Cystitis itself is not dangerous and does not cause difficulties in treatment, but it poses a risk of serious complications.
The disease can occur at any age. Due to the peculiarities of the structure of the urogenital 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. In men, the probability of developing cystitis increases after overcoming the 40-50 year milestone.
Types of diseases
Cystitis can be of several types. The cause of the disease is divided into infectious and non-infectious.
Infectious cystitis
Primary and secondary.In the first case, it is an independent disease: the healthy bladder is affected by the infection. In the second case, it is a complication of other diseases: the mucous membrane becomes inflamed based on the already developed pathology of the urinary system, kidneys or prostate.
Acute and chronic.In the acute form, the symptoms are usually severe. With inadequate or lack of treatment, the disease becomes chronic, characterized by periods of exacerbation and decline. There are cases when acute cystitis ends with 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 mouth of the ureters and the inner opening of the urethra);
- total - affects the whole organ. In this case, the course of cystitis is particularly severe.
Postcoital.It develops within 1-2 days after sexual intercourse or vaginal manipulation. Its occurrence is due to the fact that the pathogenic microflora penetrates the woman's urethra. During intimate intercourse, pressure from the movement of the penis causes vaginal mucus to enter the urethra. From this, the infection freely penetrates the bladder. Prerequisites for the development of this type of disease are frequent changes of sexual partners, abuse of contraceptive spermicides, violation of intimate hygiene rules, use of tampons, wearing of synthetic underwear, etc.
"Honeymoon Cystitis".It develops after the loss of virginity against the background of an existing violation of the vaginal microflora (candidiasis, etc. ). This happens for a similar reason: during intercourse, vaginal microflora enters the urethra and bladder, which were not exposed to infection until then.
Viral, tuberculous and parasitic.Such forms of cystitis are very rare.
Non-infectious cystitis
Non-infectious cystitis does not involve the entry of pathogenic microflora into the bladder. Depending on the cause of its occurrence, it can take the following forms:
- emission;
- chemical;
- thermal;
- traumatic;
- postoperative;
- allergic.
Separately, cystitis is classified according to the involvement of the vessels of the bladder mucosa:
- hemorrhagic - accompanied by the presence of blood impurities in the urine (hematuria);
- non-haemorrhagic – blood in the urine is not visible.
Cause
In most cases (up to 85%), cystitis 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 belonging to the genus Candida or sexually transmitted infections (chlamydia, mycoplasma, ureaplasma, etc. ).
There are two main ways to get a bladder infection:
- 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 was not observed;
- descending - with blood and lymph from the diseased kidneys through the ureters and from the vessels of the rectum and genitals. The large intestine is the habitat of the main pathogen - Escherichia coli. The pathogens of genital infections in women are found in the uterus and vagina, and in men in the urethra and prostate ducts.
Non-infectious cystitis occurs for the following reasons:
- irradiation of the pelvic organs. During radiation therapy, the radiation affects not only the organ affected by cancer (uterus, ovaries, prostate, intestines, etc. ), but also nearby, especially the bladder. High doses of radiation can lead to burning of the mucous membrane of the organ, and in the future, ulcers and fistulas will form on its walls;
- chemical burn due to the introduction of drugs into the bladder cavity;
- damage to the organ by kidney stones;
- exposure of the mucous membrane of the bladder with hot liquid;
- allergic reaction. This is not only caused by sneezing, stuffy nose, etc. , but cystitis may also occur.
In the case of non-infectious cystitis, a secondary infection usually occurs due to the vulnerability of the bladder mucosa.
Risk factors
Several factors contribute to the development of cystitis:
- hypothermia;
- reduced immunity;
- hypovitaminosis;
- improper nutrition. Spicy, salty, fried, fatty and alcoholic drinks irritate the bladder wall and dry out the body;
- violation of the microflora of the vagina;
- frequent and prolonged constipation;
- injuries of the mucous membrane of the bladder;
- sedentary lifestyle (circulation 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;
- improper use of pads and tampons;
- constant lack of sleep, overwork, stress;
- promiscuity and unprotected sex;
- diabetes;
- hormonal disorders;
- transferred operations;
- bladder catheterization;
- taking certain medicines 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 "women's" disease, as it usually affects women. Several factors contribute to this:
- anatomical features of the structure of the urinary system. Due to the wide and short urethra, the pathogenic microflora penetrates the bladder more easily. 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 effect 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;
- childbirth naturally. In such cases, the pelvic muscles lose their flexibility, the ability of the bladder sphincter to contract weakens, and the vagina expands. Penetration of infection may be facilitated under such conditions;
- hormonal changes, especially during menopause.
