Neck cystitis of the bladder in women and men

Inflammatory lesion of the bladder in the area of its neck is cervical cystitis. Let's consider the main causes of the disease, symptoms, methods of treatment and prevention.

The urinary bladder has the same structure in both men and women. It is a hollow organ of ovoid shape, which is lined from the inside with a folded mucous membrane. At the transition of the bladder into the urethra, that is, at the place of its narrowing, the neck is formed. It is located in the lower part of the bladder triangle, which is formed by the areas of the ureters. The inflammatory process of this area is trigonitis, and cervical cystitis is its variety.

Outside of urination, the neck of the organ is narrowed by the sphincter, which holds and releases urine. Its work is based on the tension and relaxation of the following muscle layers:

• External (longitudinal)
• Medium (circular)
• Internal (transverse)

The strongest is the middle layer, which forms a reinforced muscular sphincter in the neck area. Sphincter dysfunction due to the inflammatory process leads to urinary incontinence. If the disease becomes chronic, it is life-threatening. The pathology is accompanied by constant pain syndrome, urination disorders, sexual dysfunction and leads to social maladjustment.

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Epidemiology

As medical statistics show, young women most often suffer from cystitis and its cervical form. The prevalence of this disease is 10-20% among other pathologies of the genitourinary system.

Every year, about 3-5 million people seek medical help with complaints of urological disorders. According to statistics, about 0.7-0.5 cases of the disease occur per woman every year. Among men, this figure is significantly lower. Thus, there are about 5-7 episodes of the disease per 1,000 people.

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Causes cervical cystitis

Trigonitis is rare, but its occurrence causes acute painful sensations and anxiety. The causes of cervical cystitis are associated with the inflammatory process in the place where the bladder ends and the urethra begins. That is, the muscles responsible for opening and closing the exit are affected - the internal and external sphincters. This leads to urinary incontinence and involuntary emptying of the organ.

The causes of cervical cystitis are no different from the usual inflammation of the bladder. Most often, the disease is associated with the following factors:

• Bacterial infection. As a rule, pathogenic microorganisms enter the body from the outside, that is, through the external urinary opening. Infection occurs when personal or sexual hygiene is not observed (violated). The source of infection can be bacteria from the intestines or vagina. Bacteria can enter the bladder with the bloodstream from other diseased organs, for example, from the prostate when it is inflamed.
• The disease can develop when infected with viruses, fungi or chlamydia. Fungal cystitis can be a complication of candidiasis or caused by the so-called "hospital" disease, when the pathogen enters the body due to non-sterile medical instruments.
• The causes of trigonitis may be associated with damage to the walls of the bladder - irritating food substances (hot spices and seasonings, alcohol, caffeine) or poisons.
• Another cause of the disease is blood stagnation in the pelvis. In this case, the inflammatory reaction is associated with an inactive sedentary lifestyle.
• Non-infectious causes of the disease are also possible. For example, incorrect placement of internal organs. This is most often detected in women. Due to the displacement of the uterus, the blood supply to the tissues in the area of the urinary bladder triangle is disrupted, which leads to inflammatory reactions and infectious lesions.

There are other causes of cervical inflammation, but they are extremely rare. In addition to the causal factor, the trigger mechanism of the pathological process should also be taken into account. As a rule, this is reduced immunity, the presence of chronic diseases, various hormonal disorders, hypothermia, pregnancy and much more.

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Cervical cystitis after surgery

Some patients face such a problem as cervical cystitis after surgery. Doctors identify the main ways of infection getting into the bladder:

1. Ascending - the infection rises along the urethra, penetrating from the urethra into the bladder.
2. Lymphogenous – lymph transports harmful microorganisms into the bladder.
3. Hematogenous – the infection enters the genitourinary system through the bloodstream.

The causes of infection are associated with various factors, let's look at the most common ones:

• Violation of aseptic rules during surgical intervention.
• Incorrect catheterization, during which the organ mucosa was damaged or an infection was introduced.
• Trauma to an organ during a complex birth process.

