Acute cystitis

A fairly common disease faced by both adults and children is acute cystitis. Let's consider the peculiarities of the disease and the methods of its treatment.

Inflammation of the inner membrane of the bladder is most often associated with the action of pathogenic microorganisms. Infection penetrates into the bladder ascending way, that is, from the urethra or downward from the kidneys and ureters. Infection is possible through the walls of the body, through the blood and lymph.

For this urological disease, catarrhal and hemorrhagic changes in the inner membrane of the urea are characteristic. Inflammation can be primary, that is, without previous bladder pathologies. Also isolated secondary cystitis, which is divided into focal and total. Diagnostic measures and methods of treatment depend on the type of pathology and its flow characteristics.

[1], [2], [3], [4], [5], [6], [7], [8]

Epidemiology

According to medical statistics, the problem of inflammation of the bladder is more common for women. This is due to the peculiarities of the structure of their urethra. At the age of 20-40 years, cystitis occurs in 25-35% of people. Approximately 30% of women at least once in their lives, but have experienced this urological problem. In men, the incidence is extremely low, with about 10,000 people accounting for about 6-8 cases of the disease.

The main pathogens of inflammation are gram-negative enterobacteria and coagulase-negative staphylococci. Studies have shown that in 80% of cases acute cystitis occurs due to Escherichia coli, 9% Proteus spp., 4% Klebsiella spp., And about 2% Staphylococcus saprophyticus and Enterobacter spp. That is, most often the etiological agent is the E. Coli, which has a high proliferative activity.

[9], [10]

Causes of the acute cystitis

There are many reasons for the development of acute infection of the urinary system, consider the main ones:

• Infection - pathogenic and conditionally pathogenic flora enters the urethra from the vagina or anus. Infection is facilitated by a decrease in local immunity and hypothermia, the presence of an infection in the body.
• Medicamentous therapy - the use of certain medications causes side reactions, including cystitis.
• Allergy - a disease can be associated with the reaction of the urinary tract mucosa to intimate hygiene products, a reaction to food or alcohol.
• Frequent change of sexual partners - disorderly and unprotected sex increases the risk of developing infectious STDs against which the organs of the genitourinary system become inflamed and cystitis develops.
• Closely, synthetic underwear - such clothing contributes to the erection in the genital area and the proliferation of pathogens, which in turn increases the risk of developing the disease.
• Nephrological disorders - kidney diseases significantly increase the risk of a downward spread of infection, that is, from the kidneys to the bladder.
• Constipation and diseases of the gastrointestinal tract lead to activation of the opportunistic microflora, which easily penetrates into the urinary tract.

In addition to the above reasons, the development of acute cystitis contributes to a decrease in immunity. It is the weakened immune system that causes the pathogenic flora to easily enter the urinary tract, causing inflammatory reactions.

[11], [12], [13], [14], [15], [16], [17]

Risk factors

There are a number of predisposing factors, the effect of which contributes to the development of infection. The main risk factors for acute cystitis include:

• Subcooling.
• Action of alcoholic beverages.
• Stresses, suppressed states.
• Allergic reactions to food, medicine or hygiene.
• Decrease in general and local immunity.
• Pregnancy and the postpartum period.
• Non-compliance with the rules of personal, and in particular intimate hygiene.
• Traumatization and microtraumatism of the mucous membrane of the organ.
• Hormonal disorders.
• Violation of urodynamics.
• Cicatricial changes in the area of the organ, stricture.
• Chemotherapy or irradiation of the bladder area.
• Genital infections.
• Instrumental research of urino-genital organs with non-compliance with aseptic norms.
• Postoperative period.
• Crystalluria.

For the development of bacteria, it is necessary to reduce the protective forces of the immune system. The impetus for the disease can be various gynecological diseases and any other foci of infection. Among the pathogens most often detected E. Coli and staphylococcus, less proteas, Pseudomonas aeruginosa, streptococcus. In some cases, the pathogenic flora has a mixed character.

[18], [19], [20], [21], [22]

Pathogenesis

The mechanism of the development of inflammation of the bladder in 90% of cases is associated with the defeat of the mucous membrane of the organ with E. Coli, i.e. Escherichia coli. Infection occurs in several ways:

• Ascending - the infection penetrates the organ with inflammatory diseases of the urethra, prostate, testis and its appendages, seminal vesicles.
• Descending - most often associated with kidney disease.
• Hematogenous - for various infectious diseases or in the presence of a purulent focus in the body.
• Lymphogenous - infection is possible with diseases of the genitals or catheterization of the organ during cystoscopy.
• Contact - direct infection occurs when fistulas that connect the bladder to the vagina or vagina with the rectum.

Bladder mucosa has an increased resistance to infection, so the development of the disease in most cases occurs with the action of predisposing factors. These include hormonal disorders, recently transferred diseases, hypothermia and overwork, surgical interventions, beriberi and other.

