Cystitisis a condition characterized by the development of an inflammatory process that affects the bladder wall as a result of exposure to bacterial microorganisms.
Statistical cystitisis one of the most common urological disorders. Women are much more prone to the occurrence of this inflammation, due to their morphophysiological characteristics.
Causes of cystitis in women
Cystitis is considered a polyethiological pathology.
Bacterial agents can enter the bladder cavity in three ways:
- Upward path- through the urethra (urethra). The main role in this variant of the penetration of microorganisms belongs to the anatomical and morphological characteristics of the female urinary tract: a short and wide urethra, close to the anus and the vagina.
- Descending path- from the kidneys. This option develops as a complicated course of renal inflammation, for example, chronic pyelonephritis.
- Hematogenous route- the rarest option, is established when cystitis appears immediately after an infectious disease or when another source of purulent infection is found in the female body. There is also the possibility of bacterial microflora entering the bladder due to the presence of anatomical anastomoses (connections) between the lymphatic vessels of Organs genitals and the bladder, as long as inflammatory changes occur in the anterior ones.
The most common causative agent of the inflammatory process of the bladder is E. coli (in 4 out of 5 cases, which is associated with the anatomical and morphological characteristics mentioned above and the presence of this microflora in the intestine).
Less commonly, cystitis is associated with staphylococcal, streptococcal and enterococcal microorganisms. Gram-negative rods cause inflammation of the bladder as a result of instrumental and surgical interventions.
The incidence of cystitis associated with fungal microorganisms, protozoa and viruses has recently increased.
The introduction of infectious microorganisms alone is not sufficient for the development of a full inflammatory response in the bladder, as the organism has mechanisms of resistance to the action of pathogenic flora.
Factors for the development of cystitis
Thus, in addition to the etiological factor, factors that are involved in the formation of cystitis:
- hemodynamic function disorder(blood circulation) of Organs pelvic organs and, in particular, the bladder;
- disorder of urinary bladder excretory function(stagnation of urine);
- suppression of various immune components of the body(lack of vitamins, exposure to low temperatures, stress, increased fatigue, etc. );
- harmful effects of biochemical agentsand metabolic products that are excreted in the urine in the bladder wall structure;
- X-ray exposure;
- poor hygieneexternal genitalia and promiscuous sex;
- pathologies of the gastrointestinal tract, in the presence of which the microflora accumulates and increases its activity, later entering the urinary tract;
- Regular changes in hormonal metabolism, which leads to a lack of tone in the urethra and creates better conditions for infections.
The first symptomatic manifestations of cystitis in women
For the acute cystitis clinic, a woman is characterized by a sudden onset and a pronounced symptom complexwith:
- The appearance of frequent urination (polaquiuria), which is characterized by a frequency of at least once every 60 minutes and small volumes of urine; with the development of frequent urgency, patients become unable to control and retain urine;
- Dysuria (urinary disorder)is accompanied by pain in the hypogastric region (lower abdomen). With the development of the degree of the inflammatory process in the bladder wall, these symptoms progress: the more it develops, the more frequent the urge to urinate and the more intense the pain;
- Itching in the urinary tractthat occurs during urination. It develops as a result of exposure to the urinary tract mucous membrane of metabolic products from microorganisms that caused inflammation of the bladder;
- The appearance of drops of bloodat the end of the urination;
- The appearance of urine clouding, which is caused by the entry of a large number of blood cells (leukocytes and erythrocytes), bacterial microflora, cells of the superficial epithelium of the inner wall of the bladder;
- These patients are not characterized by a change in general condition.Patient temperature indicators are characterized by normal or slightly increased (subfebrile) numbers. Scientists attribute this to the fact that the mucous membrane of the bladder practically does not absorb the metabolic products of microorganisms, which, when entering the bloodstream, usually lead to intoxication of the organism and the development of characteristic symptoms of inflammation.
The connection between the sudden onset of symptoms and the previous hypothermia of a woman's body is important. Acute inflammation phenomena can sometimes be observed for 2-3 days and disappear on their own without the use of therapy.
However, in most cases, this process takes more than 6 days, sometimes up to 15 days. The presence of the disease at a later date, subject to the appointment of therapy, requires the indication of additional examination methods to identify concomitant body pathologies.
