Acute cystitis

A fairly common disease that both adults and children face is acute cystitis. Let's look at the characteristics of the disease and its treatment methods.

Inflammation of the inner lining of the bladder is most often associated with the action of pathogenic microorganisms. The infection penetrates the bladder ascendingly, that is, from the urethra, or descendingly - from the kidneys and ureters. Infection is possible through the walls of the organ, through the blood and lymph.

This urological disease is characterized by catarrhal and hemorrhagic changes in the inner lining of the bladder. Inflammation can be primary, that is, without previous pathologies of the bladder. Secondary cystitis is also distinguished, which is divided into focal and total. Diagnostic measures and treatment methods depend on the type of pathology and the characteristics of its course.

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Epidemiology

According to medical statistics, women are more likely to face the problem of bladder inflammation. This is due to the structural features of their urethra. At the age of 20-40, cystitis occurs in 25-35% of people. About 30% of women have faced this urological problem at least once in their lives. The incidence rate in men is extremely low, with about 6-8 cases of the disease per 10 thousand people.

The main causative agents of inflammation are gram-negative enterobacteria and coagulase-negative staphylococci. The 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 etiologic agent is E. coli, which has high proliferative activity.

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Causes acute cystitis

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

• Infection – pathogenic and opportunistic flora enters the urethra from the vagina or anus. Infection is facilitated by a decrease in local immunity and hypothermia, the presence of a source of infection in the body.
• Drug therapy – the use of certain medications causes side effects, which include cystitis.
• Allergy – the disease may be associated with a reaction of the urinary tract mucosa to intimate hygiene products, a reaction to food or alcoholic beverages.
• Frequent change of sexual partners – promiscuous and unprotected sex increases the risk of developing infectious STIs, which lead to inflammation of the genitourinary system and the development of cystitis.
• Tight, synthetic underwear – such clothing promotes sweating in the genital area and the proliferation of pathogenic microorganisms, which in turn increases the risk of developing the disease.
• Nephrological disorders – kidney diseases significantly increase the risk of downward spread of infection, that is, from the kidneys to the bladder.
• Constipation and gastrointestinal diseases lead to the activation of opportunistic microflora, which easily penetrates the urinary tract.

In addition to the above reasons, the development of acute cystitis is facilitated by a decrease in immunity. It is the weakened immune system that leads to the fact that pathogenic flora easily penetrates the urinary tract, causing inflammatory reactions.

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Risk factors

There are a number of predisposing factors that contribute to the development of infection. The main risk factors for acute cystitis include:

• Hypothermia.
• The effects of alcoholic beverages.
• Stress, depression.
• Allergic reactions to food, medications or hygiene products.
• Decreased general and local immunity.
• Pregnancy and postpartum period.
• Failure to comply with the rules of personal, and in particular intimate hygiene.
• Traumatization and microtraumatization of the organ mucosa.
• Hormonal disorders.
• Urodynamic disturbances.
• Cicatricial changes in the organ area, strictures.
• Chemotherapy or radiation to the bladder area.
• Genital infections.
• Instrumental examination of the genitourinary organs without observing aseptic standards.
• Postoperative period.
• Crystalluria.

For bacteria to develop, the immune system's defenses must be weakened. The disease can be triggered by various gynecological diseases and any other sources of infection. The most common pathogens are E. coli and staphylococcus, less often Proteus, Pseudomonas aeruginosa, and streptococcus. In some cases, the pathogenic flora is mixed.

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Pathogenesis

The mechanism of development of bladder inflammation in 90% of cases is associated with damage to the mucous membrane of the organ by intestinal bacteria, i.e. Escherichia coli. Infection occurs in several ways:

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

The bladder mucosa has increased resistance to infection, so the development of the disease in most cases occurs under the influence of predisposing factors. These include hormonal disorders, recent illnesses, hypothermia and overwork, surgical interventions, vitamin deficiencies, etc.

