Cystitis: diagnosis and treatment

Pulling pains in the lower abdomen, painful and frequent urination, atypical color of urine or blood impurities are the main signs of one of the most common urological diseases - cystitis. It's an inflammation of the bladder.

By itself, cystitis is not dangerous and does not cause difficulties in treatment, but it poses a threat of serious complications.

The disease can occur at any age. Due to the peculiarities of the structure of the genitourinary system, women are more prone to cystitis. According to statistics, about 80% of women have suffered from this pathology at least once in their lives. For men, the likelihood of contracting cystitis increases after reaching the age of 40-50.

Types of diseases

Cystitis can be of several types. The cause of the development of the disease divides it into infectious and non-infectious.

Infectious cystitis

1. Primary and secondary.In the first case, it is an independent disease: a healthy bladder is affected by the infection. In the second case, it is a complication of other diseases: the mucous membrane inflames on the basis of an already developed pathology of the urinary system, kidneys or prostate.

2. Acute and chronic.In the acute form, the symptoms are usually severe. With improper treatment or its absence, the disease becomes chronic, characterized by periods of exacerbation and decline. There are cases when acute cystitis ends in healing after a few days, even without treatment.

3. Depending on the location of the inflammatory focus:

   • cervical - damage to the neck of the bladder;
   • trigonal - inflammation of the triangle of the bladder (the area between the mouth of the ureters and the internal opening of the urethra);
   • total - affects the entire organ. In this case, the course of cystitis is especially serious.

4. Post-coital.It develops within 1-2 days after sexual intercourse or vaginal manipulations. Its appearance is due to the penetration of pathogenic microflora into the urethra of a woman. During intimate intercourse, under the pressure resulting from the movements of the penis, the vaginal mucus is projected into the urethra. From there, the infection freely enters the bladder. Also, the prerequisites for the development of this type of disease are the frequent change of sexual partners, the abuse of contraceptive spermicides, violation of the rules of intimate hygiene, the use of tampons, the wearing of synthetic underwear, etc.

5. "Honeymoon cystitis".It develops after deprivation of virginity against the background of existing violations of the vaginal microflora (candidiasis, etc. ). This happens for a similar reason: during sexual intercourse, the vaginal microflora is thrown into the urethra and the bladder, which until then have not been exposed to infection.

6. Viral, tuberculous and parasitic.These forms of cystitis are very rare.

Non-infectious cystitis

Non-infectious cystitis is not associated with the entry of pathogenic microflora into the bladder. Depending on the cause of the event, it can take forms such as:

• radiation;
• chemical;
• thermal;
• traumatic;
• postoperative;
• allergic.

Separately, there is a classification of cystitis depending on the degree of involvement of the vessels of the bladder mucosa:

• hemorrhagic - accompanied by the presence of blood impurities in the urine (hematuria);
• non-hemorrhagic - blood in the urine is not visualized.

causes

Inflammation of the bladder in most cases (up to 85%) is caused by an infection that enters the organ. Basically, the "provocateurs" of cystitis are Escherichia coli (about 90%), streptococci, staphylococci and other conditionally pathogenic microorganisms. Rarely, the causative agent of the disease is a fungus of the genus Candida or sexually transmitted infections (chlamydia, mycoplasma, ureaplasma, etc. ).

There are two main routes of bladder infection:

• ascending - through the urethra. This is facilitated by poor care of the genitals, poor intimate hygiene, sex life, etc. Pathogenic microorganisms can enter the body during surgery or manipulation of the bladder and urethra, during catheterization, if sterility was not observed;
• descending - from diseased kidneys through the ureters, as well as blood and lymph from the vessels of the rectum and genitals. The large intestine serves as a habitat for the main pathogen - Escherichia coli. The causative agents of genital infections in women are located in the uterus and vagina, in men - in the ducts of the urethra and prostate.

Non-infectious cystitis occurs for the following reasons:

• irradiation of the pelvic organs. During radiotherapy, the radiation affects not only the organ affected by the cancer (uterus, ovaries, prostate, intestines, etc. ), but also nearby, in particular the bladder. A large dose of radiation can lead to burning of the mucous membrane of the organ, after which ulcers and fistulas form on its walls in the future;
• chemical burn due to the introduction of drugs into the cavity of the bladder;
• injury to the organ with kidney stones;
• exposure to the bladder mucosa with hot liquid;
• allergic reaction. In its context, not only sneezing, nasal congestion, etc. , but also cystitis may occur.

In the case of non-infectious cystitis, a secondary infection usually occurs due to the vulnerability of the bladder lining.

