Neck cystitis of the bladder in women and men

Inflammation of the bladder in the region of its neck is cervical cystitis. Consider the main causes of the disease, symptoms, methods of treatment and prevention.

The bladder has the same structure, both in men and in women. It is a hollow organ of ovoid form, which is lined with a folded mucosa from the inside. When the bladder passes into the urethra, that is, at the site of its constriction, a neck is formed. It is located in the lower part of the pancreatic triangle, which is formed by the sites of the confluence of the ureters. The inflammatory process of this area is trigonitis, and cervical cystitis is its variety.

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

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

The strongest is the middle layer, which forms a strengthened muscular pulp in the neck area. Dysfunction of the sphincter due to the inflammatory process leads to urinary incontinence. If the disease takes a chronic form, then it is life-threatening. Pathology is accompanied by a constant pain syndrome, impaired urination, a disorder of sexual life and leads to social maladjustment.

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

Epidemiology

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

Annually, about 3-5 million people apply for medical help with complaints about a urological disorder. According to statistics, about 0.7-0.5 cases of disease per woman per year. Among men this indicator is much lower. So for 1000 people there are about 5-7 episodes of the disease.

[7], [8], [9]

Causes of the cervical cystitis

Trigonitis is rare, but its appearance makes you feel acute pain and anxiety. The causes of cervical cystitis are associated with an 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 inner and outer sphincters. This leads to urinary incontinence and involuntary emptying of the body.

The causes of cervical cystitis do not differ from usual inflammation of the bladder. Most often, the disease is associated with such factors:

• Bacterial lesion. As a rule, pathogenic microorganisms enter the body from the outside, that is, through the external urinary tract. Infection occurs when non-compliance (violation) of personal or sexual hygiene. The source of infection can be bacteria from the intestine or vagina. Bacteria can enter the bladder with blood flow from other diseased organs, for example, from the prostate in its inflammation.
• 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 can be associated with damage to the walls of the bladder - irritating food substances (acute spices and seasonings, alcohol, caffeine) or poisons.
• Another cause of the disease is the stagnation of blood in the small 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, the wrong location of internal organs. Most often this is found in women. Due to the displacement of the uterus, the blood supply of tissues in the region of the urinary bladder triangle is violated, which leads to inflammatory reactions and infectious lesions.

There are other causes of cervical inflammation, but they are extremely rare. In addition to the causative factor, it is necessary to take into account the triggering mechanism of the pathological process. As a rule, it is reduced immunity, the presence of chronic diseases, various hormonal disorders, hypothermia, pregnancy and much more.

[10], [11]

Cervical cystitis after surgery

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

1. Ascending - the infection rises through the urethra, penetrating from the urethra into the bladder.
2. Lymphogenous - lymph overtakes harmful microorganisms into the bladder.
3. Hematogenous - the infection enters the genitourinary system with blood flow.

Causes of infection are associated with various factors, consider the most common:

• Violation of asepsis rules during surgical intervention.
• Incorrect catheterization, in the process of which the mucous organ has been damaged or an infection has been infiltrated.
• Traumatization of the organ in the process of a complex ancestral process.

To identify postoperative trigonitis, the physician draws attention to the presence of such symptoms:

• Frequent and painful urination.
• In allocated urine there are admixtures of blood, because of what it acquires a brown or pinkish shade.
• Body temperature increased, febrile.
• Discomfort becomes permanent. Pain is given to the genitals and the anus.

Diagnosis is carried out using a general analysis of urine and blood. As a rule, a bacterial background is indicated in the urine, indicating a pathogenic microflora. Erythrocytes and leukocytes 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 procedures.

[12], [13]

Risk factors

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

• Reduced immunity.
• Subcooling the body.
• Surgical interventions in the genitourinary system.
• Renal pyelonephritis.
• Hemorrhages in the bladder from other organs.
• The beginning of menstruation.
• Diabetes mellitus and other endocrine diseases.
• The beginning of sexual activity.
• Frequent change of sexual partners.
• Anal or oral sex.
• Various infectious diseases (candidiasis, genital tuberculosis, gonorrhea).
• Urethritis
• Colpitis.
• Vulvit.
• Hormonal disorders in the body.
• Menopause.
• Non-compliance with personal hygiene.
• Disturbed blood circulation in the pelvic organs (sedentary lifestyle, tight or compressing clothing, prolonged constipation).
• Use of spicy, 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.

