In 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 have suffered from this pathology at least once in their life. For men, the likelihood of suffering from cystitis increases after passing the milestone of 40-50 years.
Types of disease
Cystitis can be of several types. The cause of the development of the disease divides it into infectious and non-infectious.
Infectious cystitis
primary and secondary.In the first case, this is an independent disease: a healthy bladder is affected by the infection. In the second, it is a complication of other diseases: the mucosa becomes inflamed on the basis of an already developed pathology of the urinary system, kidneys or prostate.
Acute and chronic.In the acute form, 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 in recovery after a few days, even without treatment.
Depending on the location of the inflammatory focus:
- cervix - damage to the bladder neck;
- trigonal - inflammation of the triangle of the bladder (the area between the mouth of the ureters and the internal opening of the urethra);
- total - affects the whole body. In this case, the course of cystitis is particularly severe.
Postcoital.It develops within 1-2 days after sexual intercourse or vaginal manipulations. Its appearance is due to the entry of pathogenic microflora into a woman's urethra. During intimate relations, under the pressure from the movements of the penis, vaginal mucus is thrown into the urethra. From it, the infection freely enters the bladder. Also, prerequisites for the development of this type of disease are the frequent change of sexual partners, the abuse of contraceptive spermicides, the violation of intimate hygiene rules, the use of tampons, the 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 intercourse, the vaginal microflora is thrown into the urethra and bladder, which until then have 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.
Causes
Inflammation of the bladder 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. 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 in the bladder:
- adhesive - through the urethra. This is facilitated by improper care of the genitals, poor intimate hygiene, sexual 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 the diseased kidneys through the ureters, as well as with blood and lymph from the vessels of the rectum and genitals. The large intestine serves as the habitat 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 channels.
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, intestines, etc. ), but also nearby, in particular, 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 in its walls in the future;
- chemical burns due to the introduction of drugs into the bladder cavity;
- organ damage 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.
In the case of non-infectious cystitis, 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;
- decreased 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 (blood 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 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 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 sexual 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 ability of the bladder sphincter weakens, the vagina expands. In such conditions, the penetration of infection is facilitated;
- hormonal changes, especially during menopause.
Every tenth woman during pregnancy is at increased risk of developing cystitis. This happens for several reasons. First, during the birth of a child, women's immunity decreases. The body becomes more vulnerable to any type of infection. Secondly, the general hormonal background changes, which is a signal for the development of inflammatory diseases of the genitourinary system. Thirdly, an increase in the uterus leads to the squeezing of the bladder. This causes a 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 increase in the synthesis of progesterone, which reduces the tone of the bladder. In the future, blockage and a sharp development of infection occur.
cystitis in men
The presence of a long and curved urethra in men significantly reduces the risk of bladder infection. The possibility of developing cystitis in men under 40-50 years old, who respect the rules of personal hygiene, are extremely small. After exceeding 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 urethral stricture. 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 appears in a more severe form and is accompanied by fever and general intoxication of the body, since cystitis in men develops as complications of other diseases. The chronic form of the disease in men continues 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, a 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.
Symptoms of the acute form of cystitis are:
- elevated temperature;
- chills;
- general weakness;
- difficult and painful urination. Urine comes out in small portions. In this process, there is a burning sensation in the urethra, and after that - pain in the lower abdomen;
- the feeling of incomplete emptying of the bladder;
- pain in the suprapubic region before and after urination;
- sharp pains in the bladder area on palpation;
- pain in the external genital organs (scrotum, penis, etc. ).
In some cases, cystitis develops urinary incontinence, 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 likely to appear: elevated body temperature up to 38-40 degrees, sweating, thirst and dry mouth. As a rule, this indicates the spread of infection in the kidneys and renal pelvis, which leads to the development of pyelonephritis. In these conditions, urgent medical attention is needed.
In patients, the manifestation of clinical signs in acute cystitis occurs in different ways. In the mildest forms of the disease, patients can 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 rotten smell in it.
In chronic cystitis, the clinical signs of the disease are in many ways similar to acute cystitis, but less pronounced. Symptoms are permanent, only their intensity changes during treatment.
