Etiology and pathogenesis
The most common pathogens of cystitis are Escherichia coli, staphylococcus, and Proteus. All these microorganisms are opportunistic. This means that for cystitis to occur, additional factors causing inflammation are necessary. In addition, cystitis can be caused by factors such as penetrating radiation, chemicals and poisons, as well as parasitic agents such as schistosoma.
The high incidence of cystitis in women is due to the anatomical features of the structure of the female genitourinary system. The short and wide urethra, paraurethral glands, in which infection can be deposited, provide ease of the ascending (urethral) route of infection, which is most often found in the pathogenesis of cystitis.
Detrusor-sphincter dyssynergia can significantly accelerate the entry of infectious agents into the bladder, which causes disruption of the laminar passage of urine through the urethra, creating conditions for turbulent flow. Thus, in the urethra, as in a mountain river, “whirlpools” will form, in which urine that has already been in the lower parts of the urethra can be thrown into the bladder. Similarly, the occurrence of cystitis contributes to the prolapse of the pelvic organs. This is accompanied by a change in the topography of the bladder and urethra, which also creates conditions for turbulent urine flow. In addition, this disrupts the blood supply to the bladder, which facilitates the penetration of infection into the mucous membrane.
A significant factor in the ascending path of bladder infection is sexual activity. The variability in the location of the external opening of the urethra creates a high probability of vaginal ectopia, while the urethra opens directly into the vestibule of the vagina, which during sexual intercourse creates conditions for retrograde passage of vaginal contents into the bladder. In addition, a frequent “complication” of the onset of sexual activity is the formation of hymenurethral adhesions, which leads to hypermobility of the urethra, which moves into the vagina during coitus. Failure to comply with sexual hygiene in this case causes an attack of acute cystitis after almost every sexual intercourse.
An important factor in the pathogenesis of cystitis is regular fluctuations in hormonal levels, which lead to episodes of urethral atony, which also facilitates the ascending route of infection. In addition, after menopause, a decrease in estrogen saturation leads to atrophy not only of the vagina, but also of the mucous membrane of the bladder, especially in the cervical area. Epithelial atrophy creates conditions for better adhesion of infectious agents, which leads to greater susceptibility to cystitis.
Another route of infection into the bladder is descending. In the presence of long-term purulent-inflammatory processes in the kidneys, which create persistent pyuria, the mucous membrane of the bladder is often affected. However, in this case, the severity of the patient’s condition is due to kidney disease and cystitis usually disappears after removal or sanitation of the source of pyuria.
Studies of the characteristics of the pelvic lymphatic system have proven a close connection between the bladder and the internal genital organs of a woman. This creates conditions for the lymphogenous spread of infection from the uterus and its appendages to the bladder. Cystitis is quite common in women suffering from chronic salpingoophoritis. On the other hand, frequent attacks of cystitis are a reason to examine the condition of the female genital organs.
Causative agents of urogenital infections, such as chlamydia, ureaplasma, and mycoplasma, are of great importance in the pathogenesis of cystitis. By entering into microbial associations with cystitis pathogens, these microorganisms facilitate adhesion and contribute to the chronicity of the inflammatory process. For example, chlamydial infection with cystitis occurs in 33-42% of women. Therefore, all women who often suffer from cystitis should be examined for urogenital infection.
Microorganisms may enter the bladder wall from foci of purulent-destructive inflammation of neighboring organs. This often happens with parametritis, prostate abscesses or appendiceal infiltration.
A significant factor in the development of cystitis is instrumental examination or manipulation of the bladder. Even a single cystoscopy or catheterization can cause the development of cystitis. Therefore, after any manipulation of the bladder, it is necessary to prescribe preventive antibacterial and anti-inflammatory therapy.
Exacerbation of chronic cystitis: treatment of the disease
For chronic inflammation of the mucous membrane of the bladder, antibacterial therapy is recommended to relieve exacerbations. In this matter, self-medication is absolutely unacceptable, since in the absence of competent therapy there is a huge risk of further development of inflammation. [7]
Drugs for the treatment of cystitis are selected individually. An “ideal” drug for the treatment of cystitis should have anti-inflammatory and antibacterial effects, as well as the ability to normalize urodynamics and reduce the risk of relapses. [7]
As part of complex treatment, in addition to antibiotics, the drug Fitolysin® may be prescribed. It is a herbal diuretic that comes in the form of a paste for oral suspension. In this form, the medicine for cystitis is absorbed faster than tablets. [2]
Phytolysin® contains 9 plant extracts and 4 essential oils, which contain vitamins, flavonoids, saponins, alkaloids and other active substances [26]. The drug has several advantages:
- convenient form of release – paste for preparing a suspension [6];
- has diuretic, antispasmodic, anti-inflammatory effects [6];
- helps fight urinary disorders, relieve inflammation and pain [1].
