Acute Cystitis

Acute cystitis is an inflammatory process, mainly of infectious origin, located in the mucous membrane of the bladder and clinically manifested by frequent and painful urination, low-grade fever, and the appearance of blood or pus in the urine.

Acute cystitis is one of the most common urological diseases.

healthy bladder and acute cystitis

Acute cystitis is an inflammation of the lining of the bladder.

Causes and risk factors

The infection enters the bladder primarily ascending (through the urethra) or descending (through the kidneys). Much less frequently, pathogenic microorganisms enter the bladder via the hematogenous route, ie, they are carried with the blood flow from the source of the primary infection, or by contact through the bladder wall.

In the context of the inflammatory process, the blood vessels in the bladder wall expand and their permeability increases. The mucous membrane becomes hyperemic and swells. Subsequently, at the focus of inflammation, erythrocyte sweating occurs, which leads to hemorrhagic phenomena. In a severe form of the disease, inflammation can also spread to the deeper layers of the bladder.

Most often, the development of acute cystitis is caused by gram-negative microbial flora (Escherichia coli, Klebsiella, Proteus). Gram-positive microorganisms (staphylococci, proteus), as well as microbial associations, cause inflammation in about 20% of cases.

acute cystitis with inflammation of the mucous membrane of the bladder

Predisposing factors for the development of acute cystitis are parainfluenza, adenovirus infection, which causes disturbances in the innervation and blood supply of the bladder wall, which creates favorable conditions for the development of bacterial flora.

Normally, a person's urinary tract is constantly cleaned by a stream of urine. In addition, the uroepithelium cells synthesize a special substance of mucopolysaccharide nature, which covers the inner surface of the bladder, protecting it against infections. The production of a protective substance is regulated, among other things, by female sex hormones - progesterone and estrogen. It is in connection with the change in the level of these hormones in women that acute cystitis is more common in the postmenopausal period.

Any damage to the protective mucous layer creates the prerequisites for the development of acute cystitis. These damages can be caused by:

  • trauma to the inner layer of the bladder (urethroscopy, cystoscopy, bladder catheterization);
  • violations of urodynamics, ie, the correct flow of urine (neurogenic bladder);
  • metabolic diseases, accompanied by the development of crystalluria;
  • exposure to ionizing radiation, aggressive and toxic chemical substances;
  • decreased general and local immunity due to frequent viral infections, hypovitaminosis conditions.

In girls and women, acute cystitis usually develops in the context of vaginal dysbiosis (dysbiosis) or as a result of a violation of personal hygiene rules. The development of acute cystitis in men and boys is often associated with the presence of anatomical and functional pathologies (phimosis, urethral stenosis, neurogenic dysfunction, diverticulum or bladder neck stenosis).

An important role in the pathological mechanism of disease development is played by blood stagnation in the small pelvis.

With a predisposition to acute cystitis, the introduction of cranberry juice in the daily diet is recommended, as cranberries contain benzoic acid, an antiseptic that is excreted in the urine.

Forms of the disease

According to the clinical picture, acute catarrhal and hemorrhagic cystitis are distinguished. The hemorrhagic form of the disease is characterized by micro or macrohematuria (a mixture of blood in the urine).

By the degree of dissemination of the inflammatory process:

  • focal (cervical trigonitis);
  • total (diffuse).

Depending on the type of pathogen:

  • specific (tuberculous, gonorrhea, chlamydia, trichomonas);
  • nonspecific.

The risk of developing specific acute cystitis in men and women increases with active sexual activity, with frequent changes of sexual partners.

Acute Cystitis Symptoms

The clinical picture of acute cystitis is very clear, characterized by:

  • imperative (appearing suddenly, stronger, often with the impossibility of containing) desire to urinate;
  • urine excretion (voiding) in small portions;
  • pain and cramps that occur at the end of urination;
  • terminal hematuria (a mixture of blood that appears in the urine at the end of urination);
  • change in the transparency and color of urine (cloudy, sometimes with a reddish hue);
  • pain, sometimes very intense, in the bladder, anus, perineum.
lower abdominal pain with acute cystitis

Acute cystitis is characterized by severe pain and frequent need to urinate.

In acute cystitis, the urge to urinate occurs even when a small amount of urine (less than 150 ml) accumulates in the bladder, due to the reflex contraction of the detrusor. The frequency of urination is determined by the severity of the inflammatory process and can go up to 3-4 times per hour.

Symptoms of acute cystitis with location of the pathological process in the bladder neck:

  • constant sharp pain radiating to glans penis, anus;
  • acute reflex urinary retention due to spasm of the pelvic floor and external sphincter muscles under the influence of severe painful irritation.