Characteristics of pain syndrome in women with cystitis
Patients with acute cystitis have varying degrees of pain syndrome:
- With a mild course of the inflammatory process, patients experience light weight or pain in the lower abdomen.Mild pain at the end of the urination accompanies moderate polaquiuria. As the inflammatory process develops, the intensity of the pain increases. In the subsequent period, this syndrome accompanies the beginning or all of the urination. Pain in the suprapubic region is no longer related to the act and becomes almost permanent, accompanied by very painful palpation on the projection of the bladder.
- In a situation where severe cystitis has developed, patients have to urinate at least 2-3 times an hour, which is accompanied by significant pain and bleeding from the urethra at the end of the act. Pain significantly worsens the patient's quality of life, as it does not disappear throughout the day.
The presence of blood cells and blood in the urine with cystitis (hematuria syndrome)
When inflammation develops in the bladder walls, it affects areas of tissue close to the confluence of the ureters and the exit of the urethra. The tissue is loose and bleeding.
This is manifested by the appearance of micro and macrohematuria (or blood) in the urine, which is often seen at the end of the urination (terminal hematuria).
One of the most serious forms of acute cystitis is considered hemorrhagic. This type of inflammation occurs when red blood cells (erythrocytes) penetrate significantly from the bloodstream of the supply arteries to the bladder cavity.
This option is possible in case of increased permeability of the blood vessel walls (condition with anemia, vitamin deficiency, disturbances in the functioning of the blood clotting system) or damage to the walls above by bacterial cells (usually streptococcal flora). Red blood cells trapped in the bladder cavity stain the urine with the color of blood.
When a hematuric syndrome arises, the doctor must carefully make the differential diagnosis between acute cystitis and a complicated acute form - hemorrhagic cystitis. For this, additional examination methods are prescribed, the type of lesion is discovered and the most correct regimen for the therapy is selected.
Characteristics of the course of acute and chronic cystitis in women
Summarizing the information above, it is possible to distinguish a marked onset of the specific disease for acute cystitis and the presence of a certain symptom complex:
- frequent urination in small portions,
- pain syndrome of various natures,
- itching associated with urination
- the appearance of drops of blood at the end of the act,
- unchanged general condition of a woman.
With the correct and timely diagnosis, the pathological condition is cured in 6 to 10 days. In the absence of improvement after the 15th day of the disease, it is worth thinking about the chronicity of inflammatory changes.
In addition to hemorrhage, there are two more forms of the complicated course of acute cystitis:
- Gangrenous.The gangrenous form is rare and occurs due to a violation of the blood supply or innervation of the bladder. Clinically, this cystitis is manifested by difficulty in urinating, accompanied by pain, elevated body temperature, pain in the sacral region. The process is extremely dangerous with the development of formidable complications, such as peritonitis, and requires immediate action in relation to treatment.
- Phlegmatic.The phlegmonous form is manifested by significant intoxication of the body, high body temperature and is accompanied by the release of a small amount of urine (oliguria). With such a complicated course, the urine acquires a putrid odor, cloudy character, flakes of fibrin formation, blood impurity.
The duration of the pathology course in the case of the development of complicated forms is significantly increased.
There is another form of cystitis - interstitial.It is characterized by the inflammation of all urinary membranes. The clinic is dominated by acutely frequent urination, reaching up to 180 times a day, active complaints of severe pain in the hypogastric region when filling the bladder and its regression after urination. The capacity of the bladder is significantly reduced, which results in the above symptoms.
Chronic cystitis, in contrast to acute cystitis, occurs extremely rarely as a primary pathology and, in most cases, is a secondary complication of the course of existing pathologies of the bladder, kidneys, urethra.
In view of this fact, it is necessary to carefully examine the body for the presence of the above pathological changes, as well as to exclude or confirm the specific origin of the microorganisms - tuberculosis bacillus, invasion by Trichomonas.
Clinically, chronic cystitis manifests itself as a continuous course with moderate differences in complaints and clinical analysis of urine, or in the form of recurrent pathology with periods of exacerbation (similar to the acute cystitis clinic) and complete regression (with absenceof any manifestations of the pathological process).
Thus, the objective manifestations of chronic cystitis correspond to those of the acute process. They correlate with the general protective properties of the body, the etiology of the bacterial agent that caused the infectious process and the severity of the inflammation. Pain, frequent urination, itching, presence of blood and turbidity of the urine are less pronounced with a constant course and correspond to an acute process with a recurrent course of chronic cystitis.
Due to the lesion of the inflammatory reaction of the mucous membrane, edema of all layers of the urinary wall and increased intravesical pressure, all conditions are created for the formation of vesicoureteral reflux, that is, throwing fluid from the bladder back tothe ureter (connects the kidneys and the bladder).
