Cystitis: Diagnosis and Treatment

Lower abdominal pain, painful and frequent urination, atypical urine color or blood impurities are the main symptoms of one of the most common urinary disorders - cystitis. This is inflammation of the bladder.

Cystitis itself is not dangerous or difficult to treat, but it poses the threat of serious complications.

The disease can occur at any age. Women are more prone to cystitis due to the peculiarities of the genitourinary system. According to statistics, about 80% of women suffer from this pathology at least once in their lifetime. For men, the likelihood of developing cystitis increases after overcoming the 40-50 milestone.

disease type

Cystitis can be of several types. The reasons for the development of the disease divide it into infectious and non-infectious.

Infectious cystitis

1. primary and secondary.In the first case, it's an independent disease: the healthy bladder is affected by the infection. Secondly, it is a complication of other diseases: inflammation of the mucous membranes on the basis of already developed pathologies of the urinary system, kidneys or prostate.

2. acute and chronic.In the acute form, symptoms are usually severe. If not treated properly or untreated, the disease can become chronic, characterized by periods of exacerbation and decline. In some cases, acute cystitis returns after a few days, even without treatment.

3. Depending on the location of the inflammatory foci:

   • cervical spine - damage to the neck of the bladder;
   • Trigone - inflammation of the trigone of the bladder (the area between the orifice of the ureter and the opening inside the urethra);
   • Total - affects the entire organ. In this case, the course of cystitis is particularly severe.

4. after sex.It develops within 1-2 days after intercourse or vaginal manipulation. It occurs due to the entry of pathogenic flora into a woman's urethra. During intimate intercourse, vaginal mucus is thrown into the urethra under pressure from penis movement. From there, the infection moves freely into the bladder. In addition, the preconditions for the occurrence of such diseases are frequent sexual partners, abuse of contraceptives, violation of intimate hygiene rules, use of tampons, wearing synthetic underwear, etc.

5. "Honeymoon Cystitis".It develops after deprivation of virginity in the context of an existing violation of the vaginal microflora (candidiasis, etc. ). This happens for a similar reason: During intercourse, vaginal flora is thrown into the urethra and bladder and has not been infected until then.

6. Viruses, tuberculosis and parasites.This form of cystitis is very rare.

noninfectious cystitis

Noninfectious cystitis is not associated with the entry of pathogenic bacteria into the bladder. Depending on why it happens, it can take the following forms:

• radiation;
• Chemical;
• hot;
• traumatic;
• postoperative;
• allergy.

In addition, according to the degree of involvement of the vessels of the bladder mucosa, cystitis has a classification:

• Hemorrhagic - accompanied by the presence of blood impurities in the urine (hematuria);
• Nonhemorrhagic - no blood is visible in the urine.

reason

In most cases (up to 85%) bladder inflammation is caused by infection that enters the organ. Basically, the "provocateurs" of cystitis are Escherichia coli (about 90%), Streptococcus, Staphylococcus, and other opportunistically pathogenic microorganisms. Rarely, the disease is caused by Candida fungi or sexually transmitted infections (Chlamydia, Mycoplasma, Ureaplasma urealyticum, etc. ).

There are two main routes of bladder infection:

• Ascent - through the urethra. Improper genital care, poor intimate hygiene, sex, etc. can all contribute to this happening. If sterility is not observed, pathogenic microorganisms can enter the body during catheterization during surgery or procedures of the bladder and urethra;
• Descent - from the diseased kidneys through the ureters, and blood and lymph from the blood vessels of the rectum and reproductive organs. The large intestine is the habitat of the main pathogen, Escherichia coli. The causative agent of female genital infection is located in the uterus and vagina, in males - in the urethra and prostate duct.

Noninfectious cystitis occurs because of the following:

• Irradiation of pelvic organs. During radiation therapy, radiation affects not only the organs affected by the cancer (uterus, ovaries, prostate, bowel, etc. ) but also nearby organs, especially the bladder. High doses of radiation can cause burns to the mucous membranes of the organs, which can then cause ulcers and fistulas to form in their walls;
• chemical burns due to the introduction of drugs into the bladder cavity;
• Damage to organs from kidney stones;
• contacting the bladder mucosa with hot liquids;
• Allergic reaction. In its background, not only sneezing, nasal congestion, etc. , but also cystitis occurs.

