Cystitis acute and chronic - Causes, symptoms and treatment. MF.

Cystitis is an infectious and inflammatory disease of the bladder, more often affecting its mucous membrane. In connection with the high prevalence, high frequency of relapses, and also the difficulty of treating chronic forms of the disease, cystitis is a serious medical problem. In addition, a pronounced sudden onset of the disease, significant unpleasant sensations in the course of the disease lead to disruption of the normal rhythm of life, forced disability. Therefore, the identification and treatment of cystitis should be timely.

Causes of cystitis

Infectious diseases of the bladder are divided into complicated and uncomplicated. To uncomplicated forms of cystitis include inflammation of the bladder in healthy non-pregnant women aged 16-65 years in the absence of other diseases of the urinary tract. Complicated forms of cystitis are also found in patients with existing diseases of the urinary tract, for example, pyelonephritis, prostatitis, with severe systemic diseases such as diabetes, heart failure, as well as in men and the elderly. This distinction of forms of cystitis is necessary for conducting adequate diagnostic and therapeutic measures.

The main cause of cystitis is infection. As a rule, uncomplicated cystitis is caused by a single microorganism, with chronic inflammation a mixed flora is determined. The main pathogen is E. coli, in a smaller percentage of cases, staphylococcus saprophytic, klebsiella, enterobacter. Most pathogens are representatives of the normal microflora of the large intestine, rectum and vagina, therefore, cystitis is classified as an autoinfection. Currently, among young people, there is an increasing incidence of cystitis caused by specific sexually transmitted infections, for example, Chlamydia. In persons with reduced immunity, fungal cystitis is common, including through infection with yeast-like fungi of the genus Candida.

In a smaller percentage of cases, the noninfectious cystitis occurs. The supercooling of the body causes constriction of the bladder vessels, disruption of the nutrition of its wall, and as a result of weakening of the protective properties and the development of inflammation.
Chemical cystitis causes aggressive substances that are mistakenly injected into the bladder for a therapeutic purpose or when attempting to terminate a pregnancy.
Allergic cystitis develops when ingested allergens. As a rule, these or other food products become allergens. Allergic cystitis is characterized by short-term flow and complete cure alone or under the influence of antihistamines.
Protracted stress, neuro-psychic overexcitation can cause functional dysuria with changes in the mucous membrane of the bladder. Such cystitis is characterized by persistent flow, a tendency to relapse and the absence of bacteria in the analysis of urine.

For the development of cystitis, it is necessary to combine at least two factors: getting microorganisms or aggressive substances into the bladder and reducing the protective properties of the mucous membrane. Infection of the bladder can occur in the following ways. The predominant is the upward path of infection from the rectum, the vagina in women, the urethral region in men. The descending way( with infection of the kidneys and ureters) is less common. It is also possible hematogenous and lymphogenic infection, when microorganisms enter the mucosa of the bladder with blood or lymph flow. In rare cases, a contact path of infection is possible if the organ next to the bladder is affected. In conditions of reduced protective properties of the bladder wall, intensive multiplication of microorganisms occurs. In the process of their life, they secrete some substances that damage the mucous membrane, and develop cystitis.

Defloration, active sex life, pregnancy, childbirth, postpartum period, menopause change as provoking factors of the disease. Girls of preschool and primary school age are 6 times more likely to have cystitis than older age groups. This is due to the immaturity of the ovaries during this period and the absence of female sex hormones in the blood, which play an important role in the formation of protective mechanisms of the vaginal mucosa and the paraurethral region. This leads to the colonization of microorganisms and the formation of cystitis as an ascending infection. When defloration( destruction of the hymen) through the damaged lymph vessels of the hymen, the infection enters the bladder. Frequent and gross sexual acts contribute to microtrauma of the vaginal mucosa and the penetration of infection into the bloodstream and then into the bladder. But more often with prolonged sexual intercourse due to the massage of the urethra, the infection ascending way enters the bladder. When pregnancy is due to the pressure of the growing uterus, stagnation of urine forms, which promotes rapid multiplication of microorganisms and predisposes to the development of inflammation. In the climacteric period, in the absence of female sex hormones, which contribute to the formation of local immunity of the mucous membrane of the vagina and bladder, cystitis also often develops.

In men, primary cystitis is extremely rare, usually with a foreign body of the bladder or after urological manipulation. In most cases, cystitis in men secondary to the background of any disease of the urinary system.

Symptoms of cystitis

Acute cystitis is characterized by rapid onset of the disease. Often, it is possible to establish a connection of inflammation with predisposing factors, for example, hypothermia, preceding sexual intercourse. Patients complain of frequent urination, a constant desire to urinate, a sharp urge to urinate( urinary incontinence).Often you have to make an effort to start urinating. In the process of urination, pain and burning in the urethra occur, after urinating in the lower abdomen. Urine goes away in small portions, the urge to urinate does not stop either day or night. In young children, because of intense pain, acute urinary retention may occur.