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Complications and consequences

Cystitis is a serious disease that without timely medical care can lead to life-threatening consequences. Let's consider the main complications of bladder damage:

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

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

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Diagnostics acute cystitis

The diagnosis – inflammation of the bladder is made on the basis of a number of clinical, laboratory and instrumental studies. Diagnosis of acute cystitis begins with collecting anamnesis. The doctor asks the patient about possible causes of the disorder and the nature of painful symptoms. Palpation of the suprapubic area is also performed, since sharp pains appear with inflammation.

At the next stage, the urologist gives a referral for tests. It is necessary to pass a general urine test and its bacteriological culture. In the general analysis, an increased number of leukocytes, uric acid, protein, mucus, erythrocytes are detected. If the disease is of a bacterial nature, then pathogenic flora is detected. A general blood test is also necessary, which will show whether the inflammatory process has affected the kidneys.

Diagnostics include cystoscopy. During this examination, the bladder is filled with a special liquid and a cystoscope is inserted into the organ to assess its condition from the inside. For women, a visit to a gynecologist is mandatory, as well as bacteriological, microscopic and PCR studies of gynecological smears. If necessary, an ultrasound of the bladder, kidneys and other organs of the genitourinary system may be prescribed.

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Tests

Timely diagnosis of cystitis helps prevent the ascending spread of infection, the development of complications and kidney damage. Tests are laboratory diagnostics, which are carried out to establish a diagnosis and monitor the effectiveness of treatment.

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

• Blood test.
• General urine analysis and according to Nechiporenko.
• Urine PCR.
• Determination of the type of pathogenic microflora and its sensitivity to antibacterial drugs.
• Vaginal smears to determine microflora and sexually transmitted infections.

1. Clinical blood test - if the disease is uncomplicated, no pathological changes are detected. In more severe cases, there are clear signs of inflammation: leukocytosis, neutrophilia, increased ESR, shift in the leukocyte formula to the left.
2. General urine analysis – this study is aimed at determining changes in the properties of urine. The laboratory evaluates the state of the following fluid parameters: color, odor, transparency, specific density, leukocytes, erythrocytes, cylinders, epithelial cells, salts, fungi and bacteria.
3. Nechiporenko analysis is performed in case of pathological indicators of general urine analysis and in case of suspected latent forms of inflammation. This method determines with high accuracy the number of leukocytes, erythrocytes and cylinders in 1 ml of urine. The middle portion of urine is used for the analysis.
4. Polymerase chain reaction - PCR reveals the genetic material of pathogenic microorganisms. Allows for qualitative and quantitative research with high specificity. Scrapings from the vagina, cervix and urethra are taken for the research.
5. Bacterial culture – reveals the causes of bladder inflammation. Urine is sown on nutrient media. After 10 days, colonies of bacteria and fungi are obtained, which are tested for sensitivity to antibiotics to select 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 genitals is carried out with a soap solution. 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 collection.

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Urine in acute cystitis

Inflammation of the bladder occurs with pronounced painful symptoms that are difficult to confuse with other diseases. But for effective treatment of cystitis, correct diagnostics are very important. Based on its results, drugs and other methods of therapy are selected. One of the most informative is urine analysis.

Let's consider the main indicators of a general urine analysis for acute cystitis:

• Color – due to inflammation of the mucous membrane of the urinary system, a small amount of blood gets into the urine, which colors it. The color of healthy urine varies from light yellow to straw.
• Transparency – a healthy person has transparent urine. Due to the action of pathogenic microorganisms, urine becomes cloudy. It contains epithelial particles and cells due to an inflammatory reaction.
• Acidity – with cystitis, urine is more alkaline, which affects the waste products of bacteria and increases the level of excreted protein.
• Leukocytes - normally urine contains a small number of leukocytes, which enter the kidneys with the bloodstream. Women have a higher number of leukocytes than men. Increased levels indicate inflammation in the bladder. If urine contains pus, this indicates the development of pyuria.
• Red blood cells – with cystitis, there are blood clots in the fluid. 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, then this indicates not only inflammation of the bladder, but also kidney damage.
• Flat epithelium - the urethra and ureter are lined with epithelium, which peels off during inflammation and exits with urine.
• Bacterial indicators – their presence indicates cystitis, since urine normally does not contain bacteria.
• Mucus occurs because during inflammation, epithelial cells are rejected, which should not normally be there.