Diagnosis

The diagnosis of acute cystitis is based on the characteristic clinical manifestations of the disease. The diagnosis is confirmed by the results of the laboratory and instrumental examination, including:

  • general urine analysis (bacteriuria, leukocyturia, erythrocyturia, a significant amount of mucus and squamous epithelial cells are characteristic);
  • bacteriological examination of urine - allows identifying the causative agent of the disease, as well as determining its sensitivity to antibiotics;
  • a general blood test (with an uncomplicated course of acute cystitis, usually no changes are detected, the test is performed to determine general health and detect possible concomitant pathology);
  • Bladder ultrasound in the context of physiological filling (in the bladder cavity there is an eco-negative suspension, a thickening of the inner walls of the organ);
  • urodynamic exam (performed with complicated acute cystitis and aims to identify possible neurogenic bladder dysfunction);
  • study of prostate secretion, bacteriological dissemination of urethral secretion, prostate ultrasonography (with acute cystitis in men).
  • gynecological examination, microscopy and bacteriological examination of secretions from the vagina, urethra and cervical canal, PCR studies for sexually transmitted diseases (with acute cystitis in women).

Acute cystitis is one of the most common urological diseases.

After the disappearance of the acute inflammatory process, cystography and cystoscopy are performed to clarify the cause of the disease.

bladder ultrasound with acute cystitis

Bladder ultrasound is included in the complex diagnosis of acute cystitis.

Acute cystitis requires differential diagnosis with urolithiasis and bladder tumors, acute paraproctitis, acute appendicitis, acute pyelonephritis.

Acute Cystitis Treatment

In acute cystitis, the patient is referred to bed rest, a diet with little milk and vegetables and plenty of drink (2. 5-3 liters of fluid per day). Sex life is excluded during the entire period of therapy. For the treatment to be successful, it is important to evacuate daily.

In the treatment of acute cystitis, local thermal procedures (heated sitz baths with herbal decoctions, dry heat in the bladder region) are widely used, which help to reduce the symptoms of the disease. However, hot baths and bladder flushing in the acute phase are strictly contraindicated.

Medical treatment of acute cystitis consists of the use of antibacterials, uroseptics, antihistamines and analgesics. Antibacterial drugs are prescribed taking into account the type of pathogen and its sensitivity to antibiotics. Until the results of bacteriological research are obtained, broad-spectrum antibiotics are used, mainly excreted in the urine, as well as preparations from the nitrofuran series.

For uncomplicated acute cystitis in adults, fluoroquinolones are used and, in children, nalidixic acid and cephalosporins are used. The choice of antibiotic is strictly made by the treating physician. Antibiotic therapy lasts 7 to 10 days.

dry heat for acute cystitis

Dry heat in the bladder area helps with acute cystitis.

The treatment regimen for acute cystitis can be supplemented with herbal medicines. Pharmaceutical preparations based on medicinal herbs with anti-inflammatory, antiseptic, tanning and diuretic effects are recommended.

After the relief of symptoms of acute cystitis, physical therapy procedures (inductothermia, UHF, electrophoresis, magnetic and/or laser therapy) are prescribed.

Possible consequences and complications

The most common complications of acute cystitis are:

  • the transition from inflammation to the chronic form, characterized by a persistent course, resistant to therapy, with periods of remission and exacerbations;
  • interstitial cystitis - the inflammatory process affects not only the mucous membrane but also the deeper layers of the bladder wall (submucosa, muscular);
  • paracystitis - the release of the inflammatory process outside the bladder with damage to the surrounding fiber;
  • cystalgia - painful and frequent urination, not accompanied by the development of pyuria (often develops in women);
  • acute pyelonephritis - an infection of the bladder through the ureters that enters the kidneys, causing inflammation in the kidneys;
  • Gangrenous cystitis is a serious complication that threatens bladder rupture and the development of peritonitis.

In girls and women, acute cystitis usually develops in the context of vaginal dysbiosis (dysbiosis) or as a result of a violation of personal hygiene rules.

Prediction

The mucous membrane of the bladder has a high regenerative capacity, so as long as treatment is started at the right time, in most cases acute cystitis ends with complete recovery in 7 to 14 days. The prognosis worsens with the development of complications.

Prevention

Prevention of acute cystitis includes the following measures:

  • regular emptying of the bladder to prevent urinary stagnation;
  • correct water regimen, providing sufficient diuresis (1-1, 5 liters per day);
  • compliance with personal hygiene standards;
  • adequate and timely treatment of genital infections and other infectious diseases;
  • increase the body's overall immunity (adequate nutrition, rejection of bad habits and promiscuous sex life, sports, adherence to the daily routine);
  • the smoothest and most delicate execution of urological operations and bladder manipulations.

With a predisposition to acute cystitis, the introduction of cranberry juice in the daily diet is recommended, as cranberries contain benzoic acid, an antiseptic that is excreted in the urine.