Every tenth woman is at increased risk of developing cystitis during pregnancy. This happens for several reasons. First of all, during pregnancy, women's immunity decreases. The body becomes more vulnerable to any kind of infection. Secondly, the general hormonal background changes, which is a sign of the development of inflammatory diseases of the urogenital system. Third, the growth of the uterus leads to compression of the bladder. This causes your blood supply to deteriorate and, as a result, leads to an increased likelihood of damage caused by pathogens. Do not forget about the increased synthesis of progesterone, which reduces the tone of the bladder. In the future, there will be congestion and a sharp development of infection.
cystitis in men
In men, the presence of a long and curved urethra significantly reduces the risk of bladder infection. Men under the age of 40-50 who observe the rules of personal hygiene have an extremely low probability of developing cystitis. After overcoming this age limit, in the presence of accompanying diseases, cystitis is diagnosed much more often.
Provocative diseases include prostatitis, prostate adenoma, vesiculitis, urethritis, prostate cancer, etc. They are usually associated with 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 - the 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 is practically asymptomatic in men.
Cystitis in children
Children of any age are susceptible to cystitis. It develops especially often in girls of preschool and school age. Many factors contribute to this. These include weak protective properties of the bladder mucosa, a wide and short urethra, and a lack of estrogen synthesis by the ovaries.
The risk of developing the disease increases if the child suffers from another disease. This weakens the immune defense and creates favorable conditions for the growth of pathogenic microflora.
Symptoms
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 can usually be asymptomatic during remission.
The symptoms of the acute form of cystitis are as follows:
- elevated temperature;
- chills;
- general weakness;
- difficult and painful urination. Urine comes out in small amounts. During the process, there is a burning sensation in the urethra, and after that - pain in the lower abdomen;
- a feeling of incomplete emptying of the bladder;
- pain in the suprapubic region both before and after urination;
- sharp pain on palpation in the area of the bladder;
- pain in the external genitalia (scrotum, penis, etc. ).
In some cases, cystitis develops into urinary incontinence, which is triggered by a strong urge to urinate.
Urine may become cloudy or reddish, indicating that it contains large numbers of bacteria, epithelium, red blood cells, and white blood cells.
In the case of acute cystitis, the picture of general poisoning of the body is likely: body temperature increased to 38-40 degrees, sweating, thirst and dry mouth. This usually indicates the spread of the infection in the kidneys and towards the renal pelvis, leading to the development of pyelonephritis. In such circumstances, emergency medical attention is required.
Patients have different clinical symptoms of acute cystitis. In milder forms of the disease, patients may only feel heaviness in the lower abdomen and mild pain at the end of urination. In some cases, the course of acute cystitis becomes pronounced, a serious inflammatory process develops. Experts often diagnose phlegmonous or gangrenous cystitis, which is characterized by fever, intoxication, a sharp decrease in the amount of urine excreted, cloudy urine and the appearance of a putrid smell.
In chronic cystitis, the clinical symptoms of the disease are similar to acute cystitis in many respects, but less pronounced. The symptoms are permanent, only their intensity changes during the treatment.
Diagnostics
Correct diagnosis of cystitis directly affects the success of the treatment of the disease. Before prescribing therapy, it is important to determine the nature and factors of the inflammation. 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, its causative agent must be determined and it must be determined which antimicrobial or antifungal agents it is sensitive to. The result of the examination determines the course of further therapy. If cystitis is non-infectious, an examination must be carried out to determine the causes of the disease. Perhaps the cause is urolithiasis or a tumor.
Diagnosing the disease includes the following steps:
- collection of anamnesis;
- determination of clinical manifestations;
- designation of laboratory tests;
- examination with instrumental methods.
Laboratory examination of cystitis
- General blood test. It is performed to identify signs of non-specific inflammation, to increase the level of leukocytes and immature forms of neutrophils, to increase the level of ESR;
- General urinalysis. It shows 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 urine sediment and a three-cup sample is prescribed.
Modern express methods can also be used to diagnose the disease:
- quick test with indicator strip. If there is an infection in the urine, a reaction will appear on the strip;
- with rapid test strips to obtain data on the leukocyte and protein content of 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 enables the identification of the esterase enzyme. It accumulates when there is pus in the urine.
After the laboratory tests are completed, the urine is cultured, i. e. a culture test is performed. Its meaning is as follows: they examine the pathogenic microflora that causes cystitis and determine the sensitivity of the microbes to antibiotics. Such a test allows the most effective drugs to be prescribed.
The reliability of tests often deteriorates due to incorrect sampling of the material and non-compliance with hygiene rules.
Instrumental research methods
Among the instrumental methods of diagnosing the disease, cystoscopy is the most common, which consists of visualizing the urethra and bladder using a cystoscope. In the case of acute 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 urogenital system.
Such a procedure is allowed only in cases of chronic cystitis, the presence of a foreign body in the bladder, or the prolonged course of the disease (10-12 days).
In addition to the above procedures, women suffering from cystitis are advised to undergo an examination by a gynecologist, diagnosis of sexually transmitted infections, pelvic ultrasound, biopsy, uroflowmetry and other tests.