In the case of noninfectious cystitis, secondary infection usually occurs due to the fragility of the bladder mucosa.

risk factor

There are many factors that can cause cystitis:

• low temperature;
• decrease in immunity;
• vitamin deficiency;
• Improper nutrition. Spicy, salty, fried, fatty and alcoholic beverages can irritate the bladder wall and dehydrate the body;
• Violation of vaginal microflora;
• frequent and prolonged constipation;
• Bladder mucosa injury;
• a sedentary lifestyle (circulatory disturbance);
• tight clothing and synthetic underwear;
• Presence of chronic gynecological, urinary or sexually transmitted diseases;
• previous urinary tract infection;
• Failure to observe personal hygiene regulations;
• Improper use of sanitary napkins and tampons;
• Persistent lack of sleep, overwork, stress;
• Promiscuity and unprotected sex;
• diabetes;
• hormone imbalance;
• transfer business;
• bladder catheterization;
• taking certain medicines, such as sulfonamides;
• genetic susceptibility;
• pregnancy and childbirth;
• Anatomical abnormalities such as phimosis in boys.

Cystitis in women

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

• Anatomical features of the structures of the urogenital system. Because the urethra is wide and short, pathogenic bacteria are more likely to invade the bladder. The opening of the urethra is close to the anus and vagina, and is prone to infection during sexual intercourse;
• Lower urinary tract pitch is low. It is caused by the influence of female sex hormones. This is especially noticeable during pregnancy, when the body produces progesterone. It relaxes the uterus and nearby organs for the safety of the child;
• Birth naturally. In this condition, the pelvic muscles lose their elasticity, the bladder sphincter is less able to contract, and the vagina dilates. In this case, the penetration of the infection is favored;
• Hormonal changes, especially during menopause.

The risk of cystitis increases for every 1 in 10 women during pregnancy. This happens for several reasons. First, during reproductive years, a woman's immunity declines. The body becomes more susceptible to any type of infection. Second, changes in the general hormonal background signal the development of inflammatory diseases of the genitourinary system. Third, the enlarged uterus causes pressure on the bladder. This can cause their blood supply to deteriorate, leading to an increased likelihood of pathogen damage. Don't forget to increase the synthesis of progesterone, which reduces the tone of the bladder. In the future, there will be a dramatic development of congestion and infections.

male cystitis

A long, curved urethra in men can significantly reduce the risk of bladder infections. Men under the age of 40-50 who follow personal hygiene rules are extremely unlikely to develop cystitis. Beyond this age limit, cystitis is diagnosed at a much higher rate in the presence of concomitant diseases.

Induced diseases include prostatitis, prostate adenoma, seminal vesiculitis, urethritis, prostate cancer, etc. Often they are accompanied by narrowing of the urethra. As a result, the bladder is not completely emptied. Stagnant urine is formed, which provides a favorable environment for the development of pathogens - pathogens of cystitis.

The disease in men occurs in a more severe form with fever and systemic intoxication, because cystitis in men is a complication of other diseases. Chronic diseases in men are almost asymptomatic.

Cystitis in children

Children of any age are also prone to cystitis. Especially it often develops in preschool and school-age girls. Many factors contributed to this. These include the weak protective properties of the bladder mucosa, a wide and short urethra, and a lack of estrogen synthesis in the ovaries.

The risk of developing this disorder increases if the child has other medical conditions. This weakens immune defenses, creating favorable conditions for the proliferation of pathogenic flora.

symptom

Depending on the form of the disease, various symptoms may appear. Chronic cystitis in remission can often be asymptomatic if acute cystitis is characterized by overt clinical manifestations with pain and frequent urination.

The symptoms of acute cystitis are:

• temperature rise;
• chills;
• general weakness;
• Difficulty and pain in urination. Urine is excreted in small portions. During this process, there is a burning sensation in the urethra, then - pain in the lower abdomen;
• A feeling of incomplete emptying of the bladder;
• pain in the suprapubic area before and after urination;
• severe pain in the bladder area on palpation;
• Pain in the external genitalia (scrotum, penis, etc. ).

In some cases, cystitis can develop into urinary incontinence, which is caused by a strong urge to urinate.

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

In case of acute cystitis, systemic intoxication may occur: increase in body temperature to 38-40 degrees, sweating, thirst and dry mouth. Usually, this indicates that the infection has spread to the kidneys and renal pelvis, leading to the development of pyelonephritis. In these cases, emergency medical care is required.

