Drawing pains in the lower abdomen, painful and frequent urination, atypical color of urine or impurities in the blood 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 does pose 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 getting cystitis increases after passing the 40-50 year milestone.
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
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.
Acute and chronic.In the acute form, symptoms are usually severe. With inadequate treatment or its absence, the disease becomes chronic, characterized by periods of exacerbation and decline. There are cases where acute cystitis ends in recovery after a few days even without treatment.
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 inner opening of the urethra);
- total - affects the entire organ. In this case, the course of cystitis is especially severe.
Post-coital.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 sexual intercourse, under pressure from penile movements, vaginal mucus is released into the urethra. From it, the infection freely enters the bladder. In addition, the prerequisites for the development of this type of disease are frequent change of sexual partners, abuse of contraceptive spermicides, violation of intimate hygiene rules, use of tampons, use of synthetic underwear, etc.
"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, vaginal microflora is released into the urethra and bladder, which until then have not been exposed to infection.
Virals, tuberculosis and parasites.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 occurrence, it can take on forms such 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
Bladder inflammation in most cases (up to 85%) is caused by an infection entering 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 infection to the bladder:
- ascending - through the urethra. This is facilitated by inadequate 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 is 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 located in the uterus and vagina, in men - in the urethra and prostate ducts.
Non-infectious cystitis occurs for the following reasons:
- irradiation of Organs pelvic organs. During radiotherapy, radiation affects not only the organ affected by the cancer (uterus, ovaries, prostate, intestines, etc. ), but also nearby, in particular, the bladder. A high dose of lightning 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 bladder cavity;
- organ damage with kidney stones;
- exposure of the bladder mucosa to hot liquid;
- allergic reaction. In this context, not just sneezing, nasal congestion, etc. , but also cystitis may 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;
- inadequate nutrition. Spicy, salty, fried, greasy and alcoholic drinks irritate the bladder walls and dehydrate the body;
- violation of the microflora of the vagina;
- frequent and prolonged constipation;
- bladder mucosal lesions;
- 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 personal hygiene rules;
- misuse of absorbents 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 often 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 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. Relaxes the uterus and nearby organs for the safety of the child;
- I give birth naturally. In this case, the pelvic muscles lose their elasticity, the ability of the bladder sphincter to contract weakens, the vagina expands. Infection penetration is facilitated under these conditions;
- hormonal changes, especially during menopause.
Every tenth woman during pregnancy is at a higher risk of developing cystitis. This happens for several reasons. Firstly, during childbirth, women's immunity decreases. The body is more vulnerable to any kind of infection. Secondly, the general hormonal background changes, which is a sign for the development of inflammatory diseases of the genitourinary system. Thirdly, an increase in the uterus leads to bladder compression. This causes a deterioration in your blood supply and, as a result, leads to an increased likelihood of damage from pathogens. Don't forget about increased progesterone synthesis, which reduces bladder tone. In the future, congestion and a strong development of infection occur.
cystitis in men
The presence of a long, 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 small. After surpassing 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. 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 - cystitis pathogens.
The disease in men occurs more severely and is accompanied by fever and general intoxication of the body, as cystitis in men develops as complications of other diseases. The chronic form of the disease at men proceeds practically without 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 illnesses. 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 may be usually asymptomatic.
Symptoms of the acute form of cystitis are:
- elevated temperature;
- goosebumps;
- 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 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, brought on by a strong urge to urinate.
Urine may be cloudy or reddish, which indicates the presence of a large number of bacteria, squamous epithelium, red blood cells, and white blood cells.
In the case of acute cystitis, a 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 the infection to the kidneys and renal pelvis, which leads to the development of pyelonephritis. Under these conditions, emergency medical attention is required.
In patients, the manifestation of clinical signs in 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 process of inflammation develops. Specialists often diagnose phlegmonous or gangrenous cystitis, which is characterized by fever, intoxication, a marked decrease in the volume of urine excreted, turbidity of the urine, and the appearance of a putrid odor.
In chronic cystitis, the clinical signs of the disease are in many ways similar to those of acute cystitis, but less pronounced. Symptoms are permanent, only their intensity changes during treatment.
Diagnosis
Proper diagnosis of cystitis directly affects the success of disease treatment. 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 get worse.
