Pulling pains in the lower abdomen, painful and frequent urination, atypical urine color or blood impurities 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 suffer from this pathology at least once in their lives. For men, the probability of contracting cystitis increases after passing the 40-50 year milestone.
types of disease
Cystitis can be of various types. The cause of the development of the disease is divided into infectious and non-infectious.
infectious cystitis
Primary school and high school.In the first case, this is an independent disease - a healthy bladder is affected by infection. In the second, it is a complication of other diseases - the mucous membrane becomes inflamed on the basis of already developed pathology of the urinary system, kidneys or prostate.
Acute and chronic.In the acute form, symptoms are often 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.
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 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.
Postcoital.It develops within 1-2 days after intercourse or vaginal manipulations. Its appearance is due to the entry of pathogenic microflora into the urethra of a woman. During intimate intercourse, under the pressure arising from the movements of the penis, vaginal mucus is expelled 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, the violation of the rules of intimate hygiene, the use of tampons, the 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, the vaginal microflora is thrown into the urethra and the bladder, which have not been exposed to infection so far.
Viral, tuberculous 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 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: no blood is seen in the urine.
Causes
Bladder inflammation 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 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 the 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 a habitat for the main pathogen - Escherichia coli. The causative agents of genital infections in women are found in the uterus and vagina, in men - in the ducts of the urethra and prostate.
Noninfectious 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 its surroundings, in particular the bladder. A high dose of rays can lead to a burn of the mucous membrane of the organ, after which in the future ulcers and fistulas form on its walls;
- chemical burn due to the introduction of drugs into the bladder cavity;
- organ injury with kidney stones;
- exposure to the mucosa of the bladder with hot liquid;
- allergic reaction. Against this background, not only sneezing, nasal congestion, etc. can occur. but also cystitis.
In the case of non-infectious cystitis, secondary infection is usually caused by the vulnerability of the bladder mucosa.
Risk factor's
There are many factors that contribute to the development of cystitis:
- hypothermia;
- decreased immunity;
- hypovitaminosis;
- inadequate nutrition. Spicy, salty, fried, fatty, and alcoholic beverages 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 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;
- transferred operations;
- bladder catheterization;
- take certain medications, such as sulfonamides;
- genetic predisposition;
- pregnancy and childbirth;
- anatomical abnormalities, such as phimosis in children.
cystitis in women
Cystitis is considered by some to be a "female" disease due to the fact that women often get 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 into 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, and the vagina expands. The penetration of the infection is facilitated in such conditions;
- hormonal changes, especially during menopause.
Every tenth woman during pregnancy has an increased risk of developing cystitis. This happens for several reasons. First of all, during pregnancy, the woman'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 compression of the bladder. This causes a deterioration in her blood supply and, as a result, leads to an increased probability 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 strong 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 of age who follow the rules of personal hygiene is extremely small. After exceeding this age limit, in the presence of concomitant diseases, cystitis is diagnosed much more often.
Provoking diseases include prostatitis, prostate adenoma, vesiculitis, urethritis, prostate cancer, etc. They are usually 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 a complication 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 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 usually be asymptomatic.
Symptoms of the acute form of cystitis are:
- High temperature;
- shaking 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 then pain in the lower abdomen;
- sensation 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 can become cloudy or reddish, indicating 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, mild 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, which is 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 respects similar to those of acute cystitis, but less pronounced. The symptoms are permanent, only their intensity changes during treatment.
Diagnostics
Proper diagnosis of cystitis directly affects the success of 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 causal 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 not of an infectious nature, it is necessary to conduct an examination to establish the causes that provoked the appearance of the disease. Perhaps the cause is a urolithiasis or a neoplasm.
Diagnosis of the disease includes the following steps:
- anamnesis collection;
- determination of clinical manifestations;
- appointment of laboratory tests;
- examination using instrumental methods.
Laboratory test for cystitis
- General blood tests. 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;
- General urinalysis. 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 rapid 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 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 esterase enzyme. It accumulates if there is pus present in the urine.
Once the laboratory tests are done, a urine culture is performed, that is, a cultural study is performed. 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 inadequate sampling of the material and non-compliance with hygiene regulations 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 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 recommended to undergo an examination by a gynecologist, diagnose genital infections, undergo ultrasound examination of the small pelvis, biopsy, uroflowmetry and other studies.
In special cases, a 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 medium is injected through the catheter, which straightens the organ to widen the field of vision. The results are visible on the radiograph.
Treatment
Drug therapy is the main treatment for cystitis. There is no universal treatment regimen: 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, fungi - fungicides, for allergies - antihistamines, etc. Acute cystitis involves taking antispasmodics, pain relievers, and nonsteroidal anti-inflammatory drugs. Additional steps are being taken to enhance the patient's immunity.
In acute cystitis, it is important not to stop the course of antibiotic therapy at the time of disappearance of signs of the disease. Such untreated disease often becomes chronic and threatens the general health of a person.
In chronic cystitis, medicinal herbal drugs demonstrate high efficacy. It is useful to take herbal decoctions 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 mucosa of the bladder. Spicy, salty, fried, smoked and pickled foods and dishes are prohibited. The 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. A hearty hot drink is prescribed.
In some cases, surgery is the only treatment for the disease. It is often 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 sexual intercourse or hygiene procedures.
A surgical method for the treatment of cystitis in men is prescribed for the appearance of cicatricial 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, the entire organ is removed.
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, the inflammation spreads further to the kidneys, the uterus and appendages may become inflamed. It also reduces the elasticity of the bladder walls, which can develop scars or ulcers. The 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, since the kidneys do not fully perform their functions. This requires urgent surgical intervention.
A complication of cystitis is also paracystitis, which is characterized by an infection in the tissues of the small pelvis, which are responsible for the innervation of the organs. The injury 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 treatment of cystitis. It consists in holding painful urination, which is associated with disruption 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 somewhat from those in 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 bladder walls. 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 appearance 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, and then bleeding ulcers. For this reason, scars are formed, the elasticity of the tissue 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 can also occur due to 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 wear light clothing in winter;
- eat properly. Spicy, spicy, sour, salty, fried, fatty, pickled foods, it is desirable to exclude or consume them in limited quantities, drinking plenty of water;
- get rid of bad habits: smoking and drinking alcohol;
- drink more liquids (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 of pads and tampons during menstruation, the use of pads being 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;
- 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. ).