The drug is produced in Europe. Its production meets the requirements of the GMP standard, which is confirmed by the appropriate certificate. [2]
Symptoms of cystitis
Often the development of acute cystitis is preceded by an episode of hypothermia, after which sharply increased painful urination begins (pollakiuria, stranguria). In this case, the frequency of urination can reach up to 100 times a day, and the volume of urination is extremely small (10-20 ml). Body temperature with this disease remains normal or is rarely low-grade. When palpating the abdomen, slight pain above the pubis may be noted.
The urine is often cloudy, the last portion is stained with blood (terminal macrohematuria), since when the neck of the bladder is damaged, its contraction causes the release of blood from the hyperemic vessels of the submucosal layer. Laboratory tests reveal pyuria, microhematuria, and some epithelium.
These symptoms usually last 7-10 days, after which the patient notices an improvement in well-being. If the course lasts longer, we can talk about the process being chronic, which requires an in-depth examination to determine the cause that supports the inflammation.
In chronic cystitis, clinical manifestations range from minor discomfort in the lower abdomen to increased urination (pollakiuria); urgency or episodes of urinary incontinence are also possible. Of course, the course of chronic cystitis is regularly interspersed with episodes of exacerbations, especially in autumn and spring.
Urinalysis shows an increase in the content of leukocytes, erythrocytes and epithelium, although in some situations there may be no pathological changes in the urinalysis.
Cystitis and its consequences
Home Articles Cystitis and its consequences
Modern urological clinics in Moscow are sounding the alarm: more and more often, during examinations, serious complications of the genitourinary system of patients are discovered. One of the reasons for this is cystitis that was treated at one time. We try to treat it ourselves, turning a blind eye to this insidious disease, considering it not so serious. But in vain. Cystitis can have a serious impact on our health. Sometimes the consequences are irreparable.
Attention! Cystitis in both women and men causes extremely negative consequences if left untreated!!!!
The most common of them is the transition of the disease to a chronic form (chronic cystitis), fraught with frequent relapses and severity. Painful urination begins to bother the patient more and more often, sometimes completely depriving him of the opportunity to live and work normally. A person becomes indifferent to everything, because all thoughts begin to be occupied by the desire not to leave the toilet and cutting, sometimes unbearable sensations in the groin area.
Other unfavorable complications of cystitis include the following:
- spread of the inflammatory process through the ureters to the renal pelvis. This usually leads to the development of a more serious disease - pyelonephritis.
- Chronic cystitis with its frequent exacerbations truly poisons a person’s life. Anyone who has suffered from this disease will understand what we mean. Over time, this leads to the development of neuroses.
- Chronic cystitis in the cervical region of the bladder contributes to damage to the sphincter, which in turn leads to urinary incontinence.
- It has been proven that a chronic disease over time leads to shrinkage of the bladder, and this may require surgical intervention.
- development of interstitial cystitis (in this case, the number of urinations can reach 100 or more times a day). This form of the disease leads to a decrease in bladder volume and is difficult to treat.
- There is evidence that chronic cystitis is one of the causes of bladder cancer.
Let your life be easy and unburdened by such a disease as cystitis.
Don’t joke with your health, urological clinics in Moscow will help solve this problem and restore excellent health. Uncontrolled use of uroseptics is one of the main reasons for the adverse effects of cystitis in women and men! Take care of yourself and be healthy!
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Diagnosis of cystitis
The diagnosis of acute cystitis is established on the basis of complaints - stranguria, anamnesis - an episode of hypothermia, sexual excess, laboratory data - pyuria, terminal macrohematuria. Ultrasound examination of the bladder in acute cystitis is not very informative, since patients cannot fill the bladder, which means its walls do not straighten and are not visualized. Ultrasound examination is used to exclude pathological changes in the upper urinary tract and kidneys, which may be a complication of acute cystitis.
Diagnosing chronic cystitis can be difficult. First of all, it is necessary to make sure that the discomfort in the lower abdomen that worries the patient is associated with the urinary system. To do this, it is necessary to perform not only a urine test according to Nechiporenko, but also a urine culture. At the same time, the absence of microflora growth in the presence of pyuria, combined with an acidic urine reaction, should suggest the tuberculous nature of inflammation of the bladder. In this case, it is necessary to culture urine on specialized media.
