Cystitis in women is an inflammatory lesion of the mucous (less often submucosal and muscular) layer of the bladder with an acute or chronic course. It is accompanied by painful rapid urination with residual burning and aching sensations, pain in the pelvic region, a feeling of insufficiently complete emptying of the bladder, subfebrility, the appearance of mucus and blood in the urine. Diagnostics includes a urine test (general analysis, according to Nechiporenko, bakposev), a gynecologist’s examination with a study of the vaginal microflora, ultrasound of the bladder, cystoscopy. Antibiotics, uroseptics, bladder instillation, physiotherapy are used in therapy.
Cystitis is one of the most common female diseases, located at the junction of clinical urology and gynecology. According to statistics, every second woman faces cystitis during her life. Pathology is mainly detected in patients of childbearing age (20-40 years); the prevalence of cystitis is also quite high in girls 4-12 years old (3 times more often than in boys of this age). In 11-21% of cases, the disease acquires a chronic course, i.e. it proceeds with 2 or more exacerbations per year.
In most cases, cystitis in women is infectious. The features of the anatomy of the female urethra (short and wide urethra), as well as the topographic proximity of the vagina, anus and urethra, facilitate the ascending penetration of pathogenic flora into the bladder.
In addition to the urethral (ascending) pathway, infection of the bladder can occur descending (from the upper urinary tract), lymphogenic (from the pelvic organs), hematogenic (from distant organs) pathways. Pathogens, as a rule, are:
- E. coli (70-95%);
- staphylococci (5-20%);
- less often – klebsiella, proteus, Pseudomonas aeruginosa;
- specific microflora. Pathology often develops against the background of colpitis, vulvitis and urethritis caused by candidiasis, gardnerellosis, mycoplasmosis, gonorrhea, ureaplasmosis, chlamydia, trichomoniasis, genital tuberculosis and other infections.
Traditionally, the primary episode or exacerbation is associated with hypothermia, acute respiratory viral infections, the onset of sexual activity, the change of sexual partner, the onset of menstruation, excessive consumption of spicy food or alcohol, wearing too tight clothes. Factors provoking cystitis in female patients may also be pyelonephritis, foreign bodies and stones in the bladder, stagnation of urine with diverticula, urethral strictures or rare emptying of the bladder, constipation.
Cystitis in girls can develop with poor hygiene of the genitals, as well as with neurogenic bladder. Cystitis in pregnant women is caused by hemodynamic and endocrine gestational changes, transformation of the microflora of the urogenital tract.
In some cases, pathology can be provoked by radiation therapy for pelvic tumors, allergies, toxic effects, metabolic disorders (diabetes mellitus, hypercalciuria). During menopause, cystitis develops under the influence of a lack of estrogens and atrophic changes in the mucosa of the urogenital tract.
The occurrence of the disease is facilitated by injury to the bladder mucosa during endoscopic manipulations and operations (catheterization, cystoscopy, transurethral resection of the bladder, etc.). Chronic cystitis, in addition to sluggish infection, can be caused by prolapse of the uterus or vagina.
The systematization of cystitis in women is based on several criteria.
- By etiology, cystitis in women can be bacterial (infectious) and non-bacterial (radiation, allergic, chemical, medicinal, toxic). Depending on the pathogenic pathogen, infectious cystitis, in turn, is divided into specific (ureaplasma, mycoplasma, chlamydia, gonorrhea, etc.) and nonspecific, caused by conditionally pathogenic flora.
- According to the nature of the course, acute and chronic (persistent) primary cystitis (which arose independently) and secondary (developed against the background of other urological diseases) are distinguished. In acute cystitis, inflammation usually affects the epithelial and subepithelial lining of the bladder mucosa.
- According to the prevalence and localization of inflammation, diffuse (total) cystitis is distinguished, limited (focal) – cervical cystitis and trigonitis (inflammation of the Lieto triangle).
