Drawing pains in the lower abdomen, painful and frequent urination, atypical color of urine or impurities of blood in it are the main signs of one of the most common urological diseases - cystitis. It is a bladder infection.
In itself, cystitis is not dangerous and does not cause difficulties in treatment, but there is a risk 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. In men, the likelihood of cystitis increases after overcoming the milestone of 40-50 years.
types of diseases
Cystitis can be of several types. The cause of the development of the disease divides them into infectious and non-infectious.
Infectious cystitis
Primary and secondary.In the first case, it is an independent disease: a healthy bladder is affected by the infection. Secondly, it is a complication of other diseases: the mucous membrane becomes inflamed due to an already developed pathology of the urinary system, kidneys or prostate.
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 aggravation and decline. There are cases when acute cystitis, even without treatment, ends with recovery after a few days.
Depending on the location of the focus of inflammation:
- 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 particularly serious.
postcoital.It develops within 1-2 days after sexual intercourse or vaginal manipulations. Its occurrence is due to the penetration of pathogenic microflora into a woman's urethra. During sexual intercourse, vaginal mucus is thrown into the urethra under the pressure created by the movements of the penis. From there, the infection passes freely into the bladder. Also, prerequisites for the development of this type of disease are frequent change of sexual partners, abuse of contraceptive spermicides, violation of the rules of intimate hygiene, use of tampons, wearing 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 bladder, which until then have not been exposed to infection.
Viruses, tuberculosis and parasites.Such bladder infections 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 event, it can take the following forms:
- 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 impurities of blood 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 penetrating 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 ways of infection of the bladder:
- ascending - through the urethra. This is facilitated by improper 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 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 a habitat for the main pathogen - Escherichia coli. The causative agents of genital infections in women are located in the uterus and vagina, in men - in the urethral and prostate ducts.
Non-infectious cystitis occurs for the following reasons:
- Irradiation of the pelvic organs. In radiation therapy, the radiation acts not only on the organ affected by cancer (uterus, ovaries, prostate, intestines, etc. ), but also nearby, especially the bladder. A high dose of radiation can lead to a burn of the mucous membrane of the organ, after which ulcers and fistulas form on the walls in the future;
- Chemical burns due to the introduction of drugs into the bladder cavity;
- 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, a secondary infection usually occurs due to the susceptibility of the bladder mucosa.
risk factors
There are many factors that contribute to the development of cystitis:
- hypothermia;
- decreased immunity;
- hypovitaminosis;
- wrong diet. Spicy, salty, fried, fatty, and alcoholic beverages irritate the bladder walls and dehydrate the body;
- violation of the microflora of the vagina;
- frequent and persistent constipation;
- injuries to the bladder mucosa;
- lack of exercise (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 mellitus;
- 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, as it is usually found in women. 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 near the anus and vagina, so infection can occur during intercourse;
- low 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 child's safety;
- birth naturally. In this case, the pelvic muscles lose their elasticity, the ability of the bladder sphincter to contract weakens, the vagina expands. The penetration of infections is facilitated under such conditions;
- Hormonal changes, especially during menopause.
Every tenth woman during pregnancy has an increased risk of contracting a bladder infection. This happens for several reasons. First, the woman's immunity decreases during childbirth. The body becomes more susceptible 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. Third, enlargement of the uterus leads to compression of the bladder. This leads to a deterioration in its blood supply and, as a result, an increased likelihood of damage from pathogens. Do not forget about the increased synthesis of progesterone, which reduces the tone of the bladder. In the future, there are traffic jams and a strong development of infection.
cystitis in men
The presence of a long and curved urethra in men significantly reduces the risk of infection in the bladder. The probability of developing cystitis in men under 40-50 years old who follow the rules of personal hygiene is extremely small. After exceeding this age limit, cystitis is much more frequently diagnosed in the presence of concomitant diseases.
The provoking 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 - causative agents 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 is practically asymptomatic.
Bladder infection in children
Children of all ages are also prone to cystitis. Especially often it develops in girls of preschool and school age. Many factors contribute to this. These include the weak protective properties of the bladder lining, a wide and short urethra, and the lack of estrogen synthesis by the ovaries.
The risk of developing the disease increases if the child has 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 can occur. If acute cystitis is characterized by a pronounced clinical picture with painful and frequent urination, then chronic cystitis can generally be asymptomatic during remission.
Symptoms of the acute form of cystitis are:
- high temperature;
- Chills;
- general weakness;
- difficult and painful urination. Urine comes out in small portions. With this there is a burning sensation in the urethra, and after it - 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 genitals (scrotum, penis, etc. ).
In some cases, cystitis develops urinary incontinence caused by a strong urge to urinate.
The urine may become cloudy or reddish, indicating the presence of large numbers of bacteria, desquamated epithelium, red blood cells, and white blood cells.
With acute cystitis, a picture of general intoxication of the body is likely: increased body temperature 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 care is required.
In patients, the manifestation of clinical symptoms in acute cystitis occurs in different ways. With milder forms of the disease, patients may experience only heaviness in the lower abdomen and slight pain at the end of urination. In some cases, the course of acute cystitis becomes pronounced, a severe inflammatory process develops. Experts often diagnose phlegmonous or gangrenous cystitis, which is characterized by fever, intoxication, a sharp decrease in the volume of urine excreted, cloudiness of urine and the appearance of a putrid odor.
In chronic cystitis, the clinical symptoms are in many ways similar to those of acute cystitis, but are less pronounced. Symptoms are permanent, only their intensity changes during treatment.
diagnosis
Correct diagnosis of cystitis directly affects the success of treatment of the disease. It is important to establish the nature and factors of the inflammation before prescribing therapy. If allergic cystitis occurs and contact with the allergen is not eliminated before taking antibiotics, the condition will only worsen.