When laboratory data confirm the presence of bladder inflammation, it is necessary to establish the cause supporting chronic bladder inflammation. In order to exclude organic obstruction, it is necessary to perform uroflowmetry. The presence of detrusor-sphincter dyssynergia can be confirmed by data from a comprehensive urodynamic study.
All women suffering from chronic cystitis should undergo an examination of the external genitalia on a gynecological chair to exclude hypermobility or ectopia of the external urethral meatus. In this case, smears are taken from the urethra, vagina and cervix to exclude urogenital infection. In addition, such patients should be consulted by a gynecologist to exclude inflammatory diseases of the reproductive system.
For long-term chronic cystitis, cystoscopy is mandatory. This study is performed to determine the extent and localization of inflammatory changes in the mucous membrane. In this case, it is recommended to take a biopsy to determine the degree of inflammatory changes in the bladder wall. In addition, we must not forget that a long-term inflammatory process several times increases the likelihood of developing a bladder tumor, for the early detection of which cystoscopy is extremely informative. In acute cystitis, instrumental examination of the bladder is contraindicated, as this will cause a sharp exacerbation of the inflammatory process.
Common complications of cystitis
Complications from cystitis can occur both during an acute episode of inflammation and against the background of a chronic course of the pathology.
Due to constant irritation, the bladder itself can lose sensitivity and change tone. This can cause incomplete emptying, difficulty urinating, or, conversely, urinary incontinence.
Long-term cystitis causes complications associated with kidney damage: pyelonephritis, kidney abscesses, renal failure.
The consequences of cystitis in men may include prostate disease, urethritis or inflammation of the epididymis.
In women, infection in the reproductive organs is also common.
Treatment of cystitis
The main principles of therapy for acute cystitis are the elimination of infectious agents in the bladder, creating conditions for stopping the inflammatory process and reducing irritative symptoms.
The first stage of treatment may be the use of antibacterial agents. First-line drugs are fluoroquinolones, especially fourth generation. Antibacterial therapy should be accompanied by the use of anti-inflammatory drugs, which can be prescribed both by injection and rectal suppositories. It is justified to prescribe drugs that improve blood supply to the bladder, which it makes sense to prescribe for at least 30 days. The use of α-blockers can relieve painfully frequent and painful urges.
In the treatment of chronic cystitis, the main thing is to eliminate the cause that contributes to the chronicity of the process - surgical elimination of hypermobility or ectopia of the urethra, removal of foreign bodies, bladder stones, administration of local or systemic hormone therapy for signs of epithelial atrophy in postmenopause. Antibacterial and anti-inflammatory drugs are prescribed in combination with vitamin therapy, but for a longer time, drugs that improve blood supply to the bladder. Physiotherapy is quite effective.
In the treatment of cystitis, the use of SolUro Duo is indicated - a highly effective herbal uroantiseptic based on cranberry extract and D-mannose for use in diseases of the urinary system. Recommended for the purpose of normalizing the functional state of the urinary tract.
SolUro Duo is prescribed for:
- acute urinary tract infections (urethritis, cystitis);
- exacerbation of chronic urinary tract infections.
Long-term chronic cystitis, which cannot be treated, causes shrinkage of the bladder, which is accompanied by a pronounced decrease in its volume while the phenomena of strangury persist. In this case, the only treatment option is surgery.
Features of chronic cystitis
This form of inflammation is characterized by periodic exacerbations. During the passage of urine, patients experience pain, discomfort, and the urge to urinate becomes more frequent. Symptoms are chronic, but their intensity may change during treatment. With this form of the disease, as a rule, microorganisms are not found in the urine. [eleven]
In the absence of obvious exacerbations and hidden symptoms, doctors talk about latent cystitis. If exacerbations occur with a frequency of more than three episodes per year, the patient is diagnosed with persistent cystitis. But if there are frequent exacerbations, signs of deformation of the bladder tissue, and the pain is constant, we may be talking about interstitial cystitis. [16]
Complications of cystitis
The most dangerous complication of acute cystitis is ascending pyelonephritis. Against the background of acute inflammation of the bladder, its functioning is disrupted, and vesicoureteral reflux occurs - a pathological phenomenon in which, during contractions of the bladder, urine is thrown into the ureter and can even enter the renal pelvis. In addition, swelling of the mucous membrane can lead to compression of the intramural portion of the ureter and disruption of the passage of urine from the kidney. An increase in pressure in the pelvis triggers a pathological mechanism for the development of acute pyelonephritis. Against the background of strangury, the patient begins to notice the appearance of pain in the lumbar region, often during urination, which indicates vesicoureteral reflux. In this case, febrile fever is noted, often with stunning chills. In this case, the patient is subject to emergency hospitalization in a urological hospital.