In addition to the general analysis, patients undergo a study according to Nechiporenko. The tests are indicated not only during the diagnostic process, but also during treatment to determine the effectiveness of the prescribed therapy.

Instrumental diagnostics

Another stage of bladder inflammation diagnostics is instrumental examinations. The following procedures are performed to confirm the diagnosis:

• Ultrasound – ultrasound examination of the bladder provides a visual image of the shape and size of the organ. It allows identifying structural changes in the mucous membranes that can cause serious complications. If necessary, a comprehensive ultrasound of the entire genitourinary system and kidneys is performed.
• Cystoscopy – allows diagnosing bladder damage at early stages. The organ is filled with liquid and an optical device is inserted. If cystitis is acute, cystoscopy is contraindicated due to high trauma and the risk of further spread of infection.
• Cystography is an X-ray examination that allows for a thorough study of the structure of the inflamed organ and excretory system. During the examination, stones, tumors, and anomalies in the structure of the organ can be detected.

The results of instrumental examinations are compared with laboratory tests and a final diagnosis is made. The diagnostics performed allows choosing the most effective treatment method.

Differential diagnosis

In addition to laboratory and instrumental examinations, if a bladder disease is suspected, differential diagnostics are carried out. Cystitis is compared with the following pathologies:

• Kidney disease.
• Bladder stones.
• Gynecological pathologies.
• Diseases of the prostate gland and urethra.
• Cystalgia.
• Tumor neoplasms.

When differentiating chronic inflammation from frequent acute attacks, it is necessary to exclude ulcerative lesions of the bladder mucosa, various tumors, and polyps. For these purposes, endovesical biopsy may be indicated.

Treatment acute cystitis

If a patient is diagnosed with acute cystitis, a comprehensive approach is used to eliminate it. The treatment plan is made based on the results of the diagnostics, individually for each patient.

First of all, the foci of infection are sanitized to restore the protective mechanisms of the organ mucosa. Treatment consists of:

• Etiotropic (antimicrobial) therapy.
• Antispasmodics and anti-inflammatory drugs.
• Medicines for the treatment of urination disorders.
• Vitamin therapy to strengthen the immune system and speed up recovery.
• Proper intimate hygiene and bed rest.
• Diet, increased drinking regime.
• Physiotherapy procedures.

The duration of treatment is from 7 to 10 days. If the therapy is ineffective, the disease becomes chronic. In rare cases, surgical intervention with subsequent drug therapy is used for treatment.

Prevention

It is much easier to prevent any disease than to cure it. This also applies to bladder inflammation, which very often occurs in an acute form. However, if the disease makes itself known more than twice a year, this indicates its transition to a chronic form.

Prevention of acute cystitis consists of the following rules:

• Proper, healthy nutrition with restrictions on foods that irritate the bladder.
• Underwear made from natural fabrics and clothing appropriate to the weather to prevent hypothermia.
• For women, when using toilet paper, you should move it from the urethra to the anus to prevent bacteria from the rectum from entering the urethra.
• Do not use intimate hygiene products that contain preservatives, aromatic fragrances, surfactants, or parabens.
• Avoid prolonged periods of urination. Always empty your bladder completely.
• Drink plenty of fluids.

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

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Forecast

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

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

Sick leave

The length of stay on sick leave depends on the form of the disease and its duration. In case of acute inflammation, the patient is discharged for 5-8 days. Hospitalization in the urological or therapeutic department is possible, but most often the patient is treated on an outpatient basis.

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

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