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 the urinary act, or is simply present in the urinary fluid, coloring it in a reddish or pinkish shade. In the first case we are talking about acute cystitis, and in the second case - a more complex problem - hemorrhagic cystitis.

Epidemiology

According to statistical data, cystitis with blood is found more often in female patients. This is mainly due to anatomo-physiological and hormonal reasons.

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

Hemorrhagic cystitis is often found in children or in young people between 25 and 30 years of age, or in women after 55 years of age. Blood in the urine is mainly found in acute or recurrent cystitis.

Causes of the 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 predominantly in children - especially boys.
• Blood in the urine can appear against the background 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 can be the result of radiation therapy.
• The appearance of blood in women is often associated with microbial lesions - for example, when E. Coli enter the urethra and bladder.

Cystitis with blood occurs under the influence of any cause that can traumatize or damage the internal mucosal tissue of the bladder. This exposes the blood vessels and blood comes out into the lumen of the organ. [1]

The categories of patients most at risk of developing cystitis with blood are:

• Sexually active women and men, especially when casual sex is abundant;
• Patients using specific contraceptive methods, such as spermicidal membranes;
• Menopausal women;
• Patients with long-term or intermittent use of urinary catheters.

Risk factors

Specific factors that contribute to the appearance of blood in cystitis can be:

• decrease in the contractile function of the musculature of the walls of the urinary tract;
• ingestion of foreign bodies into the urethra - for example, stones or sand, which damage the mucous tissues and cause inflammation;
• prolonged lack of bladder emptying, which causes a circulatory disorder in the organ;
• anatomical disorders of urinary fluid output - e.g. Narrowed bladder lumen, tumors.

Pathogenesis

Bacterial or viral infections can enter the urinary system in a number of ways:

• The ascending route (aka urethral, i.e., through the urethra);
• Hematogenous route (infection comes with blood);
• The lymphogenic route (the infection enters through the lymphatic vessels).

In women, urethral infection is more predominant, and in children, hematogenous infection is more common.

An important condition for the development of microbial cystitis with blood is the attraction of pathogens to the cells of the urothelium with further invasion.

The urothelium is capable of producing and secreting a mucopolysaccharide substance on the bladder wall, which forms its internal defense. This substance in its own way may also play an anti-adhesive role. Attraction of infection to urothelial cells occurs as a result of damage or modification of mucopolysaccharide protection: this can be explained by impaired blood circulation in the organ, increased content of receptors for microbial adhesion. Mechanical trauma to the bladder is also possible, resulting in the exposure of blood vessels and the release of blood into the urinary fluid. [2]

Symptoms of the cystitis with blood

The first signs of cystitis are not at all manifested by the discharge of blood with urine. The most common symptoms are:

• strong and sudden urge to urinate;
• falseness and increased urges;
• a strong burning sensation during urine output;
• pronounced urges against the background of a small amount of urinary fluid;
• cloudy urine, change in odor;
• A feeling of discomfort and pressure in the lower abdomen;
• a slight rise in temperature - to about 37, less often to 38°C.

In young children, acute cystitis with blood is often manifested by urinary incontinence, fever, loss of appetite, sleep disturbance.

Acute attack of cystitis with blood, accompanied by symptoms of intoxication (palpitations, vomiting, significant fever, chills) is usually typical of the fibrotic-ulcerous or gangrenous form of the disease. Such forms more often develop in patients with obvious immunodeficiency, or in complications of pyelonephritis.

Blood in chronic cystitis can be detected only during the period of exacerbation. Additional symptoms are generalized anxiety, painful palpation in the suprapubic area. [3]

Cystitis with blood in women

Cystitis in women happens often, and even sometimes becomes chronic. The reason for this is self-treatment, frivolous attitude to the disease, ignoring visits to the doctor. Other causes can be:

• severe immune compromise;
• sedentary lifestyle, prolonged sitting, 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 observe the rules of personal and intimate hygiene;
• promiscuity, unprotected sexual intercourse.

The risk of inflammation is greatly increased if a woman:

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

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

Cystitis with blood in pregnancy

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

If a woman has a history of urinary tract problems, they are likely to worsen during pregnancy.

It should be noted that cystitis with blood in a pregnant woman requires a special and serious attitude. It is unwise to hope that "it will go away" and drink only cranberry morsels. Appeal for medical help should be not only mandatory, but also immediate. If you do not carry out timely quality treatment, the risk of spontaneous abortion, premature labor and impaired intrauterine development of the baby increases.

Blood with cystitis in a child

Inflammation of the bladder is the most common infection of the urinary system that occurs in pediatric and pediatric urological practice. The disease occurs in children of all ages, but it is about 4 times more common in girls aged 4-12 years. This tendency of morbidity is associated with the peculiarities of girls' anatomy: wide and short urethra, close proximity to the anus, etc.

Blood in the urine may be noted in isolated or combined inflammatory process (e.g., cystourethritis, cystopielonephritis).

Bacterial examination of urinary fluid in children reveals predominantly uropathogenic strains of Escherichia coli, and less frequently Proteus, Klebsiella, Pseudomonas coli, and epidermal staphylococcus aureus. In about one in four cases, bacteria are not diagnostically detected in the urine.

Acute cystitis in childhood most often ends with recovery. Chronic form of the disease develops in the presence of anatomical functional prerequisites for the delay and multiplication of infection. Children with chronic form should be under the supervision of a urologist, regularly pass urine for tests and examination.

Blood in cystitis in men

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

The disease can develop after getting into the urethra microbial pathogen Escherichia coli, which normally "lives" in the intestine. But cystitis in this case is more often secondary, because first the prostate gland becomes inflamed. The urethra narrows, the bladder is not emptied completely, which leads to an increased likelihood of the development of the infectious process.

