By itself, cystitis is not dangerous and does not cause difficulties in treatment, but it poses a threat of serious complications.
The disease can appear at any age. Due to the peculiarities of the structure of the genitourinary system, women are more susceptible to cystitis. According to statistics, about 80% of women have suffered from this pathology at least once in their lives. In men, the likelihood of cystitis increases after overcoming a milestone of 40-50 years.
Types of diseases
Cystitis can be of several types. The reason for the development of the disease divides it 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, it is a complication of other diseases: the mucous membrane becomes inflamed on the basis of an already developed pathology of the excretory system, kidneys or prostate.
Acute and chronic.In the acute form, the symptoms are usually severe. With incorrect treatment or its absence, 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 mouths of the ureters and the internal opening of the urethra);
- general - affects the whole body. In this case, the course of cystitis is particularly 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 woman's urethra. During intimate contact, under pressure resulting from the movements of the penis, vaginal mucus is expelled into the urethra. From it, 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, non-compliance with the rules of intimate hygiene, the use of tampons, the wearing of synthetic underwear, etc.
"honeymoon cystitis".It develops after deprivation of virginity against the background of existing disorders 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 had not been exposed to infection.
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 appearance, 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 - blood in the urine is not visualized.
reasons
Bladder inflammation in most cases (up to 85%) is caused by an infection that enters the organ. Main "provocateurs" of cystitis are Escherichia coli (about 90%), streptococci, staphylococci and other conditionally pathogenic microorganisms. Rarely, the cause of the disease is a fungus of the genus Candida or sexually transmitted infections (chlamydia, mycoplasma, ureaplasma, etc. ).
There are two main routes of infection to 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 is not 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 found in the uterus and vagina, in men - in the urethra and prostate ducts.
Non-infectious cystitis occurs for the following reasons:
- radiation of the pelvic organs. During radiation therapy, the radiation affects not only the organ affected by cancer (uterus, ovaries, prostate, intestine, etc. ), but also the relatives, especially the bladder. A high dose of rays can lead to burning of the mucous membrane of the organ, after which ulcers and fistulas form on its walls in the future;
- chemical burn due to the introduction of drugs into the bladder cavity;
- organ injury with kidney stones;
- exposure of the mucous membrane of the bladder with hot liquid;
- alergic reaction. Against its background, not only sneezing, nasal congestion, etc. , but also cystitis may appear.
In the case of non-infectious cystitis, a secondary infection usually occurs due to the vulnerability of the bladder mucosa.
Risk factors
There are many factors that contribute to the development of cystitis:
- hypothermia;
- reduced immunity;
- hypovitaminosis;
- improper nutrition. Spicy, salty, fried, fatty and alcoholic drinks irritate the walls of the bladder and dehydrate the body;
- violation of the microflora of the vagina;
- frequent and prolonged constipation;
- injuries of the bladder mucosa;
- 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 personal hygiene rules;
- improper use of pads and tampons;
- constant lack of sleep, fatigue, stress;
- promiscuity and unprotected sex;
- diabetes;
- hormonal disorders;
- transferred operations;
- bladder catheterization;
- taking certain medications, such as sulfonamides;
- genetic predisposition;
- pregnancy and birth;
- anatomical abnormalities, such as phimosis in boys.
cystitis in women
Some consider cystitis to be a "female" disease due to the fact that women usually suffer from 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 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;
- birth naturally. In this case, the pelvic muscles lose their elasticity, the bladder sphincter's ability to contract weakens, and the vagina expands. Under such conditions, the penetration of infection is facilitated;
- hormonal changes, especially during menopause.
Every tenth woman during pregnancy has an increased risk of developing cystitis. This happens for several reasons. First, during childbirth, women's immunity decreases. The body becomes more vulnerable to any infections. Secondly, the general hormonal background changes, which is a signal for the development of inflammatory diseases of the genitourinary system. Third, the enlargement of the uterus causes pressure on the bladder. This leads to the deterioration of its blood supply and, as a result, leads to an increase in the likelihood 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 sharp development of infection appear.
cystitis in men
Having a long and curved urethra in men significantly reduces the risk of bladder infection. The probability of developing cystitis in men under the age of 40-50 who observe the rules of personal hygiene is extremely small. After overcoming this age limit, in the presence of concomitant diseases, cystitis is diagnosed much more often.
Provocative diseases include prostatitis, prostate adenoma, vesiculitis, urethritis, prostate cancer, etc. They are usually accompanied by 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 - 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 occurs practically without symptoms.
Cystitis in children
Children of any age are also susceptible to cystitis. It especially often develops in girls of preschool and school age. Many factors contribute to this. Among them are the weak protective properties of the bladder mucosa, the 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, different symptoms may appear. If acute cystitis is characterized by a pronounced clinical picture with painful and frequent urination, then chronic cystitis during remission can be generally asymptomatic.
The symptoms of an acute form of cystitis are:
- elevated temperature;
- chills;
- general weakness;
- difficult and painful urination. Urine comes out in small portions. In the process, a burning sensation appears in the urethra, and then pain in the lower abdomen;
- a feeling of incomplete emptying of the bladder;
- pain in the suprapubic area before and after urination;
- sharp pain in the area of the bladder during palpation;
- pain in the external genitalia (scrotum, penis, etc. ).
In some cases, with cystitis, urinary incontinence develops, provoked by a strong desire to urinate.
Urine can become cloudy or reddish, which indicates 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 possible: an increase in body temperature to 38-40 degrees, sweating, thirst and dry mouth. As a rule, this indicates the spread of the infection in the kidneys and renal pelvis, which leads to the development of pyelonephritis. Under these conditions, urgent medical attention is required.
