。多喝水以保持水分。避免喝咖啡、酒精、含咖啡因和柑橘汁的软饮料以及辛辣食物,直至您的感染消失。这些食品会刺激膀胱,加重尿频或尿急症状。
  • 坐浴泡澡。在温水浴缸中浸泡 15 至 20 分钟(坐浴)有助于缓解疼痛或不适。

对于复发性膀胱感染,与医生合作制定策略,以减少复发和膀胱炎可能导致的不适。

准备您的预约

如果您有膀胱炎常见的体征或症状,请与主诊医生约诊。在初步评估之后,您可能会被转诊给专门治疗尿路疾病的医生(泌尿科医生或肾脏科医生)。

您可以做什么

为就诊做好准备,您需要:

  • 询问是否需要提前做准备,例如收集尿样。
  • 写下您的症状,包括看似与膀胱炎无关的症状。
  • 列出您服用的所有药物、维生素或其他补充剂。
  • 尽可能让家人或朋友陪同就诊。有时可能难以记住医生告知的全部信息,亲戚或朋友可能记住您遗漏或者忘记的内容。
  • 写下要向医生咨询的问题

关于膀胱炎,要向医生咨询的基本问题包括:

  • 导致我的体征和症状的最可能原因是什么?
  • 还有其他可能的原因吗?
  • 我是否需要做任何检查来确认诊断?
  • 您认为可能有哪些因素导致了我患上膀胱炎?
  • 您建议哪种治疗方法?
  • 如果第一种治疗无效,您接下来会推荐哪种治疗?
  • 这种病症是否存在并发症的风险?
  • 病症的复发风险如何?
  • 我可以采取什么措施来降低复发风险?
  • 我应该去看专科医生吗?

除了您准备好的问题外,就诊期间还可以随时提出其他问题。

医生可能做些什么

医生可能会问您一些问题,包括:

  • 您第一次注意到这些症状是什么时候?
  • 您在过去是否接受过膀胱或肾感染治疗?
  • 您的不适感有多严重?
  • 您多久排尿一次?
  • 排尿能否减轻您的症状?
  • 您是否有腰痛状况?
  • 您发热吗?
  • 您是否发现阴道分泌物或尿中带血?
  • 您目前是否有性生活?
  • 您是否采取避孕措施?哪种类型?
  • 您有没有可能已经怀孕?
  • 您是否正在就任何其他医疗状况接受治疗?
  • 您是否使用过导管?
  • 您目前正在服用哪些药物,包括处方药、非处方药以及维生素和补充剂?

What you can do

To prepare for your appointment:

  • Ask if there's anything you need to do in advance, such as collect a urine sample.
  • Write down your symptoms, including any that seem unrelated to cystitis.
  • Make a list of all the medicines, vitamins or other supplements that you take.
  • Take a family member or friend along, if possible. Sometimes it can be hard to remember all the information you're told during an appointment.
  • Write down questions to ask your provider.

For cystitis, basic questions to ask include:

  • What's likely causing my symptoms?
  • Are there any other possible causes?
  • What tests do I need?
  • What treatment approach do you recommend?
  • If the first treatment doesn't work, what will we do next?
  • Am I at risk of complications from this condition?
  • Could this problem happen again?
  • What can I do to prevent this from happening again?
  • Should I see a specialist?

Be sure to ask other questions during your appointment as they occur to you.

What to expect from your doctor

Your provider is likely to ask you a number of questions, such as:

  • When did you first notice symptoms?
  • Have you been treated for a bladder or kidney infection in the past?
  • How much pain are you in?
  • How often do you use the bathroom?
  • Do you feel better after urinating?
  • Do you have low back pain?
  • Have you had a fever?
  • Have you noticed vaginal discharge or blood in your urine?
  • Are you sexually active?
  • Do you use birth control? What kind?
  • Could you be pregnant?
  • Are you being treated for any other medical conditions?
  • Have you ever used a catheter?
  • What medicines, vitamins or supplements do you take?