Cystitis: diagnosis and treatment

Pain 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 urinary diseases - cystitis. It is an inflammation of the bladder.

Cystitis itself is not dangerous and does not make it difficult to treat, but threatens with dangerous complications.

The disease can occur at any age. Due to the specific structure of the genitourinary system, women are very susceptible to cystitis. According to statistics, about 80% of women suffer from this pathology at least once in their life. For men, the likelihood of cystitis increases after passing the 40-50 age mark.

Types of diseases

Cystitis can be of many types. The causes of the development of the disease divide it into infectious and non-infectious.

Infectious cystitis

1. Primary school and secondary school.In the first case, this is an independent disease: a healthy bladder is affected by an infection. Secondly, it is a complication of other diseases: the mucous membrane becomes inflamed on the basis of developed pathologies of the urinary system, kidneys or prostate gland.

2. Acute and chronic.In the acute form, symptoms are often severe. Without proper treatment or without it, the disease becomes chronic, characterized by periods of exacerbation and deterioration. There are cases of acute cystitis that goes away on its own after a few days, even without treatment.

3. Depending on the location of the inflammatory focus:

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

4. After-fund.It develops within 1-2 days after sexual intercourse or vaginal manipulation. Its appearance is due to the entry of pathogenic microorganisms into the female urethra. During intimate intercourse, under pressure arising from penile movement, vaginal mucus is expelled into the urethra. From there, 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 spermicides, violation of the rules of intimate hygiene, use of tampons, wearing underwearsynthesis, etc. v.

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. Viruses, tuberculosis and parasites.Such forms of cystitis are 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 problem, it can take the form of:

• radiation;
• chemistry;
• heat;
• traumatic;
• Postoperative;
• allergic.

Separately, there is a classification of cystitis according to the degree of involvement of the bladder mucosal vessels:

• hemorrhage - accompanied by the presence of blood impurities in the urine (hematuria);
• no bleeding - blood in the urine is not visualized.

Reason

Cystitis in most cases (up to 85%) is caused by an infection entering the organ. Basically, the "provocateur" of cystitis is Escherichia coli (about 90%), streptococcus, staphylococcus, and other conditionally pathogenic microorganisms. Rarely, the causative agent is a fungus of the genus Candida or sexually transmitted diseases (chlamydia, mycoplasma, ureaplasma, etc. ).

There are two main routes of infection to the bladder:

• go up - through the urethra. This is caused by improper genital care, poor intimate hygiene, sex life, etc. v. Pathogenic microorganisms can enter the body during surgery or manipulation of the bladder and urethra, during catheterization, if not sterile;
• descending - from the diseased kidney through the ureters, as well as blood and lymph from the vessels of the rectum and genital organs. The large intestine serves as the residence 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 pelvic organs. During radiation therapy, radiation not only affects the organ affected by the cancer (uterus, ovaries, prostate, bowel, etc. ), but also affects nearby organs, especially the bladder. . High doses of rays can lead to burns of the mucous membranes of the organs, after which ulcers and fistulas form on the organ walls in the future;
• chemical burns due to the introduction of drugs into the cavity of the bladder;
• organ trauma with kidney stones;
• contact of the bladder mucosa with hot liquid;
• allergy. 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 because the bladder lining is damaged.

Risk factors

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

• Hypothermia;
• reduced immunity;
• anemia;
• improper nutrition. Spicy, salty, fried, fatty and alcoholic beverages irritate the bladder wall and dehydrate the body;
• violation of the microflora of the vagina;
• frequent and prolonged constipation;
• bladder mucosal injury;
• sedentary lifestyle (circulatory disorders);
• tight clothing and synthetic underwear;
• the presence of chronic gynecological, urological or sexually transmitted diseases;
• previous urinary tract infection;
• non-compliance with the rules of personal hygiene;
• improper use of pads and tampons;
• chronic lack of sleep, overwork, stress;
• promiscuity and unsafe sex;
• Diabetes;
• Hormonal disorder;
• activities are transferred;
• bladder catheterization;
• taking certain medications, such as sulfonamides;
• genetic predisposition;
• pregnancy and childbirth;
• anatomical abnormalities, such as foreskin stenosis in boys.

cystitis in women

Cystitis is considered by some to be a "female" disease that is commonly acquired by women. Several factors contribute to this:

• anatomical features of the structure of the genitourinary system. Because the urethra is wide and short, it is easier for pathogenic microorganisms to enter the bladder. The entrance to the urethra is close to the anus and vagina, so it is possible to get an infection during intercourse;
• tone of the lower urinary tract. It is due to the influence of female sex hormones. This is especially evident during pregnancy, when the body produces progesterone. It dilates the uterus and nearby organs for the safety of the child;
• give birth naturally. In this case, the pelvic muscles lose their elasticity, the bladder sphincter's ability to contract weakens, and the vagina expands. The penetration of infection is facilitated in such conditions;
• Hormonal changes, especially during menopause.

