Cystitis with blood: causes, symptoms, diagnosis

Inflammation of the bladder is characterized by frequent and painful urges to urinate. Sometimes you can observe cystitis with blood, which appears at the end of urination, or is simply present in the urine, coloring it in a reddish or pinkish hue. In the first case, we are talking about acute cystitis, and in the second case - about a more complex problem - hemorrhagic cystitis.

Epidemiology

According to statistics, cystitis with blood is more often found in female patients. This is mainly due to anatomical, physiological and hormonal reasons.

In our country, several million cases of bladder inflammation are recorded annually. The disease has been diagnosed at least once in a lifetime in 25% of women and 5% of men. In every third patient, cystitis occurs with relapses, and in 10% of cases, acute cystitis with blood becomes chronic.

Hemorrhagic cystitis is often found in children or young people aged 25 to 30 years, or in women over 55 years. Blood in the urine is determined mainly in acute or recurrent cystitis.

Causes cystitis with blood

• True cystitis with blood (hemorrhagic) is often a consequence of adenovirus infection, which penetrates from the blood into the urinary system. Such pathology is diagnosed mainly in children - especially in boys.
• Blood in the urine may appear as a result of treatment with cytostatic drugs, which in the human body are converted into acrolein, a component that irritates the inner walls of the bladder.
• Cystitis with blood may be a result of radiation therapy.
• The appearance of blood in women is often associated with microbial infections - for example, when E. coli enters the urethra and bladder.

Cystitis with blood occurs under the influence of any cause capable of injuring or damaging the internal mucous tissue of the bladder. In this case, the blood vessels are exposed and blood flows into the lumen of the organ. [ 1 ]

The following categories of patients are at the greatest risk of developing cystitis with blood:

• sexually active women and men, especially with an abundance of casual sex;
• patients using specific contraceptive methods, such as membranes with spermicidal substances;
• women in menopause;
• patients who use urinary catheters for a long time or periodically.

Risk factors

Specific factors that contribute to the appearance of blood during cystitis may include:

• decreased contractile function of the muscles of the walls of the urinary organ;
• the entry of foreign bodies into the urethra, such as stones or sand, which damage the mucous tissues and cause an inflammatory process;
• prolonged absence of emptying of the bladder, which causes circulatory disorders in the organ;
• anatomical disorders of urinary fluid excretion – for example, narrowed lumen of the bladder, tumor processes.

Pathogenesis

The penetration of a bacterial or viral infection into the urinary system can occur in different ways:

• ascending pathway (also known as urethral pathway, that is, through the urethra);
• hematogenous route (infection enters through the blood);
• lymphogenous route (infection enters through the lymphatic vessels).

In women, urethral infection is most common, while in children, hematogenous infection is most common.

An important condition for the development of microbial cystitis with blood is the attraction of pathogenic microorganisms to the urothelial cells with their subsequent invasion.

The urothelium is capable of producing and secreting a mucopolysaccharide substance onto the bladder walls, which forms its internal protection. This substance can also play an anti-adhesive role. Infection is attracted to the urothelial cells as a result of damage or modification of the mucopolysaccharide protection: this can be explained by impaired blood circulation in the organ, an increased content of receptors for microbial adhesion. Mechanical injuries to the bladder are also possible, which lead to the exposure of blood vessels and the release of blood into the urine. [ 2 ]

Symptoms cystitis with blood

The first signs of cystitis do not manifest themselves by the release of blood in the urine. The most common symptoms are:

• strong and sudden urge to urinate;
• false and frequent urges;
• severe burning sensation during urination;
• severe urge to urinate against the background of a small amount of urine;
• cloudy urine, change in smell;
• a feeling of discomfort and pressure in the lower abdomen;
• a slight increase in temperature – approximately up to 37, less often – up to 38°C.

In young children, acute cystitis with blood often manifests itself as urinary incontinence, fever, loss of appetite, and sleep disturbances.

An acute attack of cystitis with blood, accompanied by symptoms of intoxication (rapid heartbeat, vomiting, significant increase in temperature, chills) is usually typical for the fibrous-ulcerative or gangrenous form of the disease. Such forms often develop in patients with obvious immunodeficiency, or with complications of pyelonephritis.

Blood in chronic cystitis can be detected only during an exacerbation. Additional symptoms include general anxiety and painful palpation in the suprapubic area. [ 3 ]

Cystitis with blood in women

Cystitis in women occurs frequently, and sometimes even becomes chronic. The reason for this is self-medication, a frivolous attitude towards the disease, ignoring a visit to the doctor. Other reasons may be:

• a sharp weakening of the immune system;
• a sedentary lifestyle, prolonged sitting position, prolonged retention of urine in the bladder;
• consumption of sweets, spicy and fried foods, low fluid intake;
• untreated gynecological problems;
• constant stress, chronic fatigue;
• failure to comply with the rules of personal and intimate hygiene;
• promiscuous sex life, unprotected sexual contacts.

