Cystitis is inflammation of the bladder. This organ is used to accumulate and empty urine, but if the mucous membrane of the organ is damaged, its function is impaired and the person experiences unpleasant symptoms. In most cases, the pathology affects only the mucous membrane, but sometimes the inflammatory process also extends to the muscle tissue. Interstitial cystitis is the most difficult to treat.
The disease mainly affects women, which is related to the anatomical characteristics of the urethra. Inflammation in men rarely appears, usually acting as a co-morbidity against the background of chronic prostatitis.
Symptoms
The symptoms of cystitis are obvious and hard to miss. Usually, the disease begins acutely, so patients pay attention to urinary tract discomfort. Among the manifestations of pathology, consider:
- frequent urge to urinate;
- feeling of incomplete urination;
- cramps and pain during urination;
- rise in body temperature;
- the appearance of a mixture of blood in the urine;
- cloudy urine (due to the presence of pus);
- nausea, pulling pains, as during menstruation.
Despite the characteristic symptoms, the disease can have different manifestations. Hematuria is not always present, but the intensity of the pain may resemble only mild discomfort. In any case, if signs of pathology appear, you should consult a doctor in order to establish a diagnosis as soon as possible. The disease in the acute stage in the early stage is best treated, but it takes longer to overcome the chronic form.
Forms and types of chronic cystitis
By the nature of the inflammatory process, cystitis is acute and chronic. Depending on the source of development, the disease can be primary (independent disease) or secondary (inflammation spreads from neighboring areas, for example, from the kidney).
Depending on the area of damage to the bladder mucosa, cystitis occurs:
- total (general);
- focal.
The following clinical forms of cystitis are distinguished:
- catarrhal - non-purulent inflammation of the mucous membrane of the bladder;
- phlegmonosis - purulent lesion of the submucosal layer;
- granulomatous - accompanied by rashes on the mucous membrane;
- hemorrhagic, characterized by the release of blood in the urine;
- interstitial cystitis - inflammation spreads to all layers of the organ.
Several rare forms are also distinguished: ulcerative, cystic, gangrenous cystitis.
The variety of inflammatory diseases of the bladder can be divided into two large groups:
- specific cystitis caused by pathogens of sexual infections: gonococci, ureaplasmas, chlamydia.
- non-specific cystitis - they develop due to a defect in the opportunistic flora, whose representatives do not lead to diseases under normal conditions (for example, E. coli).
Finally, non-infectious cystitis is combined into a separate group. They can occur as a result of allergic factors, radiation, traumatic, thermal effects, parasitic toxins.
Causes of cystitis
In most cases, damage to the bladder and the development of the inflammatory process are associated with the penetration of infection, however, cystitis can be toxic and allergic in nature. When an infection sets in, the disease can be transmitted in several ways:
- ascending - from the urethra through the urethra - affects the bladder;
- descending - in this case, the infection appears due to inflammation of the kidneys, reaching the bladder through the ureters;
- lymphogenic - with the flow of lymph through the pelvic organs in case of changes in the genitals;
- hematogenous - the infection enters the bloodstream, but this is the rarest way of spreading;
- direct - if an abscess breaks inside the bladder and the pathogenic microflora penetrates directly into the cavity of the bladder, organ catheterization or infection during surgery may still occur.
Most often, E. coli provokes cystitis. It occurs in 80-95% of cases of uncomplicated pathology. This bacterium is normally found in the rectum, but when it enters the urethra, it triggers an inflammatory process. Enterobacteriaceae, staphylococci, fungi, and sexually transmitted infections can also cause the disease. It usually prevents the appearance of symptoms of vaginitis or bacterial vaginosis, and the symptoms of the disease can be noticed within a day after intercourse (postcoital cystitis).
Factors contributing to the development of cystitis
An organism with good immunity is able to cope with the presence of pathogenic microflora, so the symptoms of cystitis do not appear in the patient. But if they are exposed to certain factors, it manifests itself:
- damage to the mucous membrane of the bladder;
- circulatory disorders of the pelvic organs;
- hypothermia;
- the presence of other foci in the body, such as kidney infections;
- a decrease in the body's defenses;
- inflammatory diseases of the genital organs;
- lack of vitamins and minerals in the body;
- hormonal imbalance;
- improper hygiene, wearing synthetic underwear;
- stress and overwork;
- delayed bladder emptying.
In the presence of these factors, cystitis develops rapidly, and the chronic pathology enters the stage of relapse. Therefore, in order to prevent relapses, the influence of provoking factors on the body must be excluded.
Causes of transition of acute inflammation to chronic phase
The inflammatory process in the bladder can occur due to various pathogens. Bacteria are the most common, but there are cystitis and viral and fungal etiologies. If the acute form of the disease is diagnosed in time, appropriate treatment of cystitis is prescribed, and the patient follows all the doctor's recommendations, then the pathological process can be completely eliminated and recovery will come.