Risk factors

Many factors contribute to the development of cystitis:

• hypothermia;
• decreased immunity;
• hypovitaminosis;
• bad nutrition. Spicy, salty, fried, fatty and alcoholic drinks irritate the walls of the bladder and dehydrate the body;
• violation of the microflora of the vagina;
• frequent and prolonged constipation;
• injuries to the bladder mucosa;
• sedentary lifestyle (circulatory disorders);
• tight clothing and synthetic underwear;
• the presence of chronic gynecological, urological or sexually transmitted diseases;
• previous urinary tract infections;
• non-compliance with the rules of personal hygiene;
• improper use of pads and tampons;
• constant lack of sleep, overwork, stress;
• promiscuity and unprotected sex;
• Diabetes;
• hormonal disorders;
• transferred operations;
• bladder catheterization;
• taking certain medications, such as sulfonamides;
• genetic predisposition;
• pregnancy and childbirth;
• anatomical abnormalities, such as phimosis in boys.

cystitis in women

Cystitis is considered by some to be a "feminine" disease because women usually suffer from it. Several factors contribute to this:

• anatomical features of the structure of the genitourinary system. Due to the wide and short urethra, it is easier for pathogenic microflora to enter the bladder. The entrance to the urethra is located near the anus and vagina, so infection can occur during sex.
• lower tone of the lower urinary tract. It is caused by the influence of female sex hormones. This is especially evident during pregnancy, when the body produces progesterone. It relaxes the uterus and nearby organs for the child's safety;
• give birth naturally. In this case, the pelvic muscles lose their elasticity, the ability to contract the bladder sphincter weakens, the vagina expands. The penetration of the infection is facilitated under these conditions;
• hormonal changes, especially during menopause.

Every tenth woman during pregnancy is at an increased risk of developing cystitis. This happens for several reasons. Firstly, during the birth of a child, the immunity of women decreases. The body becomes more vulnerable to any type of infection. Secondly, the general hormonal background changes, which is a signal for the development of inflammatory diseases of the genitourinary system. Third, an increase in the uterus leads to compression of the bladder. This leads to a deterioration of its blood supply and, consequently, an increase in the likelihood of damage by pathogens. Do not forget about the increased synthesis of progesterone, which reduces the tone of the bladder. In the future, congestion and acute development of infection occur.

cystitis in men

The presence of a long and curved urethra in men significantly reduces the risk of bladder infection. The probability of developing cystitis in men under 40-50 years old, who follow the rules of personal hygiene, is extremely low. After passing this age limit, in the presence of concomitant diseases, cystitis is diagnosed much more often.

Provocative diseases include prostatitis, prostate adenoma, vesiculitis, urethritis, prostate cancer, etc. Usually they are accompanied by a stricture of the urethra. As a result, the bladder does not empty completely. Stagnant urine is formed, which serves as a favorable environment for the development of pathogens - pathogens of cystitis.

The disease in men occurs in a more severe form and is accompanied by fever and general intoxication of the body, since cystitis in men develops as complications of other diseases. The chronic form of the disease in men has practically no symptoms.

Cystitis in children

Children of any age are also susceptible to cystitis. Especially often it develops in girls of preschool and school age. Many factors contribute to this. Among them are the weak protective properties of the mucous membrane of the bladder, a wide and short urethra and the absence of estrogen synthesis by the ovaries.

The risk of developing the disease increases if the child has other diseases. This weakens the immune defense and creates favorable conditions for the reproduction of pathogenic microflora.

Symptoms

Depending on the form of the disease, various symptoms may appear. If acute cystitis is characterized by a pronounced clinical picture with painful and frequent urination, chronic cystitis during remission can usually be asymptomatic.

Symptoms of the acute form of cystitis are:

• high temperature;
• chills;
• general weakness;
• difficult and painful urination. Urine comes out in small portions. During the process, there is a burning sensation in the urethra, then pain in the lower abdomen;
• feeling of incomplete emptying of the bladder;
• pain in the suprapubic region before and after urination;
• sharp pain in the bladder area on palpation;
• pain in the external genitalia (scrotum, penis, etc. ).

In some cases, cystitis develops urinary incontinence, caused by a strong urge to urinate.

Urine may become cloudy or reddish, indicating the presence of a large number of bacteria, desquamated epithelium, red blood cells and white blood cells.

With acute cystitis, a picture of general intoxication of the body is likely: elevated body temperature up to 38-40 degrees, sweating, thirst and dry mouth. As a rule, this indicates the spread of infection to the kidneys and renal pelvis, which leads to the development of pyelonephritis. In these conditions, emergency medical care is necessary.

