By itself, cystitis is not dangerous and does not cause difficulties in treatment, but it poses a threat 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 life. For men, the likelihood of getting cystitis increases after crossing the milestone of 40-50 years.
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, this is an independent disease: a healthy bladder is infected. In the second case, it is a complication of other diseases: the mucous membrane becomes inflamed based on 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 deterioration and decline. There are cases when acute cystitis ends with recovery after a few days, even without treatment.
Depending on the location of the focus of inflammation:
- cervical - damage to the neck of the bladder;
- trigonal - inflammation of the triangle of the urinary bladder (the area between the mouth of the ureter and the internal opening of the urethra);
- total - affects the entire organ. In this case, the course of cystitis is particularly difficult.
Postcoital.It develops within 1-2 days after sexual intercourse or vaginal manipulations. Its appearance is a consequence of the penetration of pathogenic microflora into the female urethra. During intimate intercourse, under the pressure resulting from the movement of the penis, vaginal mucus is expelled into the urethra. From it, the infection freely enters the bladder. Also, prerequisites for the occurrence of this type of disease are frequent change 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 deprivation of virginity against the background of existing violations of the vaginal microflora (candidiasis, etc. ). This happens for a similar reason: during sexual 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 occurrence, 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 the presence of blood impurities in the urine (hematuria);
- non-hemorrhagic - blood in the urine is not visualized.
Causes
Bladder inflammation in most cases (up to 85%) 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. It is rarely the cause of fungal diseases 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. Improper genital care, poor intimate hygiene, sexual life, etc. contribute to this. 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, radiation affects not only the organ affected by cancer (uterus, ovaries, prostate, intestines, etc. ), but also nearby, especially the bladder. A high dose of air can lead to burns of the mucous membrane of organs, after which ulcers and fistulas form on the walls in the future;
- chemical burn due to introduction of drugs into the bladder cavity;
- organ injury with a kidney stone;
- exposure to hot liquid of the bladder mucosa;
- allergic reaction. Not only sneezing, nasal congestion, etc. can appear on its background. , but also cystitis.
In the case of non-infectious cystitis, secondary infection usually occurs due to the vulnerability of the bladder lining.
Risk factors
There are many factors that contribute to the development of cystitis:
- hypothermia;
- reduced immunity;
- hypovitaminosis;
- improper diet. Spicy, salty, fried, fatty and alcoholic drinks irritate the bladder walls and dehydrate the body;
- violation of the microflora of the vagina;
- frequent and long-lasting constipation;
- bladder mucosa injuries;
- sedentary lifestyle (circulation disorders);
- tight clothing and synthetic underwear;
- the presence of chronic gynecological, urological or sexually transmitted diseases;
- previous urinary tract infections;
- non-observance of personal hygiene rules;
- improper use of pads and tampons;
- constant lack of sleep, excessive work, stress;
- promiscuity and unprotected sex;
- diabetes;
- 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 due to the fact that women most often suffer from it. Several factors contribute to this:
- anatomical characteristics 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 close to 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;
- childbirth in a natural way. In this case, the pelvic muscles lose their elasticity, the ability to contract the bladder sphincter weakens, and the vagina expands. In such conditions, the penetration of infection is facilitated;
- hormonal changes, especially during menopause.
Every tenth woman during pregnancy is at an increased risk of developing cystitis. This happens for several reasons. First, during childbirth, a woman's immunity decreases. The body becomes more sensitive to any type of infection. Second, 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 leads to compression of the bladder. This causes the deterioration of its blood supply and as a result leads to an increase in the probability of damage from pathogens. Do not forget about the increased synthesis of progesterone, which reduces bladder tone. In the future, there will be congestion and a sharp development of infection.
cystitis in men
The presence of a long and curved urethra in men significantly reduces the risk of bladder infection. The probability of developing cystitis in men younger than 40-50 years old, who follow the rules of personal hygiene, is extremely small. After overcoming this age limit, with 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 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 - the causative agent of cystitis.
The disease in men occurs in a more severe form and is accompanied by an elevated temperature and general intoxication of the body, because cystitis in men develops as a complication of other diseases. The chronic form of the disease in men passes almost 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 weak protective properties of the mucous membrane of the urinary bladder, a wide and short urethra and a 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 generally be asymptomatic.
Symptoms of an acute form of cystitis are:
- elevated temperature;
- chills;
- general weakness;
- difficult and painful urination. Urine comes out in small portions. There is a burning sensation in the urethra, followed by pain in the lower abdomen;
- feeling of incomplete emptying of the bladder;
- pain in the suprapubic region both 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, cystitis develops urinary incontinence, caused by a strong urge to urinate.
Urine may 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 organism is likely: elevated body temperature up to 38-40 degrees, sweating, thirst and dry mouth. As a rule, this indicates the spread of the infection to the kidneys and renal pelvis, which leads to the development of pyelonephritis. In these conditions, urgent medical assistance is required.
In patients, the manifestation of clinical signs of acute cystitis occurs in different ways. In milder forms of the disease, patients may feel only 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 sudden 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 they are less pronounced. Symptoms are permanent, only their intensity changes during treatment.
Diagnostics
The 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 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, it is necessary to determine its causative agent and determine which antimicrobial or antifungal drugs it is sensitive to. The result of the study will determine the course of further therapy. If cystitis is of a non-infectious nature, it is necessary to conduct an examination to determine the causes that caused the appearance of the disease. Perhaps the cause is urolithiasis or a neoplasm.
