Cystitis is an inflammation of the walls of the bladder. It is characterized by frequent (every 15-20 minutes), sharply painful urination in small portions, sometimes with an admixture of blood, subfebrile body temperature. The transition of the disease into a chronic form, the ascent of infection with the development of an inflammatory process in the kidneys is possible. In the diagnosis of cystitis, the urine analysis data and the results of bladder ultrasound are informative. To determine the etiology of cystitis, a clinical analysis and bacterial culture of urine is carried out. Therapy of cystitis implies, first of all, an effective drug effect on the infectious agents that caused it.
ICD 10
N30 Cystitis
Meaning
Cystitis is an inflammation of the mucous membrane of the bladder. The disease is widespread in the population, affects adults and children, but is statistically more common in women due to the anatomical features of the structure of the female urethra.
In the USA, from 26 to 36 million people get sick with acute cystitis every year. At the same time, the incidence rates among women are 500-700 episodes per 1000 people, among men aged 21 to 50 years − 6-8 cases per 1000. In children, cystitis most often occurs at the age of 4 to 12 years. Girls suffer from cystitis three times more often than boys. According to various studies, from 11 to 21% of the population suffers from chronic form.
Causes
Infectious
Cystitis is a polyetiological disease. Most often it has an infectious etiology and is caused by representatives of conditionally pathogenic flora:
- in 75% of patients suffering from acute cystitis, the cause of the disease is E. coli;
- in 10-15% of patients, Staphylococcus saprophyticus is detected,
- Klebsiella (Klebsiella spp) is sown in 10%.
- proteus and other enterobacteria are less common.
The causative agents of cystitis can be not only bacteria, but also viruses, mycoplasmas, trichomonas, chlamydia and various fungi. The predominant pathogen penetration pathway is ascending, rarely descending (from the kidneys), rarely hematogenic (with sepsis) and lymphogenic (from other pelvic organs). The entry of microorganisms into the bladder from the urethra is facilitated by:
- inflammation of the urinary tract (urethritis, pyelonephritis) and genitals (colpitis, salpingoophoritis – in women; prostatitis, epididymitis, vesiculitis – in men);
- performing medical manipulations (bladder catheterization, cystoscopy);
- incorrect intimate hygiene technique;
- increased sexual activity;
- presence of infravesical obstruction (urethral valves, bladder neck sclerosis, urethral strictures, etc.);
- rare urination.
Non-infectious
Less often, cystitis occurs without the participation of infectious pathogens. In this case, the direct effect of irritating factors that cause aseptic inflammation on the bladder mucosa comes to the fore:
- chemicals (with intravesical instillation of drugs, chemotherapeutic drugs);
- ionizing radiation (during radiation therapy for malignant neoplasms of the pelvic organs);
- urinary calculi (with urolithiasis);
- allergic agents, immune antibodies (in case of corresponding diseases).
Pathogenesis
An indispensable condition for the development of infectious form is colonization by microorganisms of the epithelium of the bladder and their invasion into the cells of the surface layer. With the help of special adhesion factors, pathogens destroy the protective mucopolysaccharide layer of the bladder mucosa. This is facilitated by a violation of blood circulation in the vesical wall, a change in the pH and osmolarity of urine, a decrease in the production of antimicrobial peptides and secretory IgA by the mucous membrane.
The inflammatory process can be focal or diffuse, capture the surface layer of the bladder or the entire thickness of its wall. The endoscopic picture of catarrhal cystitis is characterized by bright hyperemia and swelling of the mucosa. The ulcerative variant proceeds with the formation of ulceration areas covered with fibrinous plaque. In particularly severe cases, necrosis of a section of the bladder wall develops. Chronic cystitis is characterized by the proliferation of granulations, cystic and polypous formations of the mucosa, fibrous changes in the wall.
Classification
zDisease is classified according to various criteria: current, etiology, morphological signs, localization, etc.
- Downstream: acute and chronic form (with chronic cystitis, the phase is indicated – remission or exacerbation, latent or persistent course).
- By origin: infectious (bacterial, viral, fungal, parasitic) and non-infectious (allergic, radiation, medicinal, neurogenic, autoimmune, etc.).
- By the prevalence of the lesion: trigonitis, cervical, diffuse cystitis.
- By the presence of complications: uncomplicated (without violation of urodynamics and concomitant diseases) and complicated cystitis (with violation of urodynamics and the presence of background pathologies).
- Morphological changes: catarrhal, interstitial, hemorrhagic, ulcerative, gangrenous, tumor cystitis.
Symptoms
Acute cystitis
Characterized by a sudden onset, symptoms develop and intensify in a few hours. The most characteristic sign of cystitis is painful urination, accompanied by residual burning and aching sensations. The urge to urinate becomes more frequent, the portions of urine decrease. There is a nocturia. Patients are concerned about pain in the suprapubic region, a feeling of incomplete emptying of the bladder.
Possible subfebrility, pain in the lumbar region, macrohematuria. Sometimes the urine becomes cloudy, has an unpleasant smell. These symptoms may signal a possible kidney disease, so in such cases it is necessary to urgently seek qualified medical help.