Every tenth woman during her pregnancy is at risk for cystitis. This happens for a number of reasons. Firstly, during childbirth, a woman's immunity decreases. The body becomes more vulnerable to any kind of infection. Second, changes in the general endocrine background, which are a signal for the development of inflammatory diseases of the genitourinary system. Third, uterine prolapse leads to bladder compression. This causes a decrease in the blood supply and as a result leads to an increased vulnerability to pathogens. Do not forget about increasing the synthesis of progesterone, which reduces the tone of the bladder. In the future, obstruction and the 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 cystitis in men under 40-50 years old, who observe the rules of personal hygiene, is extremely small. After crossing this age limit, when with concomitant diseases, cystitis is diagnosed much more often.

Provocative diseases include prostatitis, prostate tumors, seminal vesicles, urethritis, prostate cancer, etc. v. Usually they are accompanied by urethral stricture. As a result, the bladder does not empty completely. Stagnant urine is formed, which is a favorable environment for pathogens - the causative agent of cystitis to develop.

The disease in men occurs in a more severe form and is accompanied by fever and general intoxication, since cystitis in men develops as a complication of other diseases. The chronic form of the disease in men has almost no symptoms.

Cystitis in children

Children of all ages are susceptible to cystitis. It especially often develops in girls of preschool and school age. Many factors contribute to this. Among them are weak protective properties of the bladder mucosa, the urethra is wide and short, and the lack of estrogen synthesis by the ovaries.

The risk of developing the disease is increased if the child is sick with other illnesses. This weakens the immune defenses and creates favorable conditions for the reproduction of pathogenic microflora.

Symptom

Depending on the form of the disease, different symptoms may appear. If acute cystitis is characterized by a pronounced clinical picture with painful and frequent urination, chronic cystitis in remission is usually asymptomatic.

Symptoms of the acute form of cystitis are:

• rising temperatures;
• chills;
• general weakness;
• difficulty urinating and pain. Urine comes out in small pieces. During this process, there is a burning sensation in the urethra, and then - pain in the lower abdomen;
• incomplete feeling of the bladder;
• pain in the supraclavicular region both before and after urinating;
• sharp pain in the bladder area when palpated;
• pain in the external genitalia (scrotum, penis, . . . ).

In some cases, cystitis develops urinary incontinence, caused by a strong urge to urinate.

Urine may become cloudy or slightly red, which indicates the presence of a large number of bacteria, sloughing epithelium, and red and white blood cells.

In case of acute cystitis, the general intoxication picture of the body is likely: body temperature rises to 38-40 degrees, sweating, thirst and dry mouth. As a rule, this indicates the spread of infection to the kidneys and renal pelvis, leading to the development of pyelonephritis. In these conditions, urgent medical care is needed.

In patients, the presentation of clinical signs in acute cystitis occurs in a variety of ways. In milder forms, the patient may only feel heaviness in the lower abdomen, mild pain when urinating. In some cases, the course of acute cystitis becomes pronounced, a severe inflammatory process develops. Usually, specialists diagnose venous cystitis or cystitis, which is characterized by fever, intoxication, a sharp decrease in urinary output, cloudy urine, and the appearance of a foul odor.

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

Diagnose

The correct diagnosis of cystitis directly affects the success of the treatment process. It is important to determine the nature and factors of inflammation before prescribing therapy. If allergic cystitis occurs and the allergen exposure is not eliminated before antibiotics are given, the condition 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 drugs it is susceptible. The results of the study will determine the next course of treatment. If cystitis is non-infectious in nature, then it is necessary to conduct an examination to determine the causes that provoked the onset of the disease. Perhaps the cause is urolithiasis or cancer.

Diagnosis involves the following steps:

• prehistoric collection;
• determine clinical manifestations;
• appointment of laboratory tests;
• test using the tool method.

Lab test for cystitis

1. General blood analysis. It is performed to identify signs of nonspecific inflammation, an increase in the level of leukocytes and immature forms of neutrophils, an increase in the level of ESR;
2. 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 to determine the number of blood cells in the urine residue and a three-cup sample.

Modern accelerated methods can also be used to diagnose the disease:

• Quick test with an indicator strip. If there is an infection in the urine, then a reaction appears on the strip;
• Quick test with strips to get data on leukocyte and protein content in urine. The importance of this method is questionable, since a general urinalysis can also cope with this task;
• leukocyte esterase reaction. This method allows you to determine the enzyme esterase. It accumulates if there is pus in the urine.

After completing the laboratory tests, the urine is cultured, that is, a culture study is performed. Its meaning is as follows: pathogenic microorganisms that provoke the development of cystitis are studied and the sensitivity of microorganisms is determined to antibiotics. Such an examination allows you to prescribe the most effective drugs.

The reliability of studies is often affected by improper material sampling and patient failure to observe hygiene rules.

Instrumental research methods

Among the instrumental methods to diagnose the disease, the most common is cystoscopy, which involves imaging the urethra and bladder with a cystoscope. In case of acute cystitis, the insertion of the instrument 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 cases of chronic cystitis, with a foreign body in the bladder or with a prolonged illness (10-12 days).