- Taking into account the determined morphological changes in the bladder, cystitis can be catarrhal, hemorrhagic, cystic, ulcerative (ulcerative-fibrous), phlegmonous, gangrenous, encrusting, granulomatous, tumor-like, interstitial.
Morphological signs of cystitis
Various forms of cystitis in women differ from each other in the endoscopic picture and pathomorphological signs. According to these criteria , there are:
- Catarrhal cystitis. The endoscopic picture is characterized by swelling and fullness of the mucosa, vascular reaction (dilation, injection of vessels), the presence of fibrinous or mucopurulent plaque on inflamed areas. With a progressive course, the submucosal and even the muscular layer of the bladder may be affected.
- Hemorrhagic cystitis. Cystoscopic signs are marked erythrocyte infiltration of the mucosa, areas of hemorrhage with rejection of the mucous membrane, bleeding on contact.
- Ulcerative cystitis. It often develops with radiation damage to the bladder. Ulcers can be single or multiple in nature, affect all layers of the cystic wall (pancystitis), lead to bleeding, the formation of bladder fistulas. With scarring of ulcers, fibrous and sclerotic changes in the bladder wall develop, which leads to its wrinkling.
- Phlegmonous cystitis. Diffuse infiltration of the submucosal layer by leukocytes is noted. Purulent inflammation spreads to the serous membrane (pericystitis) and the surrounding fiber (paracystitis). Ulcers may form in the tissues near the bladder, causing diffuse damage to the entire fiber.
- Gangrenous cystitis. Affects the entire bladder wall with the development of partial or complete necrosis of the mucous membrane, less often – the muscular layer of the bladder with perforation of the wall with the development of peritonitis. The dead mucous and submucosal layers of the bladder can be rejected and exit through the urethra to the outside. The consequence of gangrenous cystitis is sclerosis and wrinkling of the bladder.
- Chronic cystitis. Endoscopically characterized by swelling, hyperemia, thickening or atrophy of the mucosa and a decrease in its elasticity. In some cases, microabcesses and ulceration may form in the mucous and submucosal layer. Long-term non-healing ulcers can be encrusted with salts, causing the development of encrusting cystitis. The predominance of proliferative processes entails the growth of granulation tissue with the formation of granular or polypoid growths (granulomatous and polypoid cystitis). Less often, cysts may form in the bladder, protruding above the surface of the mucosa singly or in groups in the form of small tubercles representing a submucosal accumulation of lymphoid tissue (cystic cystitis).
- Interstitial cystitis. The characteristic presence of glomerulations (submucosal hemorrhagic formations), a single Ganner ulcer having a linear shape with a bottom covered with fibrin, inflammatory infiltrates is determined. The outcome of interstitial cystitis in women is a shrinking of the bladder and a decrease in its capacity.
Symptoms of cystitis in women
Acute pathology manifests suddenly, as a rule, after exposure to one or more provoking factors (hypothermia, infection, trauma, coitus, instrumental intervention, etc.). Manifestations of cystitis include the classical triad: dysuria, leukocyturia (pyuria), terminal hematuria.
Urination disorders are caused by increased neuro-reflex excitability of the bladder under the influence of inflammation, swelling and compression of nerve endings, which leads to an increase in the tone of the bladder wall. Dysuric disorders are characterized by pollakiuria (increased urination), a constant desire to urinate, the need for effort to start miction, cuts in the bladder, pain and burning in the urethra, nocturia.
Symptoms increase rapidly. The urge to urinate occurs every 5-15 minutes, is imperative, while the volume of a single portion decreases. Spastic contractions of detrusor lead to urinary incontinence. Pronounced soreness accompanies the beginning and end of urination; outside of miction, pain usually persists in the perineum and pubic area.
The nature and intensity of pain with cystitis in women can vary from mild discomfort to unbearable pain. In young girls, acute urinary retention may occur against the background of pain. With cervical cystitis, dysuria is more pronounced. Extremely painful manifestations are noted in interstitial cystitis, as well as inflammation caused by chemical and radiation factors.