But often women postpone a visit to the doctor, try to treat cystitis on their own, hoping that everything will go away by itself. As a result, valuable time is lost. Microorganisms multiply actively, the intensity of inflammation increases. Having completely "settled" in the bladder, the microbes do not give up their position so easily. The inflammation becomes chronic.
It is also common for the specialist to prescribe treatment for cystitis, the patient starts taking medicine, and stops the therapy the moment he feels relief. As a result, the pathogens are not completely destroyed, the survivors divide - chronic cystitis develops, which is resistant to antibiotic therapy.
Finally, the following conditions contribute to the development of chronic cystitis:
- general decrease in immune protection, hypothermia;
- hormonal changes (pregnancy, menopause);
- ignoring the rules of personal hygiene;
- gynecological diseases;
- chronic diseases of other organs and systems: diabetes mellitus, malignant tumors.
Signs of chronic cystitis
In the medical community, the term "chronic cystitis" itself is obsolete. It is used "the old fashioned way" for better communication with patients. The slow inflammatory process of the bladder is called recurrent cystitis. Its main symptom is the development of 2 or more exacerbations within six months, or 3 episodes per year.
The period of exacerbation is accompanied by characteristic symptoms:
- frequent urination;
- pain, burning sensation, pain during urination;
- night calls;
- feeling of incomplete emptying, pain in the lower abdomen.
The aggravation of the disease can be accompanied by a moderate increase in body temperature, the appearance of blood in the urine, and its turbidity.
During the period of remission, the symptoms can be completely smoothed out. But more often, patients suffer from discomfort during urination and from intermittent moderate pain for years.
The most serious consequence of recurrent cystitis is the development of resistance (resistance) of pathogens to antibacterial drugs and the subsequent degeneration of the mucous membrane of the bladder. The mucosal epithelium undergoes cicatricial deformation or is replaced by stratified squamous epithelium. At this stage, chronic cystitis can no longer be cured with antibiotic therapy alone. Special medical procedures are required.
Acute and chronic cystitis: treatment approaches
The treatment of acute and chronic forms of the pathology is different. In general, acute cystitis is much easier to treat, since the pathology is provoked by microorganisms, against which the doctor prescribes antibiotic therapy. Antibacterial drugs are quite diverse. They quickly help to stop the attack of the disease, and the systematic use of funds leads to a complete cure of cystitis. Fosfomycin-based preparations perfectly cope with inflammation.
Chronic inflammation is more difficult to treat because it is complicated by other disorders. Complex treatment of long-lasting cystitis is carried out using several drug groups. Antibiotics continue to lead, but the doctor also prescribes anti-inflammatory drugs, vitamins and reparants. In order to prevent infections and consolidate the effect of the therapy, the patient is prescribed herbal remedies and physiotherapy courses.
cystitis in women
In women, cystitis is most often accompanied by an exacerbation of chronic inflammation, therefore, according to statistics, every second patient consults a doctor twice a year with a recurring disease.
This does not speak so much about the difficulties of treating the disease, but about the need to carefully follow the doctor's prescriptions and eliminate the factors that cause the disease.
cystitis after intercourse
Postcoital cystitis in women is provoked by urinary disorders. Pushed down and inside the external opening of the urethra, it becomes more sensitive to the penetration of pathogenic microflora. Postcoital cystitis is also caused by an overly mobile urethra, which easily moves when the penis is rubbed. In this case, the mucous membrane is easily irritated, and pathogenic microorganisms penetrate the opening of the urethra. The symptoms and treatment of this form of pathology are interrelated, so doctors approach the problem individually in each clinical case.
In addition, the cause of cystitis is the alternation of anal sex and vaginal sex, which is absolutely impossible to do, since the microflora of the rectum goes directly into the vagina and the adjacent urethra. The manual introduction of microbes and the insufficient secretion of vaginal mucus, which causes microcracks, play a role in the development of bacterial infections.
The symptoms of postcoital inflammation do not differ from each other, but the patient can notice their appearance directly during sexual intercourse - the discomfort usually appears in the first 12 hours.
The treatment of postcoital cystitis is individual, as the cause of the disease must first be determined and the therapy must be precisely controlled. With an anomaly of the urethra, the doctor recommends plastic surgery, as a result of which the problem is eliminated. Surgical intervention and hyaluronic acid injection are also possible. If an STI infection occurred during intimate intercourse, then antibacterial drugs will be needed, and then the restoration of the vaginal microflora.
What does blood in urine say
The appearance of blood in the urine indicates the development of acute hemorrhagic cystitis. It does not appear at the end, but accompanies the entire process of urination. The presence of erythrocytes gives the urine a pink color. Urine can also be "flecked" in color, that is, brownish in color, with the presence of mucous threads, fibers or brown flakes.