In special cases, cystography is prescribed. This study makes it possible to detect possible violations and neoplasms on the wall of the bladder. X-rays are used during the procedure. For more accurate results, contrast material is injected through the catheter, which straightens the organ to expand the field of view. The results can be seen on the X-ray.
Treatment
The main treatment for cystitis is medication. There is no universal treatment regimen: the doctor approaches each patient individually, depending on the nature of the disease, degree of development, etc. Based on. If the causative microflora is a bacterium, then antibiotics are prescribed, for the fungus - fungicides, in case of allergies - antihistamines, etc. Acute cystitis means taking antispasmodics, pain relievers and non-steroidal anti-inflammatory drugs. Additional measures are taken to improve the patient's immunity.
In case of acute cystitis, it is important not to stop the antibiotic treatment when the symptoms of the disease disappear. Such an untreated disease often becomes chronic and threatens a person's overall health.
Medicines based on herbs show great effectiveness in chronic cystitis. It is useful to take herbal decoctions that have anti-inflammatory and antibacterial effects. Physiotherapy methods can also be used: magnetophoresis, electrophoresis, induction and hyperthermia, EHF therapy, ultrasound treatment and laser therapy.
The complex therapy of cystitis includes prescribing a special diet for the patient. Foods that irritate the bladder mucosa should be excluded from the diet. The consumption of spicy, salty, fried, smoked and sour foods is prohibited. The food should be as light as possible and should provide the body with a large amount of vegetable fiber, which is necessary for the normal functioning of the intestinal microflora, to ensure a high level of immunity. Plenty of warm drinks are prescribed.
In some cases, surgery is the only treatment for the disease. It was usually resorted to with postcoital cystitis or 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 intercourse or hygiene procedures.
In men, an operative method is prescribed for the treatment of cystitis in the case of cicatricial sclerosis, deformation of the bladder neck or permanent narrowing of the urethra.
More complicated operations are performed in case of cervical, tuberculosis and parasitic cystitis (with the ineffectiveness of drugs). In case of an advanced form of the disease - gangrene - 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. This manifests itself in the fact that urine enters the ureters. If the process is not interrupted, the inflammation spreads to the kidneys, inflammation of the uterus and appendages is possible. It also reduces the elasticity of the bladder walls, which can cause scarring or ulcers. The spread of the infection higher up into the kidneys leads to pyelonephritis. In this disease, the amount of urine decreases. Urine accumulates in the kidneys and causes peritonitis because the kidneys are not fully functioning. This requires urgent surgical intervention.
Cystitis is also a complication of paracystitis, which is characterized by infection of the tissues of the small pelvis, which are responsible for the innervation of the organs. The change causes scarring and abscesses. In this case, saving the patient's life is possible only with surgical intervention. A complication in the form of cystalgia appears after the treatment of cystitis. It consists of maintaining painful urination, which is associated with a disturbance of the receptors, but usually passes quite quickly.
Other complications associated with cystitis include reduced reproductive capacity and urinary incontinence. In 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 those in women, and only in connection with the peculiarities of the structure of the urogenital system. In both sexes, the gangrenous form of cystitis becomes a complication. This is one of the most complex conditions, affecting the lining of the bladder wall. Purulent processes can lead to necrosis and death of the bladder tissues, perforation of the bladder walls or paracystitis is possible. At the same time, urination does not bring relief to the patient.
Also, the occurrence of diffuse ulcerative cystitis and empyema is a dangerous complication of the pathology. They develop with insufficient therapy of cystitis. At the time when the infection affects the entire mucous membrane of the organ, abscesses form on it, and later bleeding ulcers. Because of this, scars are formed and the elasticity of the tissues 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. Dysfunction of the sphincter muscle can also occur due to an infectious change in 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. It is recommended for this:
- avoid hypothermia. One should not sit in the cold, swim in cold water, or dress lightly in winter;
- eat properly. Spicy, spicy, sour, salty, fried, fatty foods, pickles, it is desirable to exclude or consume in limited quantities, drink a lot of water;
- get rid of bad habits - smoking and alcohol consumption;
- drink more fluids (at least 2 liters) - still water, fruit juices. This allows the rapid removal of pathogenic microorganisms from the bladder, preventing their reproduction;
- do not drink coffee, orange, pineapple and grape juice, as they increase the acidity of urine;
- treatment of gynecological, urological and sexual diseases;
- normalizes the work of the digestive system;
- observe the rules of personal hygiene;
- timely change pads and tampons during menstruation, while the use of pads is more beneficial;
- wear comfortable underwear made of natural materials;
- refuse tight clothing, as it interferes with the blood circulation of the pelvic organs;
- prevents overfilling of the bladder;
- if you lead a sedentary lifestyle, get up and stretch for at least 5-15 minutes every hour;
- make regular preventive visits to the urologist and gynecologist.
It will also be useful to use herbal decoctions with antiseptic and anti-inflammatory properties (marigold, chamomile, parsley, etc. ).