Cystitis: diagnosis and treatment

Drawing pains in the lower abdomen, painful and frequent urination, atypical color of urine or blood impurities in it are the main signs of one of the most common urological diseases - cystitis. It is 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 suffered from this pathology at least once in their lives. For men, the likelihood of getting cystitis increases after overcoming the milestone of 40-50 years.

Types of disease

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, this 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 in recovery 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 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 sexual intercourse or vaginal manipulations. Its occurrence is due to the ingress of pathogenic microflora into the urethra of a woman. During intimate intercourse, under pressure arising from the movements of the penis, vaginal mucus is thrown into the urethra. From it, 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, wearing 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 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.

Noninfectious cystitis

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

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

Separately, there is a classification of cystitis according to 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, "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 infection to the bladder:

• ascending - through the urethra. This is facilitated by improper care of the genitals, poor intimate hygiene, sexual life, etc. Pathogenic microorganisms can enter the body during surgery or manipulation of the bladder and urethra, during catheterization, if sterility has not been 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 located in the uterus and vagina, in men - in the urethra and prostate ducts.

Non-infectious cystitis occurs for the following reasons:

• irradiation of the pelvic organs. During radiation therapy, radiation affects not only the organ affected by cancer (uterus, ovaries, prostate, intestines, etc. ), but also nearby, 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 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. Against its background, not only sneezing, nasal congestion, etc. , but also cystitis can occur.

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;
• improper 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 of 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 "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 close to 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 evident during pregnancy, when the body produces progesterone. It relaxes the uterus and nearby organs for the safety of the child;
• childbirth in a natural way. In this case, the pelvic muscles lose their elasticity, the ability of the sphincter of the bladder to contract weakens, the vagina expands. The penetration of infection is facilitated under such conditions;
• hormonal changes, especially during menopause.

Every tenth woman during pregnancy is at increased risk of developing cystitis. This happens for several reasons. Firstly, during the bearing of a child, women's immunity decreases. The body becomes more vulnerable to any kind 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 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 a sharp development of infection occur.

cystitis in men

The presence of a long and curved urethra in men significantly reduces the risk of infection in the bladder. The likelihood of developing cystitis in men under 40-50, who follow the rules of personal hygiene, is extremely small. After overcoming 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 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 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 proceeds with virtually 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 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 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, then chronic cystitis during remission can be generally asymptomatic.

Symptoms of the acute form of cystitis are:

• elevated 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 after that - 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, provoked by a strong desire to urinate.

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

In the case of 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. Under these conditions, emergency medical attention is needed.

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 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 it.

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

Proper diagnosis of cystitis directly affects the success of the treatment of the disease. It is important to establish the nature and factors of inflammation before prescribing therapy. 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 which antimicrobial or antifungal drugs it is sensitive to. The result of the study will determine the course of further therapy. If cystitis is non-infectious in 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 using instrumental methods.

Laboratory examination for cystitis

1. General blood analysis. 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 an indicator strip. If there is an infection in the urine, then a reaction appears on the strip;
• rapid test with strips to obtain data on the content of leukocytes and protein in the urine. The importance 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 enzyme esterase. 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.

The reliability of studies often suffers due to improper sampling of material and non-compliance with hygiene rules by the patient.

Instrumental research methods

Among the instrumental methods for diagnosing the disease, the most common is cystoscopy, which consists in 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 with a protracted 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. During the procedure, X-rays are used. To obtain 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 is bacteria, antibiotics are prescribed, the fungus - fungicides, for allergies - antihistamines, etc. Acute cystitis involves taking antispasmodics, analgesics and non-steroidal anti-inflammatory drugs. Additional measures are being 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 signs of the disease. Such an untreated disease often becomes chronic, threatening the overall health of a person.

In chronic cystitis, drugs based on medicinal herbs 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, 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 mucous membrane of the bladder. Spicy, salty, fried, smoked and pickled foods and dishes are prohibited. Food should be as light as possible and deliver large amounts of plant fiber to the body, which is necessary for the normal functioning of the intestinal microflora to ensure a high level of immunity. A plentiful warm drink is prescribed.

In some cases, surgery is the only treatment for the disease. Usually resorted to it 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 for the occurrence of cicatricial sclerosis, deformation of the bladder neck, or persistent narrowing of the urethra.

More complex operations are performed for cervical, tuberculous and parasitic (with the ineffectiveness of medicines) cystitis. 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 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 interrupted, then 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 may develop scars or ulcers. Spread of the infection higher into the kidneys leads to pyelonephritis. In the case of this disease, the amount of urine decreases. Urine accumulates in the kidneys and provokes peritonitis, since the kidneys do not fully perform their functions. This requires urgent surgical intervention.

A complication of cystitis is also paracystitis, characterized by infection on the tissues of the small pelvis, which are responsible for the innervation of organs. The lesion causes scarring, 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 in maintaining painful urination, which is associated with disruption of the receptors, but usually it passes quickly enough.

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

In men, the complications of cystitis differ from women's a little 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 walls of the bladder. 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 inflammation of the bladder. At a time when the infection affects the entire mucous membrane of the organ, abscesses form on it, and later bleeding ulcers. For this reason, scars are formed, tissue elasticity 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. Sphincter dysfunction may 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 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 foods, pickled, 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 fluids (at least 2 liters) - still water, juices. This allows you to quickly remove pathogenic microorganisms from the bladder, preventing their reproduction;
• do not drink coffee, orange, pineapple and grape juices, 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 pads and tampons during menstruation, while the use of pads is preferable;
• wear 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 leading 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. ).