Treatment of the disease in men involves a priority effect on the inflammatory reaction in the prostate, after which drug therapy of cystitis is prescribed - in particular, it is required to take antibacterial drugs. In addition, it is necessary to follow a diet, drinking plenty of fluids: this allows you to accelerate the elimination of bacteria from the urinary system and potentiate the healing of damaged tissues.

Cystitis with blood after intimacy

This kind of disease is called postcoital, since the inflammation develops during the day after sexual intercourse. In this case, sexual intercourse becomes a provoking factor in the painful process.

There could be several reasons for this:

• too rough sex, or not enough natural lubrication leads to damage to the genital tissues and urethra;
• Sexual diseases that cause pain during sexual intercourse;
• Low levels of sex hormones in the female body (particularly estrogen);
• frequent and indiscriminate sexual activity;
• a combination of anal and vaginal intercourse.

Also "culprits" can be anatomical features of the genitals - for example, if the distance between the urethra and the anus is less than 4.5 cm.

Radiation cystitis with blood

In the course of oncology treatment, most patients undergo radiation therapy. The difficulty lies in the fact that, in addition to the malignant focus, other healthy organs are 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 urinary fluid begin to irritate the mucous tissue, affecting exposed nerve endings. With prolonged radiation therapy, the urothelium may become ulcerated, making the situation even worse. The ulcers begin to bleed, and blood appears in the urine.

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

Radiation cystitis with blood is a serious complication of a specific type of therapy. However, do not despair: modern means are able to help the patient and cure the insidious disease. [4]

Complications and consequences

If after the first signs of cystitis with blood, treatment followed quickly and was competent, then complications in this case develop very rarely. But in case of untimely treatment measures may worsen the condition with the development of serious and unfavorable consequences. [5]

The most likely complications include, first of all, pyelonephritis, an infectious inflammatory lesion of the kidneys. The infectious process from the main focus of inflammation - the bladder - is transported to the kidneys by the ascending route, which leads to pyelonephritis or even irreversible changes in kidney tissue.

Young children and the elderly have the highest risk of kidney damage on the background of infectious cystitis. And regular and even more 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 of the cystitis with blood

The first diagnostic steps a patient will have to undergo at the doctor's office are an interview and physical examination. Only after listening to the patient's complaints, examining him for external pathological signs, the doctor will be able to recommend certain laboratory studies and tests, for example:

• A general urinalysis helps to detect leukocyturia, erythrocyturia, and nitrites, indicating the presence of bacterial infection in the urinary system;
• Urine sterility testing is performed when infectious processes in the urethra are suspected and helps to identify the type and number of pathogens;
• The general blood test in cystitis demonstrates nonspecific inflammatory changes and can give an indirect idea of the presence and severity of the infectious process in the urinary tract.

Blood in the urine in cystitis is not necessarily detected only by laboratory methods: sometimes it can be seen on its own, for example at the end of urination (so-called "last drops" of urine). Often the urinary fluid is colored in a reddish or pinkish shade, which also indicates the presence of blood in it. It is especially dangerous if the color becomes red or "rusty", there are clots and lumps, 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, bacterial infection. The presence of inflammation can indicate both a strong increase in the level of leukocytes, and a significant decrease in their number.

Instrumental diagnosis usually includes cystoscopy, plain abdominal radiography or retroperitoneal ultrasound. If necessary, radiography with contrast, cystography or intravenous urography is indicated.

The use of a cystoscope sometimes involves taking a small section of tissue (biopsy) for further histologic examination.

Differential diagnosis

Differential diagnosis is usually aimed at excluding the secondary nature of cystitis, and the possibility of 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, tuberculous type), determine the stage and degree of spread of pathological reaction in the urinary system. [8]

Treatment of the cystitis with blood

Before prescribing therapeutic measures for cystitis with blood, the doctor should conduct a diagnosis to obtain the most complete information about the state of the bladder, to assess the need for specific and prolonged treatment.

It is mandatory to prescribe drug therapy:

• antibiotics (based on the results of bacteriologic examination of urinary 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, calming);
• antihistamines (stabilize mast cells, reduce swelling and severity of inflammation).

Among other drugs that can be included in the scheme of therapy for cystitis with blood, you can name such drugs:

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

Prevention

The following rules and principles are recommended for preventive purposes:

• strict observance of the rules of personal and intimate hygiene;
• timely correction of anatomical defects of the urinary tract, if indicated;
• timely treatment of gynecological problems, sexual infections (treatment is carried out simultaneously for both partners), urological diseases;
• sexual hygiene;
• controlling the quality of the microflora, both in the gut and in the vagina, especially when taking long-term antibiotics or using spermicidal agents;
• timely emptying of the bladder, drinking enough fluids (prevention of dehydration);
• mandatory act of urination immediately after sexual intercourse (post-coital prophylaxis for persons with persistent exacerbations after sexual intercourse).

Forecast

The following rules and principles are recommended for preventive purposes:

• strict observance of the rules of personal and intimate hygiene;
• timely correction of anatomical defects of the urinary tract, if indicated;
• timely treatment of gynecological problems, sexual infections (treatment is carried out simultaneously for both partners), urological diseases;
• sexual hygiene;
• controlling the quality of the microflora, both in the gut and in the vagina, especially when taking long-term antibiotics or using spermicidal agents;
• timely emptying of the bladder, drinking enough fluids (prevention of dehydration);
• mandatory act of urination immediately after sexual intercourse (post-coital prophylaxis for persons with persistent exacerbations after sexual intercourse).