[23], [24], [25], [26], [27], [28], [29]

Complications and consequences

Cystitis is a serious disease that, without timely medical assistance, can lead to life-threatening consequences. Consider the main complications of the bladder:

• Kidney diseases - in 95% of cases, cystitis on the ascending pathway affects the kidneys, causes nephritis, pyelonephritis, kidney failure. The latter is formed due to excessive intoxication of the organ tissues by the products of the vital activity of the pathogenic flora.
• Bladder-ureteral reflux - occurs in female patients. It is a return of urine from the bladder back to the kidneys.
• The weakening of the sphincter of the bladder - most often occurs in elderly patients, leads to persistent urinary incontinence.
• Organic changes in the tissues of the organ - degeneration of the epithelial layer, loss of elasticity and the ability to regenerate, decrease in size. This complication significantly increases the risk of rupture of the bladder.
• Without proper treatment, the cystitis passes into a chronic form, recurring with acute inflammations 2-4 times a year. This leads to damage to nearby organs. For women, there is a danger of developing infertility due to the formation of adhesions in the structures of the uterus.

Another danger of the disease is that it exerts a strong psychological pressure on a healthy person, making it essentially a hostage to the toilet. Against this background, there is depression, stress and psycho-emotional experiences.

[30], [31], [32], [33], [34]

Diagnostics of the acute cystitis

Diagnosis - inflammation of the bladder is based on a number of clinical, laboratory and instrumental studies. Diagnosis of acute cystitis begins with the collection of anamnesis. The doctor asks the patient about the possible causes of the disorder and the nature of the painful symptoms. Also palpation of the suprapubic region is carried out, since sharp pains appear in the inflammation.

At the next stage the urologist gives direction to the tests. It is necessary to pass a general analysis of urine and its bacteriological culture. In the general analysis, an increased number of leukocytes, uric acid, protein, mucus, erythrocytes. If the disease is of a bacterial nature, then the pathogenic flora is identified. Also, a general blood test is needed to show whether the inflammatory process of the kidney has affected.

Diagnosis involves cystoscopy. During this study, the bladder is filled with a special fluid and injected into the organ of the cystoscope to assess its condition from the inside. For women, a visit to the gynecologist, bacteriological, microscopic and PCR studies of gynecological smears is mandatory. If necessary, ultrasound of the bladder, kidneys and other organs of the genitourinary system can be prescribed.

[35], [36], [37], [38], [39], [40], [41], [42], [43], [44]

Analyzes

Timely diagnosis of cystitis can prevent the upward spread of infection, the development of complications and kidney damage. Analyzes refer to laboratory diagnostics, which are carried out to diagnose and control the effectiveness of treatment.

The laboratory minimum for inflammation of the bladder includes such studies:

• Blood test.
• General analysis of urine and Nechiporenko.
• RDP Urin.
• Determination of the type of pathogenic microflora and its sensitivity to antibacterial drugs.
• Smears from the vagina to determine the microflora and sexual infections.

1. Clinical analysis of blood - if the disease occurs in an uncomplicated form, then no pathological changes are detected. In more severe cases, there are clear signs of inflammation: leukocytosis, neutrophilia, increased ESR, shift of the leukocyte formula to the left.
2. General analysis of urine - this study is aimed at determining the change in the properties of urine. The laboratory assesses the state of such fluid parameters: color, odor, transparency, specific density, leukocytes, erythrocytes, cylinders, epithelial cells, salts, fungi and bacteria.
3. Nechiporenko analysis - is performed with pathological indicators of the general analysis of urine and with suspected hidden forms of inflammation. This technique with a high accuracy determines the number of leukocytes, erythrocytes and cylinders in 1 ml of urine. For the analysis, use an average portion of urine.
4. Polymerase chain reaction - PCR reveals the genetic material of pathogens. Allows to conduct qualitative and quantitative research with high specificity. For research take scrapings from the vagina, cervix and urethra.
5. Bacterial sowing - reveals the causes of inflammation of the bladder. Urine is sown on nutrient media. After 10 days, colonies of bacteria, fungi are obtained, which are tested for sensitivity to antibiotics for the selection of effective drugs.

In order for the analysis to be as reliable as possible, it is necessary to prepare for its delivery. First of all, hygiene of the external genital organs with a soap solution is carried out. Urine should be collected in the morning after sleep in a sterile container. The biomaterial is delivered to the laboratory within 1-2 hours after the fence.

[45], [46], [47], [48], [49], [50], [51]

Urine in acute cystitis

Inflammation of the bladder proceeds with a pronounced painful symptomatology, which is difficult to confuse with other diseases. But for the effective treatment of cystitis, correct diagnosis is very important. Based on its results, drugs and other therapies are selected. One of the most informative is urinalysis.