In patients, the presentation of clinical symptoms of acute cystitis occurs in different ways. In milder cases, the patient may only feel a heaviness in the lower abdomen and mild pain at the end of urination. In some cases, the course of acute cystitis becomes apparent, developing into a severe inflammatory process. Typically, specialists diagnose phlegm or gangrenous cystitis, which is characterized by fever, poisoning, a sharp decrease in urine output, cloudy urine, and a rancid odor.

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

diagnosis

The correct diagnosis of cystitis directly affects the success of disease treatment. It is important to determine the nature and factors of inflammation before prescribing. If allergic cystitis develops and exposure to the allergen is not eliminated before taking antibiotics, the situation will only get worse.

In the case of infectious cystitis, it is necessary to identify its causative agent and determine to which antibacterial or antifungal drug it is susceptible. The results of the study will determine the course of further treatment. If cystitis is non-infectious in nature, testing is necessary to determine what caused the flare-up. Maybe the cause is urolithiasis or a tumor.

The diagnosis of the disease involves the following steps:

• collect medical records;
• determine clinical manifestations;
• designated laboratory tests;
• Check using instrumental methods.

Laboratory tests for cystitis

1. General blood analysis. To identify signs of non-specific inflammation, increase levels of leukocytes and immature neutrophils, increase ESR levels;
2. General urinalysis. It detects the presence of protein in urine, increased numbers of white blood cells, red blood cells and bacteria. When leukocytosis is detected, an analysis is performed to determine the number of blood cells in the urine sediment, along with a three-cup sample.

Modern rapid methods can also be used to diagnose diseases:

• Use the indicator strips for a quick test. If there is an infection in the urine, there will be a reaction on the test strip;
• A quick test with dipsticks to get data on the amount of white blood cells and protein in the urine. The importance of this method is questionable, as a general urine test can also accomplish this task;
• Leukocyte esterase reaction. This method allows you to identify the enzyme esterase. If there is pus in the urine, it builds up.

After laboratory testing is complete, urine is cultured, a culture study. The implications are as follows: to study the pathogenic flora responsible for the development of cystitis and to determine the susceptibility of microorganisms to antibiotics. Such a test can allow you to prescribe the most effective medication.

The reliability of studies is often compromised by improper sampling of materials and patients' non-compliance with hygiene rules.

Instrumental Research Methods

Among the instrumental methods for diagnosing disease, the most common is cystoscopy, which involves the use of a cystoscope to view the urethra and bladder. In the case of an acute course of cystitis, the introduction of instruments into the bladder is contraindicated, since the procedure is very painful and facilitates the spread of infection in the organs of the genitourinary system.

This type of surgery is only permitted in cases of chronic cystitis, the presence of a foreign body in the bladder, or a prolonged disease duration (10-12 days).

In addition to the procedures described above, women with cystitis are advised to be seen by a gynecologist to diagnose genital infections, ultrasound of the small pelvis, biopsies, urine flow measurements, and other tests.

In special cases, cystography is required. This study allows you to see any irregularities and tumors on the bladder wall. During this process, X-rays are used. For more accurate results, a contrast agent is injected through the catheter to straighten the organ to expand the field of view. The results are visible on X-rays.

treat

Medication is the mainstay of treatment for cystitis. There is no one-size-fits-all treatment plan: doctors treat each patient individually based on the nature of the disease, how advanced it is, etc. If the causative flora is bacteria, antibiotics, fungi - fungicides, allergies - antihistamines, etc. are prescribed. Acute cystitis involves taking antispasmodics, analgesics, and non-steroidal anti-inflammatory drugs. Additional measures are being taken to boost the immunity of patients.

In acute cystitis, it is important not to stop antibiotic therapy when the signs of disease disappear. This untreated disease often becomes chronic, threatening a person's overall health.

In chronic cystitis, herbal-based drugs show high efficacy. It is useful to take herbal decoctions that have anti-inflammatory and antibacterial properties. Physical therapy methods may also be involved: magnetophoresis, electrophoresis, induction and hyperthermia, EHF therapy, ultrasound therapy, and laser therapy.