To identify postoperative trigonitis, the doctor pays attention to the presence of the following symptoms:

• Frequent and painful urination.
• The excreted urine contains traces of blood, which is why it takes on a brown or pinkish tint.
• The body temperature is elevated, feverish condition.
• The discomfort becomes permanent. The pain radiates to the genitals and the anus.

Diagnosis is carried out using a general urine and blood test. As a rule, the urine has an increased bacterial background, indicating pathogenic microflora. Red blood cells and white blood cells may also be present, indicating an inflammatory process. Based on the diagnostic results, a treatment plan is drawn up, which consists of taking antibacterial and anti-inflammatory medications, physiotherapy.

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Risk factors

Inflammation of the genitourinary system occurs for many reasons. Risk factors for cervical cystitis are most often associated with:

• Reduced immunity.
• Hypothermia.
• Surgical interventions in the genitourinary system.
• Renal pyelonephritis.
• Hemorrhages into the bladder from other organs.
• The beginning of menstruation.
• Diabetes mellitus and other endocrine diseases.
• The beginning of sexual life.
• Frequent change of sexual partners.
• Anal or oral intercourse.
• Various infectious diseases (candidiasis, genital tuberculosis, gonorrhea).
• Urethritis.
• Colpitis.
• Vulvitis.
• Hormonal imbalances in the body.
• Menopause.
• Failure to comply with personal hygiene rules.
• Impaired blood circulation in the pelvic organs (sedentary lifestyle, tight or constricting clothing, prolonged constipation).
• Eating spicy, fried or fatty foods.

In addition to the above factors, the pathological process can be caused by various pathogens: ureaplasma, staphylococcus, streptococcus, chlamydia, candida fungi.

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Pathogenesis

The mechanism of development of bladder inflammation is associated with the anatomical features of the structure and location of the organ, as well as the routes of infection. The pathogenesis of trigonitis indicates that pathogens enter the genitourinary system in the following way:

• Descending pathway (from the kidneys in pyelonephritis).
• Hematogenous route (from infected organs).
• Ascending route (from the rectum or genitals).
• From the external environment (surgical manipulations).

As for the anatomical structure of the organ, the bladder neck is located at its bottom. Around it is a muscular layer that contracts and holds urine. When it relaxes, the fluid is removed into the urethra. The mucous membrane is folded when the organ is empty, and smooth when full.

Frequent inflammatory diseases are largely due to the anatomical features of the bladder. This structure allows bacteria to multiply in its folds, which leads to further damage to the neck.

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Symptoms cervical cystitis

Bladder neck disease causes sharp painful sensations, which without proper treatment begin to rapidly increase and progress. Symptoms of cervical cystitis depend on the cause that caused it and the individual characteristics of the patient's body. Most often, patients face the following problems:

1. Pain in the lower abdomen, radiating to the pubic and perineal area. Burning and itching occur during bowel movements. The intensity of pain varies from mild to excruciating, which is what makes you seek medical help.
2. Burning and stinging sensations occur during urination due to tension in the inflamed tissues of the sphincter.
3. Urinary incontinence – due to the inflammatory process, the sphincter that holds urine is unable to control it. That is, the muscles open arbitrarily, even with slight fluid pressure.
4. Frequent urge to urinate – in some cases, the interval between trips to the toilet is no more than 10 minutes. This symptom intensifies at night, which leads to sleep disturbance. In this case, frequent urges can end with no urine or a couple of drops being released.
5. Changes in urine – the nature of the excreted urine changes significantly in composition due to the inflammatory process. When conducting an analysis, the presence of bacteria, leukocytes, and erythrocytes is detected. Blood and pus impurities are possible.

The presence of the above symptoms allows doctors to suspect cystitis. Further diagnostics are necessary to identify the cervical form of the lesion and determine the stage of the pathological process.

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First signs

The symptom complex of the cervical form of trigonitis differs from the usual cystitis by its greater severity and the problem of urine retention. The first signs of the disorder are manifested by the following symptoms:

• Frequent urge to go to the toilet, but because the fluid does not have time to accumulate, very little is released each time.
• Urination is accompanied by cutting pains and burning. This is due to the fact that the flow of urine irritates the inflamed mucous membrane of the organ.
• General well-being worsens, weakness appears, and the temperature may rise.
• Urinary incontinence, especially at night.

