Cystitis: diagnosis and treatment

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

In 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 life. For men, the likelihood of contracting cystitis increases after passing the 40-50 year mark.

Types of diseases

Cystitis can be of different 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, it is a complication of other diseases: the mucous membrane becomes inflamed 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 with recovery after a few days, even without treatment.

3. Depending on the location of the inflammatory focus:

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

4. Postcoital.It develops within 1-2 days after intercourse or vaginal manipulations. Its presence is due to the entry of pathogenic microflora into a woman's urethra. During intercourse, under the pressure resulting from the movements of the penis, the vaginal mucus is thrown into the urethra. From it, the infection freely enters the bladder. In addition, the prerequisites for the development of this type of disease are the frequent change of sexual partners, the abuse of contraceptive spermicides, the violation of the rules of intimate hygiene, the use of tampons, the use of synthetic underwear, etc. .

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

6. Viral, tuberculosis and parasitic.Such 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;
• chemist;
• thermal;
• traumatic;
• postoperative;
• allergic.

Separately, there is a classification of cystitis based 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-haemorrhagic: blood in the urine is not displayed.

Causes

Inflammation of the bladder in most cases (up to 85%) is caused by an infection that penetrates 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 improper 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 with blood and lymph from the vessels of the rectum and genital organs. The large intestine serves as the habitat of the main pathogen - Escherichia coli. The causative agents of genital infections in women are found in the uterus and vagina, in men - in the urethra and prostatic ducts.

Non-infectious cystitis occurs for the following reasons:

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

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

Risk factors

There are many factors that contribute to the development of cystitis:

• hypothermia;
• decreased immunity;
• hypovitaminosis;
• incorrect nutrition. Spiced, salty, fried, fatty and alcoholic drinks irritate the bladder walls and dehydrate the body;
• violation of the microflora of the vagina;
• frequent and prolonged constipation;
• lesions of the bladder mucosa;
• sedentary lifestyle (circulatory disorders);
• tight-fitting 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 sanitary pads and tampons;
• constant lack of sleep, overwork, stress;
• promiscuity and unprotected sex;
• diabetes;
• hormonal disorders;
• transactions transferred;
• 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 "female" disease due to the fact that 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 penetrate the bladder. The entrance to the urethra is located near the anus and vagina, so infection can occur during intercourse;
• lower tone of the lower urinary tract. It is caused by the influence of female sex hormones. This is especially noticeable during pregnancy when the body produces progesterone. Relax the uterus and nearby organs for the safety of the baby;
• I give birth in a natural way. In this case, the pelvic muscles lose their elasticity, the ability of the bladder sphincter to contract is weakened, the vagina expands. The penetration of the infection is facilitated in such conditions;
• hormonal changes, especially during menopause.

Every tenth woman during pregnancy is at an increased risk of developing cystitis. This happens for several reasons. First, during childbirth, women's immunity 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. Thirdly, an increase in the uterus leads to squeezing of the bladder. This causes a deterioration in its blood supply and, as a result, leads to an increased likelihood of damage from pathogens. Do not forget the increase in the synthesis of progesterone, which reduces the tone of the bladder. Congestion and a strong development of infection occur in the future.

cystitis in men

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

Provocative diseases include prostatitis, prostate adenoma, vesiculitis, urethritis, prostate cancer, etc. They are usually accompanied by a narrowing 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 manifests itself 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 proceeds practically without symptoms.

Cystitis in children

Children of any age are also susceptible to cystitis. Especially it develops in preschool and school age girls. 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 lack of estrogen synthesis by the ovaries.

The risk of developing the disease increases if the child is sick with other diseases. This weakens the immune defenses 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. In the process, there is a burning sensation in the urethra and, subsequently, pain in the lower abdomen;
• feeling of incomplete emptying of the bladder;
• pain in the suprapubic region both 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 desire to urinate.

The urine may become cloudy or reddish, which indicates the presence of a large number of bacteria, desquamated epithelium, red blood cells and white blood cells in it.

In the case of acute cystitis, a picture of general intoxication of the body is likely: high 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 required.

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

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

Diagnostics

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

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

Diagnosis of the disease includes the following steps:

• collection of anamnesis;
• determination of clinical manifestations;
• appointment of laboratory tests;
• examination with instrumental methods.

Laboratory examination for cystitis

1. General blood test. It is carried out to identify signs of non-specific 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 that determines 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 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 the urine. The importance of the method is doubtful, since even a general urine test can cope with this task;
• leukocyte esterase reaction. This method allows to identify the esterase enzyme. It accumulates if pus is present in the urine.