Complex treatment of cystitis involves prescribing a special diet for the patient. It is necessary to eliminate foods that irritate the bladder mucosa from the diet. Spicy, salty, fried, smoked and pickled foods and dishes are prohibited. Foods should be as bland as possible and deliver plenty of plant fiber to the body, which is required for the proper functioning of the gut flora to ensure high levels of immunity. Prescribe plenty of hot drinks.

In some cases, surgery is the only way to treat the disease. It is usually used in cases of postcoital cystitis or when the opening of the external urethra is very low. In this case, the surgeon moves the urethra slightly above the vaginal entrance to prevent infection during sexual intercourse or hygiene procedures.

Surgical approaches to treating cystitis in men target the occurrence of cicatricial sclerosis, bladder neck deformation, or persistent strictures of the urethra.

More complex surgery for cervical, tuberculous, and parasitic (drug-ineffective) cystitis. In the advanced form of the disease - in the case of gangrene - the damaged area of the bladder is removed, and if the gangrene is total, the entire organ.

complication

Vesicoureteral reflux is the most dangerous complication. It manifests in the fact that urine is thrown into the ureter. If this process is not interrupted, it is possible that the inflammation will spread further to the kidneys, uterus and adnexa. It also reduces the elasticity of the bladder wall, which can lead to scarring or ulceration. An infection that spreads higher into the kidneys can lead to pyelonephritis. In the case of this disease, the amount of urine decreases. Urine builds up in the kidneys and triggers peritonitis because the kidneys cannot perform their full function. This requires urgent surgical intervention.

A complication of cystitis is also paracystitis, which is characterized by infection of the small pelvic tissues, which are responsible for the innervation of the organ. The lesions lead to scars, abscesses. In this case, only surgical intervention can save the patient's life. Complications in the form of bladder pain appear after treatment of cystitis. It involves maintaining pain with urination, which is associated with destruction of receptors, but usually it passes quickly enough.

Among other complications of cystitis disease, a distinction can be made between decreased reproductive capacity and urinary incontinence. For pregnant women, untreated cystitis can lead to miscarriage because the inflammation can spread to the fetus.

In men, the complications of cystitis are slightly different from those in women and are only related to the peculiarities of the structure of the genitourinary system. In both sexes, the gangrenous form of cystitis can be a complication. It is one of the most complex diseases and it affects the mucous membranes of the bladder wall. The purulent process can lead to necrosis and death of bladder tissue, and perforation of the bladder wall or paracystitis is possible. At the same time, urination did not bring relief to the patient.

Dangerous complications of pathology are the development of diffuse ulcerative cystitis and empyema. They develop when bladder inflammation is undertreated. When the infection affects the entire mucosa of an organ, an abscess forms on it, followed by a bleeding ulcer. As a result, scarring is formed and tissue elasticity is lost. All of these can lead to a decrease in bladder volume.

Empyema is required for emergency surgical intervention when pus accumulates in the bladder due to decreased outflow. Sphincter dysfunction may also occur due to infectious lesions of the organ mucosa. In this case, urinary incontinence is observed.

prevention

With cystitis, like any other disease, prevention is better than cure. To this end, it is recommended to:

• Avoid hypothermia. Do not sit in cold places in winter, do not swim in cold water, and do not dress excessively;
• eat well. Spicy, spicy, sour, salty, fried, fatty, pickled foods should be excluded or eaten in limited quantities, and drink plenty of water;
• Get rid of bad habits - smoking and drinking;
• Drink plenty of water (at least 2 liters) - still water, juice. This allows you to quickly remove pathogenic microorganisms from your bladder, preventing them from multiplying;
• Avoid coffee, orange juice, pineapple juice, and grape juice, as they increase the acidity of your urine;
• Treatment of gynecological, urinary and venereal diseases;
• normalizes the work of the digestive tract;
• observe personal hygiene rules;
• Change sanitary napkins and tampons in time during menstruation, preferably using sanitary napkins;
• Wear comfortable underwear made of natural fabrics;
• Refuse to wear tight clothing as it disrupts blood circulation to the pelvic organs;
• prevent overfilling of the bladder;
• When living a sedentary lifestyle, get up and stretch for at least 5-15 minutes every hour;
• Make regular preventive visits to your urologist and gynecologist.

It is also useful to use herbal decoctions (from calendula, chamomile, parsley, etc. ) that have antiseptic and anti-inflammatory properties.