Usually with bloody urination, severe pain, bladder pain and a pulling sensation in the lower back. The appearance of blood in the urine is a mandatory reason to see a doctor.
Cystitis during menstruation
In some women, cystitis worsens against the background of hormonal changes during menstruation. During menstruation, the pelvic organs are most susceptible to infections, so the following can provoke the disease:
- inflammatory diseases of the female genital organs;
- hormonal fluctuations;
- allergic reaction to intimate hygiene products;
- a decrease in the body's defenses;
- failure to observe personal hygiene;
- non-specific infections, mycoses, STDs.
As a result of these factors, the pathogen enters the urethra and urethra, causing inflammation. Usually, the aggravation of the disease occurs during ovulation and 1-2 days before the start of menstruation. Vaginal discharge is an excellent breeding ground for pathogenic microflora. The symptoms of cystitis are typical during menstruation, but they are complicated by the characteristic manifestations during menstruation - aching and pulling pains in the lower abdomen.
After collecting the anamnesis and studying the results of laboratory diagnostics, the doctor can identify the cause of the pathology. The treatment regimen is standard, but simultaneous treatment of gynecological pathologies may be necessary if genital infections are diagnosed. It is important to observe personal hygiene and strengthen the immune system.
Pregnancy and cystitis
According to the results of the tests, the doctors found that asymptomatic bacteriuria can be detected even before pregnancy, so the disease manifests itself during pregnancy. Reasons for this:
- changes in the hormonal background and the ratio of progesterone and estrogen in the expectant mother's body;
- violation of urodynamics with an increase in the size of the uterus;
- weakening of the ligament apparatus, greater mobility of the organ, but a decrease in its peristalsis and tone;
- expansion of the renal pelvis due to increased blood circulation in the pelvis.
The latent course of the pathology makes early diagnosis difficult. Treatment of cystitis during pregnancy is even possible with the use of antibiotics. The doctor prescribes the name and dose of medicines that are safe for the fetus.
Diagnostic methods
The symptoms of cystitis are very typical, but the doctor still prescribes a series of tests to finally find out the causative agent of the pathology and determine the nature of the course of the disease. The specialist collects an anamnesis, analyzes the patient's complaints, and performs an external examination by palpating the bladder zone. The following diagnostic methods are used:
- echoscopy - with the help of ultrasound, you can determine the extent and prevalence of the inflammatory process, as well as assess the state of the urinary system and genitals;
- cystoscopy - endoscopic examination of the organ, which allows assessing the condition of the mucous membrane of the bladder;
- cystography - examination of the bladder with contrast material.
In women, treatment should begin with determining the causative agent. A series of laboratory tests is mandatory: general urinalysis, Nechiporenko analysis, bacteriological culture, tissue biopsy, polymerase chain reaction (for more precise identification of the pathogen). To assess the extent of the inflammatory process, doctors can send a blood test. In case of suspicion of inflammatory pathologies of the female genital organs, a gynecologist's examination and the tests prescribed by him may be necessary.
Treatment methods
In inflammatory diseases of the organ, doctors use therapeutic and surgical methods to treat the pathology. In most cases, it is possible to get rid of the disease with a properly prepared drug therapy and the addition of physiotherapy.
Drug treatment includes a combination of different groups of effective drugs, depending on the nature of the disease. The patient may receive:
- anti-inflammatory drugs - they are used to relieve the swelling of the mucous membrane and eliminate pain, the inflammatory process decreases;
- antispasmodics - are used to relieve pain symptoms, effectively eliminate bladder spasms;
- antibacterial therapy - a group of drugs that act directly on the causative agent of the pathology;
- antifungal drugs - recommended if cystitis is caused or complicated by a fungus (for example, in the case of a combined bacterial-fungal infection);
- phytopreparations - drugs in tablets and other forms that have antimicrobial and anti-inflammatory properties.
In some cases, instead of oral administration, doctors prescribe a drug drip for the patient. Bladder lavage is performed in the office. With the help of a special catheter, the desired concentration of the drug is administered, which cannot be achieved in any other way. Before the procedure, the patient must empty himself so that the drug affects the mucous membrane as long as possible.
Surgical treatment is used only in rare cases, when the inflammatory process has caused anatomical changes, or in case of severe, recurrent infections. In this case, laser correction is performed. For example, in postcoital cystitis, the only treatment option for many women is distal transposition of the urethra.
Diet in the treatment of cystitis
It is imperative to follow the diet, as spicy and salty foods contribute to the appearance of ulcers on the mucous membrane. Other products are irritants that hinder healing:
- foods high in sugar;
- citrus fruits, sour foods, fermented;
- spices;
- tomatoes and all food with tomatoes, additives (ketchups, sauces, adjika);
- soy sauce and vinegar;
- nuts and chocolate.