Diagnosis of the disease includes the following steps:
- collection of anamnesis;
- determination of clinical manifestations;
- determination of laboratory tests;
- examination by instrumental methods.
Laboratory examination 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 urinalysis. 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;
- rapid test with strips to obtain data on leukocyte and protein content in urine. The importance of the method is questionable, because a general urine test can also cope with this task;
- leukocyte esterase reaction. This method allows you to identify the enzyme esterase. It accumulates if pus is present in the urine.
Upon completion of the laboratory tests, urine culture, i. e. a cultural study, is carried out. Its meaning is as follows: the pathogenic microflora that caused the development of cystitis is studied and the sensitivity of microbes to antibiotics is determined. Such an examination allows you to prescribe the most effective drugs.
Reliability of studies often suffers due to improper sampling of material and non-observance of hygiene rules by the patient.
Instrumental research methods
Among the instrumental methods for diagnosing the disease, the most common is cystoscopy, which consists in the visualization of 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, because 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 the case of chronic cystitis, the presence of a foreign body in the bladder or a long-term course of the disease (10-12 days).
In addition to the above procedures, women with cystitis are advised to have an examination with a gynecologist, diagnosis of genital infections, ultrasound examination of the pelvis, biopsy, uroflowmetry and other studies.
In special cases, cystography is prescribed. This study allows you to see any 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 a 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, antibiotics are prescribed, fungi - fungicides, for allergies - antihistamines, etc. Acute cystitis involves taking antispasmodics, analgesics and non-steroidal anti-inflammatory drugs. Additional measures are taken to improve the immunity of patients.
In case of acute cystitis, it is important not to stop the course of antibiotic therapy at the moment when the signs of the disease disappear. Such an untreated disease often becomes chronic, threatening a person's overall health.
In chronic cystitis, drugs based on medicinal plants show high efficiency. It is useful to take herbal decoctions that have anti-inflammatory and antibacterial effects. Physiotherapy methods can also be included: magnetophoresis, electrophoresis, induction and hyperthermia, EHF therapy, ultrasound treatment and laser therapy.
Complex therapy of cystitis includes the appointment of a special diet for the patient. Foods that irritate the bladder mucosa should be eliminated from the diet. Spicy, salty, fried, smoked and sour food and dishes are prohibited. The food should be as light as possible and should deliver large amounts of plant fibers to the body, which are necessary for the normal functioning of the intestinal microflora in order to ensure a high level of immunity. An abundant 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 sexual intercourse or hygiene procedures.
The operative method of treating cystitis in men is prescribed in case of cicatricial sclerosis, deformation of the bladder neck or persistent narrowing of the urethra.
More complex operations are performed in the case of cervical, tubercular and parasitic cystitis (with the ineffectiveness of drugs). In the case of an advanced form of the disease - gangrene - the damaged areas of the bladder are removed, and if the gangrene is total, then the entire organ.
Complications
Vesicoureteral reflux is the most dangerous complication. It is expressed in the fact that urine is expelled into the ureters. If the process is not stopped, 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 develop scars or ulcers. The spread of the infection further into the kidneys leads to pyelonephritis. In case of this disease, the amount of urine decreases. Urine accumulates in the kidneys and causes peritonitis, because the kidneys do not fully perform their functions. This requires immediate surgical intervention.
A complication of cystitis is paracystitis, characterized by infection of the tissues of the small pelvis, which are responsible for the innervation of the organ. The lesion causes scars, abscesses. In this case, saving the patient's life is possible only through surgical intervention. After the treatment of cystitis, a complication in the form of cystalgia occurs. It consists of maintaining painful urination, which is associated with a receptor disorder, but usually passes quickly enough.
Among other complications of diseases with cystitis, one can distinguish a decrease in reproductive capacity, urinary incontinence. For pregnant women, untreated cystitis can lead to miscarriage, as the inflammation can spread to the fetus.
In men, the complications of cystitis are slightly different 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. It is one of the most complex conditions, affecting the mucous membranes of the bladder walls. Purulent processes can lead to necrosis of 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.
Another dangerous complication of the pathology is the occurrence of diffuse ulcerative cystitis and empyema. They arise with insufficient therapy for inflammation of the urinary bladder. At the time when the infection covers the entire mucous membrane of the organ, abscesses are formed on it, and later bleeding ulcers. For this reason, scars form, tissue elasticity is lost. All this leads to a decrease in the volume of the bladder.
Emergency surgical intervention is required for empyema, when pus accumulates in the bladder due to reduced 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. This is recommended for:
- avoid hypothermia. You should not sit in the cold, swim in cold water, or dress lightly in winter;
- eat properly. Spicy, hot, sour, salty, fried, fatty, sour, it is preferable to exclude or consume in limited quantities, drink 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;
- treat gynecological, urological and venereal diseases;
- normalize the work of the digestive tract;
- adhere to the rules of personal hygiene;
- timely change pads and tampons during menstruation, while the use of pads is desirable;
- wear comfortable underwear made of natural fabrics;
- refuse tight clothing, because it disturbs the blood circulation of the pelvic organs;
- prevent overfilling of the bladder;
- when you lead a sedentary lifestyle, get up, stretch every hour for at least 5-15 minutes;
- perform regular preventive visits to the urologist and gynecologist.
It will also be useful to use herbal decoctions with antiseptic and anti-inflammatory properties (from calendula, chamomile, parsley, etc. ).