If the disease becomes chronic, discomfort appears during sexual intercourse, nagging pain in the suprapubic region of the abdomen. The disease occurs with frequent exacerbations.

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Cervical cystitis in women

Inflammatory disease of the bladder in the neck area is cervical cystitis. It is diagnosed in women much more often than in men. The main cause of the disease is an infection, that is, bacteria, viruses, fungi, protozoa. Infection can get into the bladder in different ways, but for women, the ascending route of infection is most typical (from the genitals or rectum), which is explained by their anatomical features of the structure.

Trigonitis very often develops when the immune system's protective properties are reduced, due to hypothermia, and also during vaginal intercourse preceded by oral sex (infection occurs due to the high content of pathogenic microorganisms in the oral cavity).

Symptoms of inflammation:

• Urinary incontinence.
• Frequent urge to urinate.
• Constant pain in the lower abdomen, pubic area and perineum.
• Itching, burning and stinging when urinating.

Treatment of cervical cystitis in women consists of drug therapy, diet and strict bed rest. Therapeutic nutrition is aimed at flushing the infection out of the bladder. During the illness, you should drink more clean water, fruit drinks, compotes, herbal infusions and teas. Spices, fried, fatty and other products/dishes that irritate the mucous membrane of the organ are prohibited.

Antibacterial drugs are prescribed to destroy the infectious agent, and painkillers are prescribed to reduce discomfort. During treatment, it is recommended to wear comfortable underwear made of natural fabrics that is not tight.

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Stages

Cervical cystitis has certain stages, each of which is characterized by certain symptoms and requires special treatment. Let's consider the main stages of inflammation of the bladder neck:

1. Latent is the mildest form of the disease. It is characterized by rare exacerbations that occur in an acute form, but more often it is stable. Laboratory diagnostics do not reveal bacteriological changes, but there are endoscopic disorders of the mucous membrane.
2. Persistent – manifests itself less acutely, but the disease proceeds in a chronic form. It is characterized by laboratory and endoscopic changes. Despite the fact that the reservoir function of the organ is impaired, the symptoms are stable. There is no pronounced urge to urinate.
3. Interstitial - has pronounced symptoms and is the most severe stage of the disease. Accompanied by severe acute pain in the lower abdomen and significant disruptions in the storage function of the affected organ. Manifested by uncontrolled urination. Difficult to treat.

To determine the stage of the inflammatory process, it is necessary to undergo a comprehensive diagnosis, which consists of various laboratory and instrumental methods.

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Forms

Urinary tract pathology has a certain classification. Types of cervical cystitis are divided into chronic and acute. Let's consider each of them in more detail.

• Acute (uncomplicated)

The infection penetrated the urethra and caused an inflammatory process. Against this background, the first symptoms appear: weakness, painful urination, increased sleepiness, lethargy, abdominal pain. In this case, a characteristic sign of the pathology is a problem with urination. If you do not seek medical help in a timely manner, the disease will become chronic.

• Chronic

Most often, this type of inflammation is detected in women. It can occur due to the action of various viruses, pathogens and bacteria. It is characterized by reduced resistance of the body. It can be asymptomatic, which complicates its diagnosis. Painful sensations during urination are often mistaken for premenstrual syndrome, so a visit to the doctor is constantly postponed. Cystoscopy is indicated to determine the disease (an effective but painful diagnostic method).

If we consider the types of cystitis based on morphological changes, the following types are distinguished: necrotic, catarrhal, cystic, encrusting, polypous and ulcerative.

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Acute cervical cystitis

One of the most frequently diagnosed types of trigonitis is acute cervical cystitis. In most cases, this is an infectious lesion that occurs due to the penetration of pathogens from the upper part of the urethra. It is caused by various reasons, but most often by hypothermia.

Characterized by the following symptoms:

• Sharp and acute pain in the lower abdomen.
• Severe burning and itching when urinating.
• Blood or pus in the urine.