A mandatory and permanent sign is leukocyturia, in connection with which the urine acquires a cloudy purulent character. Hematuria is more often microscopic in nature and develops at the end of urination. The exception is hemorrhagic cystitis in women, in which macrohematuria is the leading manifestation. With acute cystitis, the body temperature can rise to 37.5-38 ° C, the general well-being and activity suffer sharply.
The manifestations of chronic cystitis are similar to those in the acute form, but are not so pronounced. Pain during emptying of the bladder is moderate, and the frequency of urination allows you not to lose performance and stick to your usual lifestyle. During periods of exacerbations, the clinic of acute/subacute inflammation develops; during remission, clinical and laboratory data on the active inflammatory process are usually absent.
A feature of the course of cystitis in women is the frequent recurrence of the disease: more than half of the patients relapse within a year after the first episode of the disease. With a repeated attack of cystitis that has developed within a month after the end of therapy, you should think about maintaining the infection; later than 1 month – about reinfection. The most common complication of cystitis is infectious inflammation of the kidneys – pyelonephritis. With a chronic course of pathology, sclerotic changes in the bladder may develop.
Recognition of cystitis in women is based on clinical and laboratory data and echoscopic and endoscopic examination data. Diagnosis is carried out by a specialist urologist. Typical characteristic complaints of dysuria. Palpation of the suprapubic region is sharply painful.
- Routine examination must necessarily include consultation with a gynecologist, examination of the patient in a chair, microscopic, bacteriological and PCR examination of gynecological smears.
- In the general analysis of urine, a significant increase in leukocytes, erythrocytes, protein, mucus, uric acid salts is determined. With bacterial cystitis in women, urine back-seeding is characterized by an abundant growth of pathogenic flora.
- Cystoscopy allows to determine the morphological form of the bladder lesion, the presence of tumors, urinary stones, foreign bodies, diverticula of the bladder, ulcers, fistulas, to perform a biopsy.
- Ultrasound of the bladder indirectly confirms the presence of cystitis in women by characteristic changes in the walls of the bladder, the presence of “echonegative” suspension.
Treatment of cystitis in women
Treatment should take place under the supervision of a gynecologist and a urologist. Relief of the acute form of cystitis usually takes 5-7 days. In acute cystitis, women are recommended to adhere to a gentle, mainly dairy-vegetable diet, increase the water load. Assigned:
- Etiotropic therapy. Antibiotics from the group of fluoroquinolones (ciprofloxacin, norfloxacin), fosfomycin, cephalosporins, nitrofurans are used. When a specific microflora is detected, appropriate antimicrobial, antiviral, antifungal drugs are used.
- Symptomatic therapy. To relieve pain, NSAIDs (nimesulide, diclofenac), antispasmodics (papaverine, drotaverine) are prescribed.
- Phytotherapy. In addition to the main drug therapy, herbal teas (infusions of bearberry, horsetail, knotweed, lingonberry leaf, etc.), herbal pharmaceuticals can be recommended.
- Local therapy. With recurrent cystitis, in addition to the above-mentioned etiotropic and symptomatic therapy, bladder instillation, intravesical iontophoresis, UHF, inductothermy, magnetolaser therapy, magnetotherapy are indicated. If recurrent cystitis is diagnosed in a menopausal woman, intravaginal or periurethral use of estrogen-containing creams is recommended.
With the development of gross hyperplasia of the neck of the bladder, transurethral resection is resorted to – a TOUR of the bladder.
Prognosis and prevention
In the issue of preventing cystitis in women, it is important to observe personal and sexual hygiene, timely treatment of gynecological and urological diseases, prevention of cooling, regular emptying of the bladder. It is necessary to strictly observe asepsis during endovesical examinations and catheterization of the bladder. To reduce the likelihood of relapse of the disease, it is necessary to increase immunity, conduct preventive treatment courses in autumn and spring.