Diagnosis of cystitis in women
The urologist is responsible for verifying the diagnosis and prescribing therapy for cystitis.
In order to correctly diagnose inflammatory pathology, it is necessary to clearly record the patient's complaints and her anamnesis (which preceded the development of the pathology).
The clinical manifestations are quite specific and can immediately indicate the presence of this disease, however, it is necessary to carefully make the differential diagnosis between all types of cystitis, as well as other pathologies of the bladder and diseases of Organs abdominal organs.
From the anamnesis, data on stress and exposure to low temperatures, medications in use, as well as other lesions located in Organs pelvic organs and in the genitourinary system will be useful.
After the complaints and anamnesis has been cleared up, a (general) clinical examination of urine can assist in verifying the diagnosis - it will reveal increased levels of white and red blood cells (leukocytes and erythrocytes, respectively).
To identify the type of bacterial microorganism that caused the inflammatory process, urine is grown in a special nutrient medium, which can be used later to select the most effective antibacterial medication.
Before urinating for bacteriological examination, it is necessary to qualitatively treat the area of the external genitals with an antiseptic solution. Cystoscopy in the presence of an acute inflammatory reaction is contraindicated.
In order to diagnose chronic cystitis, together with the collection of complaints and anamnesis data, cystoscopy during the remission period helps. This will establish all the necessary characteristics of the inflammatory disease. With this manipulation, it is possible to remove a biopsy material - the urinary mucosa. In addition, to identify chronic cystitis, it is recommended to perform an X-ray examination with contrast.
Cystitis in pregnant women
Any pathological changes in the female body during pregnancy are accompanied by a certain risk to the fetus.
In addition, an unstable and even unstable pregnant woman to stress not only feels the discomfort of the disease itself, but also worries about the health of the fetus.
During pregnancy, a woman's hormonal metabolism changes and, as a result, her immunity significantly decreases.
This fact is the most important prerequisite for the development of the inflammatory process.
The bacterial microflora that enters the bladder cavity does not show significant resistance from the immune cells and a focus of inflammation is formed. The symptoms of cystitis in pregnant women correspond to the acute inflammation clinic described above.
Thus, given the vulnerability of the female body during pregnancy to the effects of microorganisms, the obstetrician-gynecologist is obliged to carefully monitor the condition of the patients, while the pregnant woman must consult the doctor in case of any violation.
Acute cystitis is dangerous due to the development of kidney inflammation - pyelonephritis, which significantly worsens the patient's condition and adversely affects the health of the fetus.
It is dangerous to perform medical procedures in the immediate postpartum period, because there is a decrease in the tone of the urethra and changes in the mucous membrane of the bladder. The symptoms are dominated by impaired urinary function, pain at the end of the act and possible turbidity of the urine.
Cystitis at girls
It is statistically observed that girls of school and pre-school age are more prone to inflammatory processes in the bladder than other children.
Scientists attribute this to a number of factors:
- In addition to the morphophysiological characteristics, during this period the hormonal function of the ovaries has not yet been formed in girls, the immune system does not work as in older children and adults.
- In part, the increase in morbidity at this age is due to inadequate or insufficient hygiene of the external genitals due to the child's parents(at an early age) or due to a lack of care skills ingirls.
- The development of acute cystitis in girls during puberty and after puberty may be associated with deflowering of the hymen, in which case deflowering cystitis is mentioned. At a very early age, when urine enters the vaginal mucosa, an inflammatory reaction occurs in the latter, which leads to the reflux of the microflora back into the bladder cavity, forming a vicious circle.
The clinical manifestations of acute inflammation of the urinary bladder in girls are:
- Frequent urination, accompanied by pain in the abdomen.This problem manifests itself most often between the ages of 6 and 13, and girls don't always have time to go to the bathroom. The pathology is completely cured in 3-4 days with the help of properly selected antibacterial drugs.
- The timing of the inflammatory process is more dangerous, which requires a complete diagnosis for the development of complications.This type of cystitis is clinically expressed by frequent urination and the presence of pain in the lumbar and abdominal region.
- If urethritis occurs in a child, a pathological reflux of urine from the urethra back into the bladder may form, which will lead to a relapse of the disease or the worsening of an existing pathology.This complication is called reflux and develops as a result of turbulence in the flow of urine at the end of the urinary tract.
- It has been established that in girls with chronic recurrent bladder inflammation, urine entering the vaginal mucosa causes an inflammatory process. Subsequently, the microflora of that area returns to the urethra, which leads to the simultaneous defeat of the bladder, urethra and vagina.