In the case of infectious cystitis, it is necessary to determine its causative agent and establish which antimicrobials or antifungals it is sensitive to. The outcome of the study will determine the course of further therapy. If the cystitis is of a non-infectious nature, it is necessary to carry out an examination to establish the causes that provoked the appearance of the disease. Perhaps the cause is urolithiasis or a neoplasm.
Diagnosis of the disease includes the following steps:
- anamnesis collection;
- determination of clinical manifestations;
- scheduling laboratory tests;
- examination using instrumental methods.
Laboratory test for cystitis
- General blood analysis. It is performed to identify signs of non-specific inflammation, increase the level of leukocytes and immature forms of neutrophils, increase the level of ESR;
- 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 that determines the number of blood cells in the urinary sediment and a three-cup sample is prescribed.
Modern express methods can also be used to diagnose the disease:
- quick test with an indicator strip. If there is an infection in the urine, a reaction will appear on the strip;
- rapid strip test to obtain data on the content of leukocytes and proteins in the urine. The importance of the method is doubtful, as a general urinalysis can also handle this task;
- leukocyte esterase reaction. This method makes it possible to identify the esterase enzyme. It accumulates if there is pus in the urine.
After the completion of the laboratory tests, the 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. This exam allows you to prescribe the most effective drugs.
The reliability of studies often suffers due to inadequate 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 of visualizing the urethra and bladder through a cystoscope. In the case of an acute course of cystitis, the introduction of instruments into the bladder is contraindicated, as 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, 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 have an examination by a gynecologist, diagnose genital infections, have 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 in the walls of the bladder. During the procedure, X-rays are used. For more accurate results, a contrast agent is injected through the catheter, which straightens the organ to widen the field of view. Results are visible on 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 a bacterium, then antibiotics are prescribed, the fungus - fungicides, for allergies - antihistamines, etc. Acute cystitis involves the use of 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 interrupt the course of antibiotic therapy when signs of the disease disappear. Such an untreated disease often becomes chronic, threatening a person's overall health.
In chronic cystitis, medicines based on medicinal herbs show high efficiency. It is useful to take decoctions of herbs that have anti-inflammatory and antibacterial effects. Physiotherapy methods may also be involved: magnetophoresis, electrophoresis, induction 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 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 plentiful hot drink is prescribed.
In some cases, surgery is the only treatment for the condition. Usually resorted to him with post-coital cystitis or with a very low location of the external opening of the urethra. In this case, the surgeon moves the urethra just above the entrance to the vagina to prevent infection during intercourse or hygiene procedures.
A surgical method for the treatment of cystitis in men is prescribed for the occurrence of scarring sclerosis, deformation of the bladder neck or persistent narrowing of the urethra.
More complex operations are carried out 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, the entire organ is removed.
complications
Vesicoureteral reflux is the most dangerous complication. It is expressed in the fact that urine is released 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. Spread of the infection to 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 surgical intervention.
A complication of cystitis is also paracystitis, characterized by infection in the tissues of the small pelvis, responsible for the innervation of the organs. The injury causes scarring, abscesses. In this case, saving the patient's life is only possible with surgical intervention. A complication in the form of cystalgia appears after treatment of cystitis. It consists of maintaining the pain when urinating, which is associated with the rupture of the 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, the complications of cystitis differ slightly from women, and only in relation to 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 bladder tissues 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. By the time the infection affects the entire mucous membrane of the organ, abscesses and, later, bleeding ulcers form. For this reason, scars are formed, tissue elasticity is lost. All this leads to a decrease in bladder volume.
Urgent surgical intervention requires empyema, when pus accumulates in the bladder due to decreased outflow. Sphincter dysfunction 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 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 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 the 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, with the use of pads being preferred;
- wear comfortable underwear made of natural fabrics;
- refuse tight clothes, as it interrupts the blood circulation of Organs pelvic organs;
- avoid overfilling the bladder;
- when leading a sedentary lifestyle, get up, stretch every hour for at least 5 to 15 minutes;
- carry out regular preventive visits to the urologist and gynecologist.
It will also be useful to use decoctions of herbs with antiseptic and anti-inflammatory properties (from calendula, chamomile, parsley, etc. ).