Chronic cystitis
Chronic cystitis is diagnosed in the presence of 2 exacerbations within 6 months or 3 episodes during the year. The exacerbation proceeds according to the type of acute cystitis (imperative urges, pains, pain over the womb). The pain may be permanent or occur in connection with urination (at its beginning, during or at the end). With chronic inflammation of the bladder, symptoms persist for a long time, for several weeks, may subside and worsen again
Cystitis in women
The wide prevalence of cystitis in women is due to the short length and wide lumen of the urethra, the proximity of other natural foci of opportunistic flora (vagina, anus). These anatomical features of the female body contribute to the easy penetration of pathogens into the urethra, their rapid migration to the bladder and the development of cystitis. Most often, women of childbearing age get cystitis.
Cystitis during pregnancy
Cystitis in pregnant women can develop at any time. The probability of developing cystitis increases due to the displacement of internal organs, which are pressed by an increasing uterus, changes in hormonal background and hemodynamics. The impact of these factors causes incomplete emptying of the bladder, and the remains of urine in the bladder serve as a favorable environment for the development of bacteria.
At the first signs of cystitis, a pregnant woman should undergo an extraordinary consultation with a gynecologist who carries out pregnancy management, and tell him about the symptoms that have appeared. If necessary, the doctor will give the patient a referral to a urologist.
Cystitis in children
Cystitis can develop in a child of any age, however, for girls of preschool and school age, the risk of the disease increases 5-6 times. The main reasons for the frequent development of cystitis in children of this group are a number of factors. The ovaries of girls have not yet begun to produce estrogens, the barrier properties of the mucous membranes are low, and a wide and short urethra allows pathogenic microorganisms to easily enter the bladder cavity.
The probability of developing cystitis increases with the occurrence of other diseases due to a decrease in immunity and the formation of favorable conditions for the reproduction of pathogenic microbes in the urethra. The main way to prevent cystitis in girls is careful observance of hygiene rules.
Complications
The complicated course of cystitis is most often associated with the upward spread of infection and the development of pyelonephritis (the so-called “reflux pyelonephritis”). However, kidney failure rarely develops against this background. Recurrent acute cystitis in the absence of competent etiotropic therapy and non-compliance with preventive recommendations can turn into a chronic form with subsequent sclerotic changes in the bladder. Dysuric disorders in cystitis limit the patient’s activity and ability to work for an average of 3-4 days.
Diagnostics
The main methods of diagnosis of acute cystitis are clinical and laboratory. In chronic cystitis, instrumental examination of the lower urinary tract plays an important role. If symptoms of cystitis occur, it is urgently necessary to make an appointment with a urologist. Methods used:
- Examination on the chair. Mandatory examination for women. Since many inflammatory diseases of the female genital area occur with similar symptoms, it is necessary to exclude them from the circle of diagnostic search. During the examination, pay attention to the external opening of the urethra, the presence and nature of vaginal discharge.
- Urine test. Urine sampling is performed for general and cultural examination. Urine test is characterized by leukocyturia, hematuria, proteinuria, bacteriuria. With the help of bakposev, the type of pathogen, the degree of bacteriuria, sensitivity to antibacterial drugs are determined
- Bladder ultrasound. Allows you to visualize the edematous thickened wall of the bladder. The main task of sonography is to exclude tumor pathology, stones, the presence of residual urine.
- Cystoscopy. It is carried out with recurrent cystitis outside of exacerbation. With the help of endoscopic examination and biopsy, the morphological form of cystitis is established, differential diagnosis is performed.
- Additional examination. According to indications, it may include ultrasound of the kidneys, uroflowmetry, cystography.
Differential diagnosis of cystitis should be carried out with urolithiasis, tuberculosis, neoplasms of the bladder, neurogenic dysfunction.
Treatment
During the period of exacerbation of pathology, fatty and spicy foods should be excluded from the diet, increase fluid intake (water, herbal tea, cranberry juice), urinate more often. To relieve pain with cystitis, a warm heating pad placed on the lower part of the abdomen helps well.
Antibacterial therapy
Cystitis of bacterial etiology requires antimicrobial therapy. However, the growth of resistance of uropathogens to the main groups of antibiotics requires careful drug selection.
One of the modern drugs for the treatment of cystitis is fosfomycin. Most bacterial agents are sensitive to it. The drug reaches its maximum concentration in the urine, which significantly reduces the duration of treatment. The low probability of side effects and their mild severity makes it possible to use the drug in the treatment of cystitis in pregnant women and children.
Also, fluoroquinolones, non-fluorinated quinolones, cephalosporins, macrolides, nitrofurans can be used as a first-line drug. The course of treatment of acute cystitis is 3-5 days, chronic − 7-10 days. As before, uroseptics (nitroxoline), combined phytopreparations (kanefron, urostin), etc. have not lost their effectiveness. Nonsteroidal anti-inflammatory drugs are indicated for pain relief.
Local therapy
Local anti-inflammatory therapy involves intravesical instillation of various drugs: dioxidine, silver solutions, heparin. However, without sufficient reason, catheterization of the bladder is undesirable, since the introduction of a urethral catheter can cause re-infection. In the complex treatment of this disease, physiotherapy (iontophoresis, UHF or inductothermy), physical therapy are used.
Prognosis and prevention
With proper selection and timely appointment of etiotropic treatment, disease ends in recovery. Chronic inflammation leads to fibrosclerotic changes in the bladder, which may require surgical treatment. Complicated forms are usually supported by the course of concomitant disease (leukoplakia, tuberculosis, bladder tumor). It is important to accurately determine the cause of cystitis and minimize the risk of recurrence of the disease.
To prevent cystitis, it is necessary to strictly observe the rules of personal hygiene, avoid hypothermia, empty the bladder in time, consume a sufficient amount of fluid, and treat concomitant infections in a timely manner.