With infectious cystitis, it is necessary to determine the causative agent and determine what antimicrobial or antifungal drugs it is sensitive to. The result of the study determines the course of further therapy. If the cystitis is non-infectious in nature, it is necessary to conduct an examination to determine 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:
- anamnesis;
- determination of clinical manifestations;
- appointment of laboratory tests;
- Investigation with instrumental methods.
Laboratory test for cystitis
- General blood analysis. It is carried out to identify signs of nonspecific 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. If 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 indicator strips. If there is infection in the urine, a reaction will appear on the strip;
- Rapid test with strips for obtaining data on the leukocyte and protein content in the urine. The importance of the method is doubtful, since even a general urine test can cope with this task;
- Leukocyte Esterase Reaction. This method allows you to identify the enzyme esterase. It accumulates when there is pus in the urine.
After the laboratory tests are completed, urine is cultured, that is, a culture study is conducted. Its importance is as follows: the pathogenic microflora that provoked the development of cystitis is examined and the sensitivity of microbes to antibiotics is determined. Such an examination will allow you to prescribe the most effective drugs.
The reliability of studies often suffers from improper material collection and non-compliance with hygiene regulations by the patient.
Instrumental research methods
Among the instrumental methods of diagnosing the disease, the most common is cystoscopy, which consists in visualizing the urethra and bladder with a cystoscope. With an acute course of cystitis, the insertion of instruments into the bladder is contraindicated, since the procedure is extremely painful and contributes to the spread of infection in the organs of the genitourinary system.
Such a procedure is allowed only in 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 recommended to undergo a gynecological examination, 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 injuries and neoplasms on the walls of the bladder. X-rays are used during the procedure. To get more accurate results, a contrast medium 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, then antibiotics are prescribed, the fungus - fungicides, with allergies - antihistamines, etc. Acute cystitis involves taking antispasmodic, analgesic and nonsteroidal anti-inflammatory drugs. Additional measures are taken to improve the patient's immunity.
In acute cystitis, it is important not to stop the course of antibiotic therapy at the time the signs of the disease disappear. Such an untreated disease often becomes chronic and threatens a person's overall health.
With chronic cystitis, drugs based on medicinal herbs show high effectiveness. It is useful to take herbal decoctions with anti-inflammatory and antibacterial effects. Physiotherapeutic methods can 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 food and dishes are prohibited. Food should be as light as possible and provide the body with large amounts of plant fibers 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. It is usually resorted to in postcoital cystitis or when the external opening of the urethra is very low. In this case, the surgeon moves the urethra slightly over the entrance to the vagina to prevent infection during sexual intercourse or hygiene procedures.
An operative method of treating cystitis in men is prescribed in the event of the appearance of cicatricial sclerosis, deformation of the neck of the bladder or persistent narrowing of the urethra.
More complex operations are performed with cervical, tuberculous and parasitic (with the ineffectiveness of drugs) cystitis. With an advanced form of the disease - gangrene, the damaged areas of the bladder are removed, and if the gangrene is complete, then the entire organ.
complications
Vesicoureteral reflux is the most dangerous complication. It is manifested by the fact that urine is thrown into the ureters. If the process is not interrupted, then the inflammation will spread further to the kidneys, inflammation of the uterus and appendages is possible. It also decreases the elasticity of the bladder walls, which can cause scars or ulcers to form. Spread of infection to the kidneys leads to pyelonephritis. With 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.
Also a complication of cystitis is paracystitis, which is characterized by infection of the tissues of the small pelvis responsible for the innervation of the organs. The lesion causes scarring, abscesses. In this case, saving the patient's life is possible only through surgical intervention. A complication in the form of cystalgia occurs after treatment of cystitis. It consists in maintaining painful urination, which is associated with disruption of the receptors, but usually passes quickly enough.
Among other complications of the disease with cystitis, one can distinguish a decrease in reproductive capacity, urinary incontinence. In pregnant women, untreated cystitis can lead to miscarriage because the inflammation can spread to the fetus.
In men, the complications of cystitis differ a little from women 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 diseases, it affects the mucous membrane of the bladder walls. Purulent processes can lead to necrosis of the tissues of the bladder and their death, perforation of the walls of the bladder or paracystitis is possible. At the same time, urination does not bring relief to the patient.
Also a dangerous complication of pathology is the appearance of diffuse ulcerative cystitis and empyema. They develop into cystitis if therapy is inadequate. At a time when the infection affects the entire mucous membrane of the organ, abscesses form on it, and later bleeding ulcers. Because of this, scars form, 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 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 foods, pickled, it is desirable to exclude or consume them in limited quantities, drink 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 and prevent their reproduction.
- do not drink coffee, orange, pineapple and grape juices, as they increase the acidity of urine;
- Treatment of gynecological, urological and venereal diseases;
- normalize the work of the digestive tract;
- observe the rules of personal hygiene;
- change pads and tampons in a timely manner during menstruation, giving preference to the use of pads;
- wear comfortable underwear made from natural fabrics;
- refuse tight clothes, as this disrupts blood flow to the pelvic organs;
- prevent overfilling of the bladder;
- If you lead a sedentary lifestyle, get up and stretch for at least 5-15 minutes every hour.
- conduct regular preventive visits to the urologist and gynecologist.
It is also useful to use herbal decoctions with antiseptic and anti-inflammatory properties (from calendula, chamomile, parsley, etc. ).