Cystitis in women
Cystitis is an inflammatory disease of the bladder, which is accompanied by frequent painful urination in small portions. It can occur acutely and chronically, characterized by frequent relapses of the disease. Women are most often ill after the onset of sexual activity.
Signs and causes of occurrence
Emptying of the bladder occurs through the urethra – urethra. In women, it has a relatively wide lumen and a small length. It opens in the perineum, in front of the vagina and anal opening. Due to anatomical features and location, pathogenic microflora from the external environment easily penetrates into it. After penetration into the urethra, the infection enters the bladder, into its mucous membrane and begins to multiply, which leads to inflammation. Infection is the main cause of female cystitis.
In addition to the ascending (through the urethra) pathway of infection, descending ones are also possible:
hematogenic – bacteria enter with the blood flow from inflammatory foci in other areas of the body;
lymphogenic – the infection penetrates into the bladder with the flow of lymph from the pelvic organs;
urinary infection descends from the overlying parts of the excretory system (kidneys, ureters).
Cystitis in women often develops against the background of inflammatory diseases of the genitals (colpitis, vulvitis) and the urethra (urethritis). Most often the disease is caused by:
E. coli (overwhelming number of cases);
staphylococcus (up to 1/5 of all cases);
mycoplasma;
chlamydia;
klebsiella;
yeast – like fungi of the genus Candida;
Pseudomonas aeruginosa;
gonococcus;
proteus;
trichomonads.
Provoking factors
The occurrence of cystitis in a woman in the vast majority of cases is associated with the onset of sexual activity, since the partner brings his microflora to the anogenital area, which turns out to be more aggressive than his own. New episodes can be caused by each change of sexual partner in the future.
Menstrual blood is a good breeding ground for bacteria, so the first menstruation, insufficiently careful observance of personal hygiene rules also contribute to the development of female cystitis. His appearance is provoked by transferred acute respiratory infections, hypothermia, wearing tight synthetic underwear and clothing. The use of spicy seasonings with food and alcohol cause stagnation of venous blood in the pelvis, which favors the development of inflammation in the bladder.
Conditions that lead to a violation of the normal outflow of urine: concretions (stones) in the renal pelvis and ureters, scarring of the urethra, urethral diverticula, rare urination, pressure of the pregnant uterus on the ureters – all this facilitates the introduction and reproduction of microbes in the bladder wall. During pregnancy, the occurrence of cystitis is also facilitated by stagnation of blood in the pelvis, hormonal changes, decreased immune protection and violation of the usual vaginal microflora.
Inflammation of the calyx-pelvic system of the kidneys (pyelonephritis) leads to the ingress of pathogenic bacteria into the bladder with urine flow. In girls, before the onset of sexual activity, cystitis occurs in case of non-compliance with personal hygiene or the introduction of intestinal microflora into the urethra with improper washing.
Many chronic diseases lead to inflammation in the bladder. These can be:
pelvic tumors and associated radiation treatment;
metabolic diseases (diabetes mellitus, parathyroiditis);
prolapse of the uterus and vagina;
chronic inflammation of the parametral (perinatal) fiber.
Allergic reactions and toxic effects of certain medications can lead to damage to the mucous membrane of the bladder. Complication in the form of cystitis often occurs during diagnostic and therapeutic invasive interventions: catheter insertion, endoscopic resection of the bladder through the urethra, cystoscopy.
Classification of the disease
Due to the occurrence , cystitis is isolated:
infectious;
non-infectious (toxic, radiation, medicinal).
By the nature of the course , cystitis happens:
acute – the clinic of the disease develops suddenly, after treatment it lasts for more than a year;
chronic – after the onset of the disease, its clinic persists for more than 6 months, proceeds with stages of exacerbation and remission (subsiding).
Depending on the type of pathogen, cystitis can be:
gonorrhea;
mycoplasma;
ureaplasmic;
tuberculous;
nonspecific – develops under the influence of conditionally pathogenic microflora.
Depending on the localization of the pathological process , there are:
diffuse cystitis – covers the entire surface of the bladder;
limited – this type includes inflammation of the neck of the bladder and trigonitis – inflammation of the triangle bounded by the mouths of the ureters and urethra.
Cystitis, which develops independently, is called primary; arising against the background of other inflammatory diseases by infection, secondary.
Symptoms of cystitis in women
Acute cystitis in women develops suddenly, patients can often indicate the day, or even the hour of the appearance of symptoms. It usually occurs some time after exposure to provoking factors (infections of the genitourinary system, hypothermia, invasive intervention).
A combination of three main symptoms is characteristic:
dysuria – urination disorders;
hematuria – discharge of blood in the urine (with cystitis, this occurs at the end of urination);
leukocyturia is an increase in the content of leukocytes in the urine.
In the acute course of the disease, the symptoms of cystitis in women progress rapidly, every 5-10 minutes there are urges to go to the toilet. Urine is excreted in small portions, its passage through the urethra causes a sharp burning pain, especially at the beginning and end of the process. After urination, there is no feeling of complete emptying of the bladder, discomfort persists in the perineum and in the area of the pubic symphysis.
Such symptoms are caused by an inflammatory process in the bladder wall, under the influence of which edema occurs with compression of sensitive nerve endings. Pathological impulses from them lead to an increase in the tone of the muscular layer of the bladder, painful spasms of its sphincter, urinary incontinence.
Violation of urination in cystitis is characterized by:
pollakiuria – frequent discharge of urine;
nocturia – urination preferably at night;
cutting pains in the bladder;
burning sensation in the urethra;
constant desire to urinate;
the need to make an effort at the beginning of urination.