The risk of developing an inflammatory process increases significantly if a woman:

• practices combined anal-vaginal intercourse;
• wipes after defecation not from front to back, but vice versa;
• regularly uses pads or tampons (including daily ones) and rarely changes them;
• wears underwear made of dense synthetic fabrics;
• often tries to suppress urination.

In women, the disease often develops against the background of hormonal changes – for example, with the onset of menopause or during pregnancy.

Cystitis with blood during pregnancy

The inflammatory process makes itself known during pregnancy quite often, and there is an explanation for this. Firstly, the uterus increases in size and presses on the ureters and bladder. This causes a disruption of blood circulation in the organs, prevents adequate urine flow, and promotes the development of a bacterial infection. Secondly, pregnant women experience a decrease in the quality of their immune defense: the body does this intentionally so that the uterus does not reject the baby, mistaking new tissues for a foreign body. Thirdly, strong hormonal changes also contribute to the development of the disease.

If a woman has previously had problems with the urinary tract, then during pregnancy they will most likely worsen.

It should be noted that cystitis with blood in a pregnant woman requires a special and serious attitude. Hoping that it will “go away on its own” and drinking only cranberry juice is, at the very least, unreasonable. Seeking medical help should not only be mandatory, but also immediate. If timely, high-quality treatment is not provided, the risk of spontaneous abortion, premature birth, and impaired intrauterine development of the baby increases.

Blood in cystitis in a child

Bladder inflammation is the most common urinary tract infection encountered in pediatric and pediatric urological practice. The disease occurs in children of all ages, but is found approximately 4 times more often in girls aged 4-12 years. This incidence rate is associated with the anatomy of girls: a wide and short urethra, close proximity to the anus, etc.

Blood in the urine may be observed in isolated or combined inflammatory processes (for example, in cystourethritis, cystopyelonephritis).

When conducting bacterial culture of urine fluid in children, predominantly uropathogenic strains of E. coli are cultured, less often - Proteus, Klebsiella, Pseudomonas aeruginosa, and Staphylococcus epidermidis. In approximately every fourth case, bacteria in the urine are not detected by diagnostic means.

Acute cystitis in childhood most often ends in recovery. The chronic form of the disease develops in the presence of anatomical functional prerequisites for the delay and reproduction of infection. Children with the chronic form should be under the supervision of a urologist, regularly submit urine for analysis and undergo examination.

Blood in cystitis in men

Cystitis is not as common in men as it is in women. However, not many people know that the inflammation in male patients is more severe, with pronounced symptoms and blood in the urine. Moreover, the disease is mainly associated with a problem in the prostate.

The disease can develop after the microbial pathogen Escherichia coli, which normally "lives" in the intestines, enters the bladder. But cystitis is often secondary, since the prostate gland becomes inflamed first. The urethra narrows, the bladder is not completely emptied, which increases the likelihood of an infectious process developing.

Treatment of the disease in men involves primarily affecting the inflammatory reaction in the prostate, after which drug therapy for cystitis is prescribed - in particular, taking antibacterial drugs is required. In addition, it is necessary to follow a diet, drink plenty of fluids: this allows you to speed up the removal of bacteria from the urinary system and potentiate the healing of damaged tissues.

Cystitis with blood after intimacy

This type of disease is called postcoital, since the inflammation develops within 24 hours after sexual contact. In this case, sexual intercourse becomes a provoking factor of the painful process.

There may be several reasons:

• too rough sex or insufficient natural lubrication leads to damage to the tissues of the genitals and urethra;
• diseases of the genital area that cause pain during sexual intercourse;
• low levels of sex hormones in the female body (in particular, estrogens);
• frequent and promiscuous sexual intercourse;
• combination of anal and vaginal intercourse.

Also, the “culprits” may be the anatomical features of the genitals – for example, if the distance between the urethra and anus is less than 4.5 cm.

Radiation cystitis with blood

During the treatment of oncology, most patients undergo radiation therapy. The difficulty is that, in addition to the malignant focus, other healthy organs are also exposed to radiation. Among them is the bladder: the rays affect its tissues, which causes the development of radiation cystitis.

When the urothelium, the natural protective layer of the bladder, is damaged, elements of the urinary fluid begin to irritate the mucous tissue, affecting the exposed nerve endings. With long-term radiation therapy, the urothelium can become covered with ulcers, which further aggravates the situation. The ulcers begin to bleed, and blood appears in the urine.

With such a problem, intravesical treatment is often the only correct solution: sodium hyaluronate or alginate, chondroitin sulfate are prescribed, that is, substances that can restore the protective layer and correct autoimmune reactions.