Treatment of bladder inflammation in women
When choosing a set of therapeutic measures to cure any pathology, first, it is necessary to decide on the diet and diet. Thus, in acute cystitis, the patient needs outpatient treatment, with the exception of complicated cases where hospitalization is inevitable.
Diet therapy includes increasing fluid intake to increase urine production (it is recommended to drink plenty of water and / or unsweetened tea), excluding dishes that have an irritating effect on the mucous membranes (spicy, salty, spicy) andalcohol. The diet should be dominated by products of plant origin and lactic acid.
In the treatment of cystitis in women, three main types of drug therapy should be used:
- pathogenic symptomatic
From the names of each type of treatment, it is clear which factors in the development of the disease are affected.
The first step is the choice of etiotropic therapy - the impact on the causative agent of the disease.
For that, antibacterials from the group of Nitrofurans or Fluoroquinolones are prescribed as prescribed by the attending physician. When a specific causative agent of the inflammatory process is identified, the appropriate drugs (antiviral, antifungal) are selected.
In the case of a bacteriological examination of the patient's urine, it is possible to select the most effective antibiotic in a specific situation with its additional prescription.
Antibiotic therapy is performed for 3 to 14 days, even if the clinical symptoms disappear long before these terms. Only with the indication of the correct antibiotic therapy can the causative agent of the disease be completely eliminated.
To conduct pathogenic and symptomatic therapy, several groups of drugs are prescribed:
- non-steroidal anti-inflammatory drugs- are indicated in the presence of constant pain in the patient, are fast-acting and also affect the degree of the inflammatory process;
- antispasmodics- help to stop attacks of severe pain syndrome;
- M-anticholinergics- help to reduce the frequency of urination;
- Immunomodulators- increase the protective properties of the woman's body.
Treatment of cystitis at home
In addition to the use of drugs, in the treatment of cystitis in women, folk remedies in the form of decoctions, which are prepared at home and have pronounced immunomodulatory properties, should be used:
- Lingonberryis used to treat all organs of the urinary system, including cystitis.To prepare the product, take 1 tablespoon of blueberry berries and pour 1 glass of heated water until it boils. After that, the mixture is infused for at least 1 hour. It is prescribed to drink half a glass before meals, 3 times a day. It can also be used in the form of herbal preparations, consisting of 3 parts of the blackberry leaves, 2 parts each of violets, dandelion, sage. 1 part of the marshmallow, chamomile and mint rhizome is added to the collection. In the container, the mixture is filled with hot water and infused for at least 1 hour. The finished product is taken 2 tablespoons up to 8 times a day.
- Horsetail also has a beneficial effect in the treatment of cystitis.The preparation recipe is simple: add 2 cups of boiling water to 2 tablespoons of ponytail, leave for 1 hour and consume this volume during the day.
However, care must be taken to ensure that the patient does not have inflammatory kidney disease, in which these loads are contraindicated.
Recommendations after treatment
Depending on the woman's age (girl), causes of occurrence and predisposing factors, patients are advised to monitor responsibly, excluding the impact of previous culprits on the development of the inflammatory process:
- It is necessary, during the next month after recovery, to use herbal decoctions and follow the prescribed diet.
- At the first signs of cystitis, try to rest at home in bed.
- In the case of chronic cystitis, it is necessary to reduce as much as possible all the factors that lead to the development of an exacerbation of the process.
Prevention of cystitis among women and girls
To prevent this inflammatory disease, it is necessary to:
- Get regular checkupsand immediately identify all medical problems.
- The elimination of stress factorsand strict adherence to the thermal regime (without prolonged exposure to low temperatures) are important.
- The woman must maintain hygiene, for that it is enough to change her underwear regularly and at least one wash of the external genitals per day.
- It should be remembered that the key to success in preventing many pathological changes is to strengthen the immune systemin several ways, one of which is medication.
Therefore, cystitis is a very common disease, but easy to diagnose. There are well-studied reasons and factors that predispose to the development of a pathological inflammatory process.
It is necessary to remember the importance of a timely visit to the doctor to prevent the development of a chronic (if not secondary) process, as well as a series of serious complications, some of which are life-threatening for the patient.
An acute cystitis clearly differentiated and detected early requires the indication of a simple scheme for the eradication of antibiotic therapy, pathogenic and symptomatic situational treatment, strict adherence to the established diet and regime.
If all the recommendations and consultations above are observed, the prognosis of life and the ability to work are favorable.