The severity of pain in cystitis varies from minor discomfort to excruciating acute pain. Such differences are due to the different localization of the inflammatory process in the bladder. The strongest sensations occur when the muscle layer and the neck of the bladder are affected, where there is a large number of nerve endings. Severe pain is accompanied by cystitis, which was caused by radiation therapy or chemical agents.
General inflammatory phenomena can be expressed to varying degrees, sometimes the body temperature rises to subfebrile figures, weakness and decreased performance occur, appetite worsens. Constant pain and the desire to urinate greatly disrupt a woman’s daily activities.
The admixture of leukocytes in the urine makes it cloudy, there may be so many of them that they have a pronounced precipitate. The discharge of blood is usually invisible to the eye, as it occurs in microscopic volumes. A visible admixture of blood appears with a special kind of disease – hemorrhagic cystitis. In this case, hematuria is the leading sign.
A characteristic feature of acute cystitis is the frequent occurrence of relapse during the first year after the disease: it develops in half of the cases. If the disease resumes immediately after treatment, it means that the infection has persisted in the bladder. A relapse a month after recovery indicates a re-infection.
Endoscopic diagnostics in girls
Cystoscopy is an examination of the walls of the bladder using an endoscope that is inserted through the urethra. The damage pattern will differ with different morphological variants of the disease.
Acute cystitis usually captures only the surface layers of the mucous membrane, but as the disease progresses, the pathological process moves deeper down to the muscle layer.
Catarrhal
The mucous membrane is hyperemic, edematous, its vessels are dilated and clearly visible on the surface. Areas of inflammation are covered with a mucous coating with an admixture of pus or fibrin clots.
Phlegmonous
Infiltration of the submucosal layer by leukocytes with the formation of purulent inflammation is observed. The damage can capture all layers of the bladder and spread to its serous membrane (pericystitis). With the defeat of the pericubular fiber, purulent cavities form in it.
Gangrenous
Affects all layers of the bladder wall, develops complete or partial necrosis of the mucous membrane. If necrosis has affected the muscular and serous layer, perforation of the organ occurs with the addition of peritonitis. Necrotic tissues are rejected during healing and exit through the urethra to the outside. Healing occurs through the formation of rough scars that narrow and deform the lumen of the organ.
Hemorrhagic
The mucous membrane is sharply hyperemic, easily bleeds when in contact with the endoscope. Numerous hemorrhages in the submucosal layer exfoliate the overlying layers of cells.
Ulcerative
The number of ulcerative defects can be different, often all layers of the bladder are damaged (pancystitis) with the formation of fistulas. If a large blood vessel enters the pathological focus, bleeding develops. Most often, this form of the disease is caused by radiation damage to the bladder. The healing of ulcerative defects occurs through scarring, which narrows and deforms the organ cavity.
Chronic cystitis in women
Chronic inflammation leads to atrophy or hypertrophy of the mucous membrane, it is edematous, hyperemic. Under the influence of a long-term pathological process, the elasticity of the bladder wall decreases.
Slow healing of ulcers of the mucous membrane may be accompanied by the deposition of uric acid salts on the affected areas – this is encrusting cystitis.
An increase in the size of the bladder’s own lymphoid follicles and their protrusion into the lumen of the organ is called cystic cystitis.
Excessive overgrowth of delicate granulation tissue during the healing of an ulcerative defect leads to the formation of granulation cystitis. If it takes the form of small tubercles – polyps, this is a polypoid form of the disease.
Interstitial cystitis is characterized by the formation of glomerulations, a single Gannner ulcer and results in a decrease in the volume of the bladder.
Treatment of cystitis in women
Diagnosis and treatment of female cystitis is carried out by a urologist, but the patient is additionally monitored by a gynecologist.
As an etiological therapy, antibiotics are used that create high concentrations in the urine and act on gram-negative microflora (ciprofloxacin), broad-spectrum antibiotics (cephalosporins). If a resistant microflora is detected as a result of urine back-sowing, the selection of treatment is carried out individually, taking into account the sensitivity of the pathogen to drugs.
Pain syndrome is stopped by nonsteroidal anti-inflammatory drugs (Naiz), antispasmodics (no-shpa, papaverine). Herbal preparations (Kanefron), herbal preparations containing lingonberry leaves, bearberry, horsetail have proven themselves well.
Treatment of cystitis in women must necessarily be accompanied by treatment of colpitis, otherwise the infection will re-enter the urethra and rise into the bladder. To restore the microflora of the vagina, irrigation with bifidumbacterin is prescribed.
A woman is recommended to adhere to a dairy-vegetable diet – it latches urine, which allows you to compensate for inflammatory damage to the organ wall. It is necessary to exclude the intake of alcohol, spicy seasonings, smoked meats and other irritating substances during the exacerbation of the disease. A large amount of warm liquid (mors, herbal tea) will help to quickly remove the pathogen from the body.
In the treatment of recurrent cystitis, physiotherapy methods are connected: ultra-high frequencies (UHF), magnetotherapy, laser therapy, inductothermy, intravesical iontophoresis, irrigation of the walls of the bladder with antiseptics and healing substances (sea buckthorn oil). In the menopausal period, estrogen-containing creams are prescribed for topical use.
Surgical treatment is required for significant scarring of the neck of the bladder.
Prevention of cystitis in girls
Prevention includes:
adequate treatment of inflammatory diseases of the genitourinary system;
the use of barrier contraception at the beginning of sexual life and when changing partners;
careful observance of personal hygiene rules;
avoiding hypothermia;
empty the bladder in time.
Prevention of exacerbations in the chronic course of the disease consists in the appointment of herbal and immunomodulatory drugs in the autumn-spring period.