Diagnosing
The correct diagnosis of cystitis directly affects the success of the treatment of the disease. It is important to determine 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 determine which antimicrobial or antifungal drug it is sensitive to. The result of the study will determine the course of further therapy. If the cystitis is non-infectious in nature, it is necessary to carry out 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:
- collection of anamnesis;
- determination of clinical manifestations;
- appointment of laboratory tests;
- examination using instrumental methods.
Laboratory examination for cystitis
- General blood analysis. 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 analysis of urine. It detects the presence of proteins 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 an indicator strip. If there is an infection in the urine, then a reaction appears on the strip;
- rapid strip test to obtain data on the content of leukocytes and proteins in urine. The importance of the method is doubtful, since a general urine test can also cope with this task;
- leukocyte esterase reaction. This method allows you to identify the esterase enzyme. It accumulates if pus is present in the urine.
After completing the laboratory tests, the urine is cultured, that is, a culture study is performed. Its meaning is as follows: the pathogenic microflora that provoked 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.
The reliability of studies often suffers due to improper 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 insertion 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 allowed only in case of chronic cystitis, the presence of a foreign body in the bladder or with a prolonged course of the disease (10-12 days).
In addition to the above procedures, women with cysts are advised to undergo an examination by a gynecologist, diagnose genital infections, undergo an ultrasound examination of the small pelvis, biopsy, uroflowmetry and other studies.
In special cases, cystography is prescribed. This study allows you to see any violations and neoplasms in the walls of the bladder. During the procedure, X-rays are used. To obtain more accurate results, a contrast agent is injected through the catheter, which directs the organ to expand the field of vision. The results are visible on x-ray.
Treatment
Drug therapy is the main treatment of 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 being taken to improve the patient's immunity.
In acute cystitis, it is important not to interrupt the course of antibiotic therapy at the time of disappearance of the signs of the disease. Such an untreated disease often becomes chronic, threatening a person's overall health.
In chronic cystitis, drugs based on medicinal herbs show high efficiency. It is useful to take herbal decoctions that have anti-inflammatory and antibacterial effects. Physiotherapy methods may also be included: magnetophoresis, electrophoresis, induction and hyperthermia, EHF therapy, ultrasound treatment and laser therapy.
Complex therapy of cystitis involves prescribing a special diet for the patient. It is necessary to eliminate from the diet foods that irritate the bladder mucosa. Spicy, salty, fried, smoked and pickled foods and dishes are prohibited. Food should be as light as possible and provide the body with large amounts of plant fibers, which are 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 used 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 hygienic 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 persistent urethral stricture.
More complex operations are performed for cervical, tuberculous and parasitic cystitis (with the ineffectiveness of drugs). In the case of an advanced form of the disease - gangrenous - 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 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 develop sores or ulcers. The spread of the infection higher in the kidneys 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 in the tissues of the small pelvis, which are responsible for the innervation of the organs. The lesion causes scars, abscesses. In this case, saving the patient's life is possible only with surgical intervention. After the treatment of cystitis, a complication appears in the form of cystalgia. It consists in holding painful urination, which is accompanied by disruption of receptors, but usually passes quickly enough.
Among other complications of the disease with cystitis, a decrease in reproductive capacity, urinary incontinence can be distinguished. For 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 of women and only in relation to 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, it affects the mucosa 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 mucosa of the organ, abscesses and later bleeding ulcers are formed. For this reason, wounds are formed, 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 decreased flow. Dysfunction of the sphincter can also occur due to an infectious damage to 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, pickled foods, it is desirable to exclude or consume in limited quantities, drinking a lot of water;
- give up bad habits - smoking and drinking alcohol;
- drink more liquids (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;
- healing gynecological, urological and venereal diseases;
- normalization of the work of the digestive tract;
- observe the rules of personal hygiene;
- change pads and tampons on time during menstruation, while the use of pads is preferred;
- wear comfortable underwear made of natural fabrics;
- refuse tight clothes, as they disrupt the blood circulation of the pelvic organs;
- prevent overfilling of the bladder;
- when leading a sedentary lifestyle, get up, lie down every hour for at least 5-15 minutes;
- to carry out 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. ).