The onset of the disease is acute, with a general deterioration in well-being and an increase in temperature. A distinctive feature of acute cervical cystitis is a pronounced urination disorder, up to fluid incontinence.

As a rule, the acute form progresses quickly – about a week. But despite this, it requires medical care. Without properly formulated treatment, the symptoms will return again, and the disease can become chronic.

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Chronic cervical cystitis

Most often, the excretory system of women is affected by chronic cervical cystitis. This occurs due to circulatory disorders, for example, when the anterior wall of the vagina is lowered or the uterus is in an incorrect position. Very often, it occurs with the addition of a secondary infection.

The disease may be without any pronounced symptoms, so many patients do not even realize that they need treatment. That is, pain in the lower abdomen, discomfort and pain when urinating can be mistakenly perceived as manifestations of premenstrual syndrome. Because of this, going to the doctor is postponed. At this time, the mucous membrane of the bladder gradually swells and becomes loose, the pathological inflammatory process affects other organs.

Cystoscopy is indicated for diagnosing the chronic form of the disease, i.e. examination of the internal surface of the organ using a special device. This study reveals signs of the pathological process, which allows choosing effective treatment.

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Complications and consequences

Trigonitis, like any other disease, left without medical care and proper treatment, causes various consequences and complications. Cervical cystitis is characterized by the following problems:

• Complications of sexual life.
• Decreased reproductive capacity.
• Inflammation of the appendages and uterus.
• Urinary incontinence due to sphincter dysfunction.
• Damage and modification of the membranes of the affected organ.
• Bleeding due to hematuria.
• Vesicoureteral reflux (urine flow from the bladder into the ureters).
• Pyelonephritis (infectious and inflammatory diseases of the kidneys).
• Bladder tissue necrosis.
• Menstrual cycle disorders.
• Infertility.
• Ectopic pregnancy.
• Cysts, polyps, tumors in the affected area.

Chronic inflammation can lead to paracystitis. This condition occurs when the pathological process spreads to other organs and tissues. This leads to inflammation of the pelvic tissue, which significantly increases the risk of the formation of purulent foci and the transfer of infection to the pelvic organs.

If the infection that causes paracystitis penetrates the uterine cavity or fallopian tubes via the lymphatic or hematogenous route, it leads to salpingitis and adnexitis. In this case, there are nagging pains in the lower abdomen that radiate to the pelvic area and lower back.

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Diagnostics cervical cystitis

If inflammation of the urinary tract is suspected, patients are prescribed a set of studies. Diagnosis of cervical cystitis is necessary to establish the type of disease (acute, chronic), its stage, and the presence of complications.

The examination consists of:

• Collection of anamnesis and palpation for pain in the area of the external genitalia and pubis.
• Chemical analysis of a smear from the urethra or vagina. In case of cervical inflammation, the smear will contain an increased amount of protein deposits.
• General urine and blood analysis. If there is inflammation, the results will show significant leukocytosis.
• Urine culture for bacterial flora.

After the above-mentioned studies have been carried out, the patient is prescribed a set of laboratory and instrumental diagnostic procedures. They allow the diagnosis to be confirmed.

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Tests

To identify the cervical form of trigonitis, patients are prescribed the following tests:

• Complete blood count.
• General urine analysis (leukocytes, erythrocytes, mucus, bacteria, transitional epithelium).
• Urine analysis according to Nechiporenko (leukocytes and erythrocytes).
• Three-glass urine sample (number of leukocytes in all portions).
• Determination of microflora sensitivity to antibacterial drugs.

In addition to the above laboratory tests, additional tests may be prescribed:

• PCR diagnostics (polymerase chain reaction) for detection of infectious agents.
• Analysis of microflora for dysbacteriosis.
• Bacteriological urine culture to detect opportunistic microflora.

You can also diagnose suspected genitourinary disorders using express tests. They simplify diagnosis and provide reliable results for confirming or excluding the disease several times faster.

• Rapid test for the amount of protein, leukocytes and erythrocytes in urine.
• Rapid test for pathogenic microorganisms (has an indicator strip that is highly sensitive to nitrites).
• Leukocyte esterase reaction – detects esterase in urine (appears in the presence of pus).