Upon completion of laboratory tests, urine is cultured, that is, a cultural study is carried out. Its meaning is as follows: the pathogenic microflora that provoked 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.

Reliability of studies often suffers from improper sampling of the material and failure of the patient to comply with hygiene rules.

Instrumental research methods

Among the instrumental methods for diagnosing the disease, the most common is cystoscopy, which consists of viewing the urethra and bladder using a cystoscope. In the case of an acute course of cystitis, the introduction of tools 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 allowed only in case of chronic cystitis, the presence of a foreign body in the bladder or with a prolonged course of the disease (10-12 days).

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

In special cases, cystography is prescribed. This study allows you to see any violations and neoplasms on the walls of the bladder. X-rays are used during the procedure. For more accurate results, a contrast agent is injected through the catheter, which straightens the organ to expand the field of view. The results are visible on the x-ray.

Treatment

Drug therapy is the main treatment for cystitis. There is no universal treatment regimen: the doctor approaches each patient individually based on the nature of the disease, the degree of its development, etc. If the pathogenic microflora consists of bacteria, then antibiotics, fungi - fungicides, allergies - antihistamines, etc. are prescribed. Acute cystitis involves taking antispasmodics, analgesics, and non-steroidal anti-inflammatory drugs. Additional measures were 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 the disappearance of the signs of the disease. Such an untreated disease often becomes chronic, threatening a person's overall health.

In chronic cystitis, medicinal herbal drugs demonstrate high efficiency. It is useful to take herbal decoctions that have anti-inflammatory and antibacterial effects. Physiotherapy methods may also be involved: magnetophoresis, electrophoresis, induced 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 the foods that irritate the mucous membrane of the bladder. Spicy, salty, fried, smoked and pickled foods and dishes are prohibited. Food should be as light as possible and provide the body with large amounts of plant fiber, which is necessary for the normal functioning of the intestinal microflora to ensure a high level of immunity. A copious hot drink is prescribed.

In some cases, surgery is the only treatment for the disease. Usually it was used with postcoital cystitis or with a very low position 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 bladder neck 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 - gangrene - the damaged areas of the bladder are removed, and if the gangrene is total, the entire organ.

Complications

Vesicoureteral reflux is the most dangerous complication. It is expressed in the fact that urine is thrown into the ureters. If the process is not stopped, the inflammation spreads further to the kidneys, inflammation of the uterus and appendages is possible. It also reduces the elasticity of the bladder walls, 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 the infection of the tissues of the small pelvis, which are responsible for innervation of the organs. The lesion causes scars, abscesses. In this case, saving the patient's life is possible only with surgery. A complication in the form of cystalgia appears after the treatment of cystitis. It consists in maintaining painful urination, which is associated with the disruption of receptors, but usually passes quickly enough.

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

In men, complications of cystitis differ slightly from female ones 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. It is one of the most complex conditions, it affects the mucous membrane of the bladder walls. Purulent processes can lead to necrosis of the tissues of the bladder and their death, perforation of the bladder walls or paracystitis is possible. At the same time, urination does not bring relief to the patient.

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

Urgent surgical intervention requires empyema, when pus accumulates in the bladder due to a decrease in outflow. Dysfunction of the sphincter can also occur due to an infectious lesion of the mucous membrane of the organ. In this case, urinary incontinence is observed.

Prevention

Cystitis, like any other disease, is better safe than sorry. For this we recommend:

• avoid hypothermia. You shouldn't sit in the cold, swim in cold water, or dress lightly in winter;
• eat properly. Spicy, spicy, acidic, salty, fried, fatty, pickled foods, it is advisable to exclude or consume in limited quantities, drinking plenty of water;
• get rid of bad habits: smoking and drinking alcohol;
• drink more fluids (at least 2 liters) - plain water, juices. This allows you to quickly remove pathogenic microorganisms from the bladder, preventing its reproduction;
• do not drink coffee, orange, pineapple and grape juices, as they increase the acidity of the urine;
• treat gynecological, urological and venereal diseases;
• normalize the work of the digestive tract;
• observe the rules of personal hygiene;
• promptly change sanitary pads and tampons during menstruation, while the use of sanitary pads is preferable;
• wearing comfortable underwear made from natural fabrics;
• refuse tight clothing, as it disrupts the blood circulation of the pelvic organs;
• prevent overfilling of the bladder;
• when you lead a sedentary lifestyle, get up, stretch every hour for at least 5-15 minutes;
• carry out 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. ).