Let's consider the basic indicators of the general analysis of urine at an acute cystitis:

• Color - due to inflammation of the urinary mucosa, a small amount of blood gets into the urine, which stains it. The color of healthy urine varies from light yellow to that of straw.
• Transparency - a healthy person has a clear urine. Due to the action of pathogenic microorganisms, urine becomes turbid. It receives particles of the epithelium and cells due to an inflammatory reaction.
• Acidity - with urinary cystitis urine is more alkaline, which affects the products of the life of bacteria and increases the level of secreted protein.
• Leukocytes - Normally, urine contains a small amount of white blood cells that enter the kidneys with blood flow. In women, the number of leukocytes is higher than that of men. Elevated indices indicate inflammation in the bladder. If urine contains pus, this indicates the development of pyuria.
• Erythrocytes - with cystitis in the fluid there are blood clots. If more than two red cells are detected during the analysis, this indicates an acute form of inflammation.
• Protein - if its amount is higher than 1 g per 1 liter of urine, it speaks not only of inflammation of the bladder, but also of kidney damage.
• The flat epithelium - the urethra and the ureter are lined with an epithelium, which flakes off during the inflammation and goes out with the urine.
• Bacterial indicators - their presence indicates a cystitis, as in the norm urine does not contain bacteria.
• Slime - arises due to the fact that during inflammation the epithelial cells are rejected, which should not normally be present.

In addition to the general analysis, the patients undergo a Nechiporenko study. The analyzes are shown not only during the diagnosis, but also during treatment to determine the effectiveness of the prescribed therapy.

Instrumental diagnostics

Another step in diagnosing inflammation of the bladder is instrumental research. To confirm the diagnosis, the following procedures are carried out:

• Ultrasound - ultrasound examination of the bladder gives a visual image of the shape and size of the organ. It allows to reveal structural changes of mucous membranes, which can cause serious complications. If necessary, a comprehensive ultrasound of the entire genitourinary system and kidneys is performed.
• Cystoscopy - allows you to diagnose bladder damage in the early stages. The body is filled with liquid and an optical device is inserted. If cystitis occurs in an acute form, then cystoscopy is contraindicated because of high traumatism and the risk of further spread of the infection.
• Cystography is an x-ray examination that allows you to carefully study the structure of the inflamed organ and excretory system. During the study, concrements, tumor neoplasms, anomalies in the structure of the organ can be detected.

The results of instrumental examinations are compared with laboratory analyzes and put the final diagnosis. Diagnosis carried out allows you to choose the most effective method of treatment.

Differential diagnosis

In addition to laboratory and instrumental examinations, if there is a suspicion of bladder disease, differential diagnosis is performed. Cystitis is compared with such pathologies:

• Kidney diseases.
• Concrement of the bladder.
• Gynecological pathology.
• Diseases of the prostate and urethra.
• Cistalgia.
• Tumor neoplasms.

When differentiating chronic inflammation with frequent acute attacks it is necessary to exclude ulcerative lesions of the bladder mucosa, various tumors, polyps. Endosevical biopsy can be indicated for these purposes.

Treatment of the acute cystitis

If the patient is diagnosed with acute cystitis, then an integrated approach is used to eliminate it. The treatment plan is based on the results of the diagnosis performed, individually for each patient.

First of all, sanation of foci of infection is carried out to restore the protective mechanisms of the mucous organ. Treatment consists of:

• Etiotropic (antimicrobial) therapy.
• Spasmolytics and anti-inflammatory drugs.
• Preparations for elimination of urination disorders.
• Vitaminotherapy to strengthen the immune system and accelerate recovery.
• Proper intimate hygiene and bed rest.
• Diet, intensified drinking regimen.
• Physiotherapy.

Duration of treatment is from 7 to 10 days. If the therapy turned out to be ineffective, then the disease turns into a chronic form. In rare cases, surgical intervention with further drug therapy is used for treatment.

Prevention

Any disease is much easier to prevent than cure. This also applies to inflammation of the bladder, which often occurs in an acute form. In this case, if the disease makes itself felt more often than twice a year, then this indicates its transition to a chronic form.

Prevention of acute cystitis consists of such rules:

• Correct, healthy food with the restriction of products that cause irritation of the bladder.
• Underwear made of natural fabrics and weather clothes to prevent subcooling.
• For women, when using toilet paper, you should lead from the urethra to the anus to prevent bacteria from entering the urethra from entering the urethra.
• Do not use products for intimate hygiene, which include preservatives, aromatic fragrances, surfactants, parabens.
• Do not allow prolonged abstinence to urinate. Always empty the bladder completely.
• Eat plenty of fluids.

In addition to the above recommendations, it is necessary to promptly treat any diseases and regularly undergo preventive examinations.

[52], [53], [54], [55], [56], [57], [58], [59]

Forecast

In most cases, acute cystitis has a favorable prognosis. If inflammation of the bladder occurs in patients with impaired fluid outflow, then often the disease takes a chronic form.

If the disease occurs in a gangrenous or necrotic form, then its outcome depends on the correctness of the composition of the therapy. In this case, patients are prescribed not only drug therapy, but also surgical intervention.

Sick leave

The length of stay on the sick depends on the form of the disease and its duration. In acute inflammation, it is prescribed for 5-8 days. Possible hospitalization in the urological or therapeutic department, but more often the patient is treated out-patiently

When the hospital sheet is issued, the doctor takes into account the results of laboratory and instrumental diagnostics, the presence of an elevated body temperature and the general condition of the patient. It is especially important to get sick for female patients. Since their treatment requires regular hygienic care for the genitals and urinary tract. Hospitals with acute cystitis are prescribed by a therapist or urologist.

[60], [61], [62], [63], [64], [65], [66]