In addition to the above procedures, women with cystitis are advised by their gynecologists to have a pelvic exam, diagnosis of genital infections, small pelvic ultrasound, biopsy, ureteroscopy, and other studies.

In special cases, computed tomography is prescribed. This study allows you to see any violations and tumors on the wall of the bladder. In this process, 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. The results are visible on X-rays.

The treatment

Drug therapy is the mainstay of treatment for cystitis. There is no universal treatment protocol: the doctor approaches each patient based on the nature of the disease, the extent of the disease development, etc. v. If the pathogenic microflora is bacteria, antibiotics are prescribed, fungi - fungicides, allergies - antihistamines, etc. v. Acute cystitis is associated with the use of antispasmodics, analgesics, and nonsteroidal anti-inflammatory drugs. Additional measures are being taken to improve the patient's immunity.

In acute cystitis, it is important not to stop antibiotic therapy by the time signs of the disease have disappeared. Such an untreated disease often becomes chronic, threatening a person's overall health.

In chronic cystitis, drugs based on medicinal herbs show high effectiveness. It is useful to use herbal decoctions with anti-inflammatory and antibacterial effects. Physiotherapy methods may also involve: electrophoresis, electrophoresis, induction and hyperthermia, EHF therapy, ultrasound therapy, and laser therapy.

Complex therapy of cystitis includes the appointment of a special diet to 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 a large amount of vegetable fiber to the body, which is necessary for the normal functioning of the intestinal microflora to ensure a high level of immunity. A plump warm drink is prescribed.

In some cases, surgery is the only treatment for the disease. Usually used for cystitis at the nape of the neck 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.

A surgical approach to the treatment of cystitis in men is prescribed for the presence of nodular sclerosis, bladder neck deformity or persistent urethral stricture.

More complex surgeries are performed for cervicitis, tuberculosis, and parasites (with the loss of effect of the drug). In the case of the disease in a severe form - lymphadenopathy - damaged areas of the bladder are removed, and if there is total necrosis, then the entire organ.

Complications

Ureteral purulent reflux is the most dangerous complication. It is expressed in urine being expelled into the ureter. If this process is not interrupted, then the inflammation will spread further to the kidneys, inflammation of the uterus and appendages is possible. It also reduces the elasticity of the bladder wall, which can cause scarring or ulcers. The higher spread of the infection into the kidney leads to pyelonephritis. In the case of this disease, the amount of urine is reduced. Urine accumulates in the kidneys and causes peritonitis, because the kidneys are not performing their full functions. This requires urgent surgical intervention.

A complication of cystitis is also inflammation of the seminal vesicles, characterized by infection of the tissues of the small pelvis, which is responsible for the nourishment of the organs. Injuries causing scarring, abscesses. In this case, only surgical intervention can save the patient's life. A complication in the form of persistent pain appears after the treatment of cystitis. It involves sustained 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 decreased fertility, urinary incontinence. For pregnant women, untreated cystitis can lead to miscarriage, as the infection can spread to the fetus.

In men, the complications of cystitis differ slightly from women and are related only to the peculiarities of the structure of the genitourinary system. In both sexes, the nodal form of cystitis becomes a complication. This is one of the most complicated conditions, it affects the mucous membrane of the bladder wall. The pyogenic process can lead to necrosis of bladder tissues and their death, and perforation of the bladder wall or inflammation of the air sacs can occur. At the same time, urination does not bring relief to the patient.

In addition, a dangerous complication of the disease is the appearance of diffuse ulcerative cystitis and edema. They develop with inadequate therapy for cystitis. At the time when the infection affects the entire mucous membrane of the organ, abscesses form on it, 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 is required, when pus accumulates in the bladder due to decreased outflow. Sphincter dysfunction can also occur due to infectious damage of the organ's mucous membranes. In this case, urinary incontinence is observed.

Prevent

Cystitis, like any other disease, is prevention rather than treatment. For this, it is recommended:

• avoid hypothermia. You should not sit in the cold, swim in cold water, or dress lightly in winter;
• Eat right. Spicy, spicy, sour, salty, fried, fatty, pickled foods, to be excluded or consumed in limited quantities, drink plenty of water;
• get rid of bad habits - smoking and drinking;
• drink more fluids (at least 2 liters) - water, juice. This allows you to quickly remove pathogenic microorganisms from the bladder, preventing their reproduction;
• do not drink coffee, oranges, pineapples and grape juices, as they increase the acidity of urine;
• treatment of gynecological, urological and venereal diseases;
• normalizes the work of the gastrointestinal tract;
• compliance with the rules of personal hygiene;
• timely change of pads and tampons during menstruation, while the use of pads is preferred;
• wear comfortable underwear made of natural fabrics;
• refuse tight clothing, as it disrupts the blood circulation of the pelvic organs;
• prevent the bladder from overfilling;
• with a sedentary lifestyle, get up and stretch every hour for at least 5-15 minutes;
• Make regular preventive visits to the urologist and gynecologist.

It will also be helpful to use herbal decoctions with antiseptic and anti-inflammatory properties (from calendula, chamomile, parsley, etc. ).