In order to speed up recovery, the patient is recommended a light and nutritious diet. Fried foods, smoked meats, marinades, and fatty foods should be excluded. It is best to steam, steam or boil. Eliminate any food that may trigger an allergy.
An attack of cystitis can also be triggered by heavy meals, during which the patient suffers from constipation. As the stool mass stagnates, intestinal peristalsis deteriorates, stagnation occurs in the bladder, as a result of which the mucous membrane is irritated again. Due to the high protein content, you should not eat too much meat, fish, beans, or cheese. Replace them with foods rich in fiber - vegetables and permitted fruits.
During treatment, try to eat at home, cook for yourself and do not add new dishes or foods to the menu. Remember that the diet completely excludes alcoholic beverages and also limits coffee and tea. Herbal juices, infusions and decoctions, fruit drinks and compotes will be useful. It is better to replace ordinary water with slightly alkaline mineral water.
Physiotherapy
Among the methods of treating the disease, physiotherapy is widely used. It is usually recommended during the recovery phase, when the acute inflammation of the bladder has been removed and there has been a positive trend towards recovery. Physiotherapy is also effective for submucosal localization of the causative agent of the pathology, when antibacterial drugs do not have the appropriate effect. It is used as physiotherapy:
- phonophoresis;
- electrophoresis;
- magnetotherapy;
- UHF;
- modulated currents.
The session does not last long, but 10-15 procedures are required to achieve the effect. Effective treatment of cystitis with combined methods helps to get rid of the disease completely.
Question answer
How long does cystitis last?
The duration of cystitis depends on the form of the pathology. The acute lasts for 7-10 days, after which, with proper treatment, recovery occurs, but the chronic form of the disease can last for several months, reminding itself of periods of exacerbation.
Is it possible to visit the bath or hot shower with cystitis?
A hot shower or bath really helps relieve spasm and pain, however, these heat effects are contraindicated in cystitis, as it contributes to the exacerbation of the inflammatory process.
Which doctor should we consult and what tests should be given?
Women with suspicion of cystitis should contact a general practitioner, men - a urologist. If necessary, the patient can be referred to a gynecologist for examination. Tests - urine test, blood test and ultrasound or cystoscopy.
How does age affect the course of the disease?
Cystitis occurs most often in women aged 20-45, which is associated with active sexual activity, unstable hormone levels and a higher risk of developing gynecological pathologies. In older women, the pathology occurs less often and is associated with a weakening of the immune system.
Is it possible to cure chronic cystitis?
Like any other chronic disease, cystitis occurs with periods of exacerbation and remission. It is difficult to completely cure the disease, but with proper treatment, a stable and very long remission can be achieved, without urinary tract symptoms.
Do I need a special diet for cystitis symptoms?
Yes, during the period of exacerbation of the disease, patients are advised to follow a diet, excluding salty, spicy, irritating foods. Despite frequent urination, you should not strictly limit yourself to fluid intake. You can drink up to 2 liters of clean water, compote, weak tea. But alcohol and coffee are prohibited in the acute stage.
What characteristics should be considered when choosing a uroseptic?
Let's start by saying that the selection of the drug and the appointment of the antibiotic course are only the responsibility of a specialist: urologist, nephrologist, therapist. It is unacceptable to independently stop the treatment of cystitis or change the method of treatment.
The use of tetracyclines and cephalosporins in cystitis quickly leads to the resistance of pathogens. Therefore, drugs of these groups are practically not used to treat cystitis. Doctors prescribe ampicillins, fluoroquinolones and various combinations of uroseptics. Herbal uroseptics are also widely used, the main advantage of which is good tolerability and the almost complete absence of contraindications. Preparations belonging to this group can be used to treat pregnant and lactating mothers.
The doctor selects a uroseptic individually, analyzing the data of each clinical case. To determine the sensitivity of pathogens to a specific antibiotic, a special test is carried out - bacteriological analysis of urine by inoculation on culture medium.
How to treat cystitis at home and can it be done?
If symptoms of cystitis appear, a urologist, nephrologist or family doctor should be consulted as soon as possible. Only a specialist can correctly assess the characteristics of the clinical picture, perform a comprehensive examination, make a correct diagnosis and prescribe the necessary treatment.
But often patients are faced with the fact that the doctor's appointment is scheduled for a certain time, and the pain needs to be relieved immediately. To reduce the progression of the pathological process, follow the drinking regime - drink about 2 liters of water, compotes, fruit drinks. Hypothermia is a common cause of worsening of the condition, so it is worth dressing warmly and protecting yourself from drafts.
Try to avoid overexertion as well. Rest (physical and sexual) helps to wait for an appointment with a specialist. It is undesirable to take painkillers and antispasmodics on your own without an extreme need - they can "smear" the clinical manifestations of the disease, and it will be more difficult for the doctor to make a correct diagnosis.