To obtain reliable test results, it is very important to collect the material for the study correctly. Thus, failure to comply with hygiene rules can significantly distort the diagnostic results. Therefore, before collecting urine, intimate hygiene should be performed. The first portion of the liquid is flushed into the toilet, and then the container for analysis is filled, which should be delivered to the laboratory as quickly as possible.

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Instrumental diagnostics

In addition to general and laboratory tests, patients are also shown instrumental diagnostics. It is necessary to identify changes in the mucous membrane and sphincters. It consists of the following methods:

• Cystography (X-ray examination) – determines the general functional state of the kidneys, ureters and adjacent organs. It is performed by filling the organ with X-ray contrast agents, which allow assessing the shape, size and position of the bladder.
• Ultrasound examination – is performed to exclude kidney and genital diseases. It reveals thickening and heterogeneity of the mucous membrane, presence of urinary stones.
• Excretory urography.
• Biopsy.
• Cystoscopy.

Particular attention is paid to cystoscopy. This diagnostic method is quite traumatic and painful. It is performed using an endoscope, which performs a morphological examination of the bladder walls. It allows detecting tumors, ulcerative changes, fistulas, urinary stones and foreign bodies. Cystoscopy is contraindicated in acute inflammatory disease, since the introduction of an endoscope into the affected organ can lead to the spread of infection through the genitourinary system.

Differential diagnosis

In its symptoms, trigonitis is similar to other diseases of the genitourinary system. Differential diagnostics are necessary to determine the real cause of the pathological condition. First of all, cervical cystitis is differentiated from a number of other diseases that can occur with dysuria:

• Overactive bladder.
• Prostatitis (acute, chronic).
• Bladder stones.
• Diseases of the genital organs.
• Tumors, including malignant neoplasms.

If the inflammatory process is difficult to treat and the disease becomes chronic, then differential diagnostics are carried out with the following pathologies:

• Tuberculosis.
• Ulcer.
• Bladder cancer.
• Prostate adenoma.
• Bladder diverticulum.
• Neurogenic dysfunction.
• Infravesical obstruction.

The final diagnosis is established on the basis of cystoscopy and endovesical biopsy.

Treatment cervical cystitis

Complex therapy is indicated to eliminate trigonitis. Treatment of cervical cystitis is practically no different from methods of removing inflammation of the bladder. Patients are prescribed antibiotics, according to the type of inflammation, painkillers and vitamin complexes. All drugs are prescribed by a doctor only after receiving the results of the diagnostics.

Prevention

To reduce the risk of developing inflammation of the genitourinary system, you should lead a healthy lifestyle and promptly seek medical help for the treatment of any diseases. Prevention of cervical cystitis consists of following these simple recommendations:

• Avoid hypothermia.
• Ensure timely emptying of the bladder and bowels.
• Eliminate a sedentary lifestyle.
• Avoid overindulging in salty, sour, fried and smoked foods, hot spices and seasonings.
• Wear comfortable underwear made from natural fabrics.
• Drink at least two liters of clean water daily.
• Observe the rules of intimate hygiene.
• Avoid casual sex.
• Treat gynecological diseases and pyelonephritis in a timely manner.
• Take vitamin complexes.
• Maintain a healthy diet.

The above rules significantly reduce the risk of developing the disease. If inflammation does occur, you should immediately consult a doctor. Self-medication is fraught with the transition of the pathology to a chronic form and the development of life-threatening complications.

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Forecast

In most cases, inflammation of the urinary system has a positive prognosis. If the disease is diagnosed at an early stage and effective therapy is carried out, then the risk of complications or inflammation becoming chronic is minimal.

Chronic cervical cystitis and its prognosis depend on the severity of pathological symptoms and the presence of concomitant diseases. Without medical care, the disease can lead to dangerous consequences. Good treatment results for both acute and chronic forms are possible with a comprehensive approach to therapy and the elimination of predisposing factors. With secondary trigonitis, the prognosis depends entirely on the outcome of the underlying pathology.

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