In patients, the manifestation of clinical signs of acute cystitis occurs in different ways. In milder forms of the disease, patients may feel only heaviness in the lower abdomen, mild pain at the end of urination. In some cases, the course of acute cystitis becomes pronounced, a severe inflammatory process develops. Often, experts diagnose phlegmonous or gangrenous cystitis, characterized by fever, intoxication, a sharp decrease in the volume of urine excreted, turbidity of urine and the appearance of a putrid odor.

In chronic cystitis, the clinical signs of the disease are in many respects similar to acute cystitis, but less pronounced. The symptoms are permanent, only their intensity changes during treatment.

Diagnostic

Correct diagnosis of cystitis directly affects the successful treatment of the disease. It is important to establish the nature and factors of inflammation before prescribing treatment. If allergic cystitis occurs, and contact with the allergen is not eliminated before taking antibiotics, the condition will only worsen.

In the case of infectious cystitis, it is necessary to determine its causative agent and establish what antimicrobial or antifungal drugs it is sensitive to. The result of the study will determine the course of further therapy. If the cystitis is non-infectious in nature, then it is necessary to conduct an examination to establish the causes that caused the onset of the disease. Perhaps the cause is urolithiasis or neoplasm.

Diagnosis of the disease includes the following steps:

• history taking;
• determination of clinical manifestations;
• appointment of laboratory tests;
• Examination using instrumental methods.

Laboratory examination for cystitis

1. General blood test. It is carried out to identify signs of nonspecific inflammation, increase the level of leukocytes and immature forms of neutrophils, increase the level of ESR;
2. General urine analysis. It detects the presence of protein in the urine, an increase in the number of white blood cells, red blood cells and bacteria. When leukocytosis is detected, an analysis is prescribed to determine the number of blood cells in the urine sediment and a three-cup sample.

Modern express methods can also be used to diagnose the disease:

• rapid test with an indicator strip. If there is an infection in the urine, a reaction appears on the strip;
• rapid test with strips to obtain data on the content of leukocytes and proteins in urine. The significance of the method is doubtful, since a general urine test can also cope with this task;
• leukocyte esterase reaction. This method allows you to identify the esterase enzyme. It accumulates if pus is present in the urine.

At the end of the laboratory tests, the urine is cultured, that is, a culture study is carried out. Its meaning is as follows: the pathogenic microflora that caused the development of cystitis is studied, and the sensitivity of microbes to antibiotics is determined. Such an examination allows you to prescribe the most effective drugs.

The reliability of the studies often suffers from poor sampling of the material and non-compliance with hygiene rules by the patient.

Instrumental research methods

Among the instrumental methods of diagnosing the disease, the most common is cystoscopy, which involves visualizing the urethra and bladder using a cystoscope. In the case of an acute course of cystitis, the introduction of instruments into the bladder is contraindicated, since the process is extremely painful and contributes to the spread of infection in the organs of the genitourinary system.

Such a procedure is permissible only in case of chronic cystitis, the presence of a foreign body in the bladder or a prolonged course of the disease (10-12 days).

In addition to the above procedures, women with cystitis are advised to undergo examination by a gynecologist, diagnose genital infections, undergo ultrasound of the small pelvis, biopsy, urine flow and other studies.

In special cases, cystography is prescribed. This study allows you to see possible violations and neoplasms on the walls of the bladder. During the procedure, X-rays are used. To obtain more precise results, a contrast agent is injected through the catheter, which straightens the organ to widen the field of vision. The results are visible on the x-ray.

Treatment

Drug therapy is the main treatment for cystitis. There is no universal treatment scheme: the doctor approaches each patient individually depending on the nature of the disease, the degree of its development, etc. If the pathogenic microflora is bacteria, antibiotics are prescribed, the fungus - fungicides, for allergies - antihistamines, etc. Acute cystitis involves taking antispasmodics, analgesics and nonsteroidal anti-inflammatory drugs. Additional measures are taken to improve the patient's immunity.

In acute cystitis, it is important not to stop the course of antibiotic therapy at the time of disappearance of the signs of the disease. Such an untreated disease often becomes chronic, threatening a person's overall health.

In chronic cystitis, herbal drugs show high effectiveness. It is useful to take herbal decoctions that have anti-inflammatory and antibacterial effects. Physiotherapy methods can also be involved: magnetophoresis, electrophoresis, inducto- and hyperthermia, EHF therapy, ultrasound treatment and laser therapy.