With a pronounced inflammatory process, a common poisoning of the body is possible: an increase in body temperature to 38-40 degrees, general weakness, sweating, dry mouth, thirst. As a rule, this indicates the spread of infection with the development of pyelonephritis( infectious disease of kidney and renal pelvis).

In the recurrent form of cystitis, exacerbations are replaced by periods of complete absence of inflammation. At the same time, even a minimal impact of provoking factors can again cause the development of the disease.

The chronic form of cystitis is characterized by both mild and serious disorders of urination, slight discomfort or sharp pains in the lower abdomen, which are permanent in nature and slightly change during treatment. Such manifestations of cystitis occur because of persistent changes in the wall of the bladder due to frequent previous microbial attacks. With chronic cystitis, microorganisms in the urine are not detected.

If you have the above complaints, you should contact the therapist or nephrologist as soon as possible. Self-medication or loss of time can cause the transition of acute cystitis to a chronic form, the occurrence of complications.

The main sign of the presence of cystitis, except for external manifestations, is the detection of leukocytes and bacteria in the general analysis of urine. In the presence of bacteria, it is possible to sow urine with the identification of organisms and determine their sensitivity to antibiotics. It is also possible the appearance in the urine of a small number of red blood cells. With hemorrhagic cystitis, urine becomes the color of "meat slops", in which a large number of erythrocytes is determined. Ultrasound is informative only if the process is very pronounced or when the disease is chronic. This reveals thickening of the wall of the bladder, its stratification, puffiness.

Echogram for chronic cystitis.

In the lumen of the bladder appears a suspension of the dropped cells of the mucous membrane and microbial conglomerates.

Complications of cystitis

One of the most common complications of cystitis is pyelonephritis. In this case, the infection process ascending way passes from the bladder to the ureter in the renal pelvis, from there to the tissue of the kidneys. Of particular importance in this case is the casting of infected urine into the renal pelvis with increasing pressure in the bladder due to inflammation.

Another serious complication is the transition of uncomplicated cystitis to hemorrhagic form. In this inflammation covers not only the mucous membrane, but also other layers of the wall of the bladder. Bacteria in the course of their vital activity destroy the wall of the bladder, bleeding occurs. Hemorrhagic cystitis is characterized by visible changes in the properties of urine: it becomes red due to the admixture of blood, an unpleasant smell appears. Bleeding from the wall of the bladder can be a serious problem for the patient and even require surgical intervention.

Treatment of cystitis

Treatment of cystitis should be timely and comprehensive. Uncomplicated acute cystitis is treated on an outpatient basis. Depending on the proposed pathogen, antimicrobial therapy( ciprofloxacin, ofloxacin, levofloxacin) is prescribed. For the treatment of inflammatory syndrome, anti-inflammatory drugs( diclofenac, nimesulide) are recommended.

Since the first hours of the disease for the anesthetization and relief of urination, it is necessary to use anesthetic drugs( solpadene, suppositories with anesthesin) and spasmolytic drugs( no-shpa, papaverine).

To ensure adequate removal of infected urine and prevention of stagnant phenomena, it is recommended to consume liquid in an amount of at least two liters per day. In addition, it is necessary to abstain from sexual intercourse for 5-7 days. Also, in order to restore the protective properties of the mucosa of the bladder, the use of immunostimulating drugs is indicated.

Complicated cystitis , as a rule, must be treated in a hospital setting. In this case, the recognition of the disease that contributes to the occurrence of cystitis, as well as its adequate treatment. In some cases, for example, with the omission of the uterus in women or prostate adenoma in men, surgical treatment is indicated.

For the treatment of chronic form of cystitis and for preventive purposes it is permissible to use herbal preparations having a diuretic effect. Also, some plants( bearberry, field horsetail, sporach, berries cranberries and cranberries, celandine) have bacteriostatic, spasmolytic and analgesic properties. In Russia, some herbal medicines have been patented, for example, kanefron, cystone, which have proven themselves in the complex treatment of cystitis. Exacerbations of chronic cystitis are treated similarly to acute cystitis.

Prevention of cystitis

As a prophylaxis of cystitis or its exacerbation in the chronic form of the disease, it is recommended to empty the bowel and bladder regularly, avoid constipation. To lead an active way of life, to move more, as it helps to eliminate stagnant phenomena in the organs of the abdominal cavity. In addition, it is necessary to observe the rules of personal hygiene, especially of the genitals. It is very important for women to carry out a sanation of the vagina in a timely manner. With chronic cystitis, a complete cure is impossible without identifying and treating the primary cause.

Physician therapist, nephrologist Sirotkina EV