Radiation cystitis with blood is a serious complication of a specific type of therapy. However, there is no need to despair: modern means can help the patient and cure the insidious disease. [ 4 ]

Complications and consequences

If after the first signs of cystitis with blood the treatment followed quickly and turned out to be competent, then complications in this case develop extremely rarely. But if the treatment measures are not timely, the condition may worsen with the development of serious and unfavorable consequences. [ 5 ]

The most probable complications include, first of all, pyelonephritis – an infectious inflammatory lesion of the kidneys. The infectious process from the main source of inflammation – the bladder – is transported to the kidneys in an ascending manner, which leads to pyelonephritis or even to irreversible changes in the kidney tissue.

Young children and the elderly have the highest risk of kidney damage due to infectious cystitis. Regular and especially prolonged hematuria most often leads to the development of anemia, with symptoms characteristic of this condition: dizziness, dark circles under the eyes, pale skin, weakness, fatigue, etc. [ 6 ]

Diagnostics cystitis with blood

The first diagnostic stages that the patient will have to go through at the doctor's appointment are a survey and a physical examination. Only after listening to the patient's complaints and examining him for external pathological signs, the doctor will be able to recommend certain laboratory studies and tests, for example:

• A general urine analysis helps to identify leukocyturia, erythrocyturia, and nitrites, which indicate the presence of a bacterial infection in the urinary system;
• urine sterility testing is performed when infectious processes in the bladder are suspected and helps to identify the type and number of pathogenic microorganisms;
• A general blood test for cystitis shows non-specific inflammatory changes and can provide an indirect idea of the presence and severity of the infectious process in the urinary tract.

Blood in the urine during cystitis is not necessarily detected only by laboratory methods: sometimes it can be seen independently - for example, at the end of urination (the so-called "last drops" of urine). Often, the urine is colored reddish or pinkish, which also indicates the presence of blood in it. It is especially dangerous if the color becomes red or "rusty", strands and clots appear, which indicates the presence of a large amount of blood in the urine. [ 7 ]

Leukocytes in cystitis in the blood are considered one of the markers of the inflammatory process in the body. The main function of these cells is to counteract the penetration of viruses and bacterial infections. The presence of inflammation can be indicated by both a strong increase in the level of leukocytes and a significant decrease in their number.

Instrumental diagnostics usually include cystoscopy, plain abdominal radiography or ultrasound of the retroperitoneal organs. If necessary, radiography with contrast, cystography or intravenous urography are prescribed.

The use of a cystoscope is sometimes associated with the removal of a small piece of tissue (biopsy) for further histological examination.

Differential diagnosis

Differential diagnostics is usually aimed at excluding secondary cystitis and the likelihood of developing primary diseases such as bladder stones, tumor processes, neurogenic urinary dysfunction, preinvasive cancer. In addition, it is necessary to separate special forms of inflammation (for example, tuberculosis type), determine the stage and extent of the spread of the pathological reaction in the urinary system. [ 8 ]

Treatment cystitis with blood

Before prescribing treatment for cystitis with blood, the doctor must conduct diagnostics to obtain the most complete information about the condition of the bladder and assess the need for specific and long-term treatment.

Drug therapy is mandatory:

• antibiotics (based on the results of bacteriological examination of urine fluid);
• amitriptyline (one of the basic representatives of tricyclic antidepressants, capable of normalizing mast cells, increasing the working capacity of the bladder, reducing the severity of symptoms, and calming);
• antihistamines (stabilize mast cells, reduce swelling and the severity of the inflammatory process).

Among other drugs that can be included in the treatment regimen for cystitis with blood, the following can be named:

• Uristat (Phenazopyridine);
• nitrofuran series drugs;
• nonsteroidal anti-inflammatory drugs;
• opioids;
• drugs to improve microcirculation and metabolic processes.

Prevention

For preventive purposes, it is recommended to adhere to the following rules and principles:

• strict adherence to the rules of personal and intimate hygiene;
• timely correction of anatomical defects of the urinary tract, if there are indications for this;
• timely treatment of gynecological problems, sexually transmitted infections (treatment is carried out simultaneously for both partners), urological diseases;
• maintaining sexual hygiene;
• control of the quality of microflora, both in the intestines and in the vagina, especially with prolonged use of antibiotics or when using spermicides;
• timely emptying of the bladder, drinking sufficient amounts of fluid (prevention of dehydration);
• mandatory act of urination immediately after sexual intercourse (postcoital prophylaxis for individuals with constant exacerbations after sexual intercourse).

Forecast

For preventive purposes, it is recommended to adhere to the following rules and principles:

• strict adherence to the rules of personal and intimate hygiene;
• timely correction of anatomical defects of the urinary tract, if there are indications for this;
• timely treatment of gynecological problems, sexually transmitted infections (treatment is carried out simultaneously for both partners), urological diseases;
• maintaining sexual hygiene;
• control of the quality of microflora, both in the intestines and in the vagina, especially with prolonged use of antibiotics or when using spermicides;
• timely emptying of the bladder, drinking sufficient amounts of fluid (prevention of dehydration);
• mandatory act of urination immediately after sexual intercourse (postcoital prophylaxis for individuals with constant exacerbations after sexual intercourse).