Complex therapy of cystitis includes the appointment of a special diet for the patient. It is necessary to eliminate from the diet foods that irritate the bladder mucosa. Spicy, salty, fried, smoked and marinated foods and dishes are prohibited. Food should be as light as possible and provide the body with large amounts of vegetable fiber, necessary for the normal functioning of the intestinal microflora to ensure a high level of immunity. Abundant hot drink is prescribed.

In some cases, surgery is the only treatment for the disease. It is usually resorted to with postcoital cystitis or with a very low location of the external opening of the urethra. In this case, the surgeon moves the urethra slightly above the entrance to the vagina to prevent infection during intercourse or hygiene procedures.

An operative method for the treatment of cystitis in men is prescribed in case of scarring sclerosis, deformation of the neck of the bladder or persistent narrowing of the urethra.

More complex operations are performed for cervical, tuberculous and parasitic cystitis (with the ineffectiveness of drugs). In the case of an advanced form of the disease - gangrenous - the damaged areas of the bladder are removed, and if the gangrene is total, then the whole organ.

Complications

Vesicoureteral reflux is the most dangerous complication. This results in the fact that urine is thrown into the ureters. If the process is not interrupted, the inflammation further spreads to the kidneys, inflammation of the uterus and appendages is possible. It also reduces the elasticity of the walls of the bladder, which can develop scars or ulcers. Spreading the infection further up the kidneys leads to pyelonephritis. In the case of this disease, the amount of urine decreases. Urine accumulates in the kidneys and causes peritonitis, as the kidneys do not fully perform their functions. This requires urgent surgery.

A complication of cystitis is also paracystitis, characterized by infection of the tissues of the small pelvis, responsible for the innervation of the organs. The lesion causes scars, abscesses. In this case, saving the patient's life is possible only with surgical intervention. A complication in the form of cystalgia appears after the treatment of cystitis. It consists of maintaining painful urination, which is associated with a disturbance of the receptors, but which usually passes quite quickly.

Among other complications of the disease with cystitis can be distinguished a decrease in reproductive capacity, urinary incontinence. For pregnant women, untreated cystitis can lead to miscarriage, as the inflammation can spread to the fetus.

In men, the complications of cystitis differ a little from those in women and only in connection with the peculiarities of the structure of the genitourinary system. In both sexes, the gangrenous form of cystitis becomes a complication. This is one of the most complex conditions, it affects the mucous membrane of the walls of the bladder. Purulent processes can lead to necrosis of bladder tissues and their death, perforation of the walls of the bladder or paracystitis is possible. At the same time, urination does not bring relief to the patient.

The occurrence of diffuse ulcerative cystitis and empyema is also a dangerous complication of the pathology. They develop with insufficient therapy for bladder inflammation. At a time when the infection affects the entire mucous membrane of the organ, abscesses form on it, and then bleeding ulcers. Due to this, scars are formed, tissue elasticity is lost. All this leads to a decrease in the volume of the bladder.

Urgent surgery requires empyema, when pus accumulates in the bladder due to decreased outflow. Sphincter dysfunction can also occur due to infectious damage to the mucous membrane of the organ. In this case, urinary incontinence is observed.

Prevention

Cystitis, like any other disease, is better to prevent than to treat. For this, it is recommended:

• avoid hypothermia. You should not sit in the cold, swim in cold water or dress lightly in winter;
• eat properly. Spicy, spicy, sour, salty, fried, fatty, pickled foods, it is desirable to exclude or consume in limited quantities, drinking plenty of water;
• get rid of bad habits - smoking and drinking alcohol;
• drink more liquids (at least 2 liters) - plain water, fruit juices. This allows you to quickly remove pathogenic microorganisms from the bladder, preventing their reproduction;
• do not drink coffee, orange, pineapple and grape juice, as they increase the acidity of urine;
• cure gynecological, urological and venereal diseases;
• normalize the work of the digestive tract;
• observe the rules of personal hygiene;
• timely change of pads and tampons during menstruation, while the use of pads is preferable;
• wear comfortable underwear made from natural fabrics;
• refuse tight clothes, as this disrupts the blood circulation of the pelvic organs;
• prevent overfilling of the bladder;
• when leading a sedentary lifestyle, get up, stretch every hour for at least 5-15 minutes;
• make regular preventive visits to the urologist and gynecologist.

It will also be useful to use herbal decoctions with antiseptic and anti-inflammatory properties (from calendula, chamomile, parsley, etc. ).