In patients, the manifestation of clinical signs of acute cystitis occurs in a different way. In milder forms of the disease, patients may only experience heaviness in the lower abdomen, slight pain at the end of urination. In some cases, the course of acute cystitis becomes pronounced, a severe inflammatory process develops. Often, experts diagnose phlegmonous or gangrenous cystitis, characterized by fever, intoxication, a sharp decrease in the volume of excreted urine, turbidity of urine and the appearance of a putrid smell in it.
In chronic cystitis, the clinical signs of the disease are in many ways similar to acute cystitis, but are less pronounced. Symptoms are constant, only their intensity changes during treatment.
Diagnosis
The correct diagnosis of cystitis directly affects the success of the 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 causative agent and to establish which antimicrobial or antifungal drugs it is sensitive to. The result of the examination will determine the course of further treatment. If cystitis is non-infectious in nature, it is necessary to conduct an examination to determine the reasons that provoked the appearance of the disease. Perhaps the cause is urolithiasis or a neoplasm.
The diagnosis of the disease includes the following steps:
- history taking;
- determination of clinical manifestations;
- appointment of laboratory tests;
- research using instrumental methods.
Laboratory test for cystitis
- General blood analysis. It is carried out to identify signs of non-specific inflammation, an increase in the level of leukocytes and immature forms of neutrophils, an increase in the level of ESR;
- General analysis of urine. 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 express methods can also be used to diagnose the disease:
- quick test with indicator strip. If there is an infection in the urine, then a reaction appears on the strip;
- a rapid test with strips to obtain data on the content of leukocytes and protein in the urine. The significance of the method is doubtful, since the 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 in the urine.
After the completion of the laboratory tests, the urine is cultured, i. e. a cultural study is carried out. Its importance is as follows: the pathogenic microflora that provokes the development of cystitis is studied, and the sensitivity of microbes to antibiotics is determined. Such research allows you to prescribe the most effective drugs.
The reliability of research often suffers due to incorrect sampling of the material and non-compliance with hygiene rules 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, as the process is extremely painful and contributes to the spread of infection in the organs of the genitourinary system.
Such a procedure is permissible only in case of chronic cystitis, the presence of a foreign body in the bladder or in case of a prolonged course of the disease (10-12 days).
In addition to the above procedures, women with cystitis are advised to undergo an examination by a gynecologist, diagnose genital infections, undergo an ultrasound examination of the small pelvis, biopsy, uroflowmetry and other tests.
In special cases, cystography is prescribed. This examination allows you to see any disorders and neoplasms on the walls of the bladder. X-rays are used during the procedure. To obtain more accurate results, a contrast agent 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 bacterial, antibiotics are prescribed, fungi - fungicides, in case of allergies - antihistamines, etc. Acute cystitis involves taking antispasmodics, analgesics and nonsteroidal 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 course of antibiotic therapy at the moment of disappearance of the signs of the disease. Such an untreated disease often becomes chronic, endangering a person's overall health.
In chronic cystitis, drugs based on medicinal herbs show high effectiveness. 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.
Complex therapy of cystitis includes prescribing 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 foods and dishes are prohibited. The food should be as light as possible and supply the body with large amounts of vegetable fiber, which is necessary for the normal functioning of the intestinal microflora to ensure a high level of immunity. A copious warm drink is prescribed.
In some cases, surgery is the only treatment for the disease. It is usually 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 intercourse or hygiene procedures.
An operative method for the treatment of cystitis in men is prescribed for the appearance of cicatricial sclerosis, deformation of the bladder neck or permanent narrowing of the urethra.
More complex operations are performed for cervical, tuberculous and parasitic (with the ineffectiveness of drugs) cystitis. In an advanced form of the disease - gangrene - the damaged parts of the bladder are removed, and in complete gangrene - the entire organ.
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, then the inflammation spreads further to the kidneys, inflammation of the uterus and appendages is possible. It also reduces the elasticity of the bladder walls, which can lead to scarring or ulcers. The spread of the infection higher in the kidney leads to pyelonephritis. In the case of 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.
A complication of cystitis is also paracystitis, characterized by infection of the tissues of the small pelvis, which are 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. After treatment of cystitis, a complication appears in the form of cystalgia. It consists in maintaining painful urination, which is associated with disruption of receptors, but usually passes quickly enough.
Among other complications of the disease with cystitis can be distinguished a decrease in reproductive ability, 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 little from women's 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. This is one of the most complicated conditions, affecting the lining 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 inflammation of the bladder. At a time when the infection affects the entire mucous membrane of the organ, abscesses form on it, and later bleeding ulcers. For this reason, scars are formed, tissue elasticity is lost. All this leads to a decrease in the volume of the bladder.
Urgent surgical intervention is required for empyema when pus accumulates in the bladder due to decreased outflow. Dysfunction of the sphincter 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 cure. 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 foods, pickled, it is desirable to exclude or consume in limited quantities, drinking a lot 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, preventing their reproduction;
- do not drink coffee, orange, pineapple and grape juices, as they increase the acidity of urine;
- treats gynecological, urological and venereal diseases;
- normalization of the work of the digestive tract;
- observe the rules of personal hygiene;
- timely change of pads and tampons during menstruation, while the use of pads is preferable;
- wear comfortable underwear made of natural fabrics;
- refuse tight clothes, as they disrupt the blood circulation of the pelvic organs;
- prevents overfilling of the bladder;
- when you lead a sedentary lifestyle, get up, stretch every hour for at least 5-15 minutes;
- conduct regular preventive visits to a urologist and gynecologist.
It will also be useful to use herbal decoctions with antiseptic and anti-inflammatory properties (from calendula, chamomile, parsley, etc. ).