[14], [15], [16]

Pathogenesis

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

• Descending path (from kidneys with pyelonephritis).
• Hematogenous pathway (from infected organs).
• Ascending path (from the rectum or genital organs).
• From the external environment (surgical manipulation).

As for the anatomical structure of the organ, the neck of the bladder is located in its lower part. Around it is a muscle layer, which shrinks and retains urine. When it relaxes, fluid is removed to the urethra. The mucous membrane with an empty organ is folded, and when filled, it is smooth.

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

[17], [18]

Symptoms of the cervical cystitis

Disease of the neck of the bladder causes sharp painful sensations, which, without proper treatment, begin to grow rapidly 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 such problems:

1. Pain in the lower abdomen, giving to the area of the pubis and perineum. During emptying, burning and itching appear. The intensity of pain varies from mild to painful, which forces you to seek medical help.
2. Burning and rubbing occur during urination due to the stress of the inflamed sphincter tissues.
3. Urinary incontinence - due to the inflammatory process of the sphincter, which holds the urine unable to control it. That is, the muscles open arbitrarily, even with a slight pressure of the liquid.
4. Frequent urge to urinate - in some cases, the break between going to the toilet is no more than 10 minutes. This symptom intensifies at night, which leads to sleep disturbance. In this case, frequent desires can result in the fact that urine is absent or a couple of drops are released.
5. Changes in urine - the nature of the secreted urine due to the inflammatory process varies significantly in composition. During the analysis, the presence of bacteria, leukocytes, erythrocytes is detected. Possible admixtures of blood and pus.

The presence of the above symptomatology allows doctors to suspect cystitis. Further diagnosis is necessary to identify the cervical form of the lesion and to determine the stage of the pathological process.

[19]

First signs

Symptomocomplex of the cervical form of trigonitis differs from ordinary cystitis with greater severity and the problem of urine retention. The first signs of the disorder are manifested by such symptoms:

• Frequent urge to go to the toilet, but due to the fact that the liquid does not have time to accumulate, each time it stands out very little.
• Urination is accompanied by cutting pains and burning. This is due to the fact that the urine flow irritates the inflamed mucous organ.
• The general state of health worsens, there is a weakness, the temperature can rise.
• Urinary incontinence, especially at night.

If the disease takes a chronic form, then there is discomfort during intercourse, drawing pains in the suprapubic area of the abdomen. The disease occurs with frequent exacerbations.

[20], [21], [22], [23], [24]

Cervical cystitis in women

Inflammatory disease of the bladder in the region of its neck is cervical cystitis. In women, it is diagnosed 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 way of infection (from the genitals or rectum) is most characteristic, which is explained by their anatomical features of the structure.

Trigonitis very often develops with reduced protective properties of the immune system, due to hypothermia, as well as in vaginal intercourse, which was preceded by oral caresses (infection occurs because of the high content of pathogens in the oral cavity).

Symptoms of inflammation:

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

Treatment of cervical cystitis in women consists of medication, diet and strict bed rest. Therapeutic diet is aimed at washing out the infection from the bladder. During the illness should be consumed more clean water, fruit drinks, compotes, vegetable decoctions and teas. Under the ban fall spices, fried, fatty and other foods / dishes that cause irritation of the mucous membrane of the body.

To destroy the pathogen of infection, antibacterial drugs are prescribed, and pain relievers are used to reduce discomfort. During treatment it is recommended to wear comfortable underwear made of natural fabrics, which does not tighten.

[25], [26]

Stages

The cervical form of cystitis has certain stages, each of which is characterized by a certain symptomatology and requires special treatment. Consider the main stages of inflammation of the neck of the bladder:

1. Latent is the easiest form of the disease. It is characterized by rare exacerbations, which occur in acute form, but more often passes stably. Laboratory diagnosis does not detect bacteriological changes, but there are endoscopic mucosal disorders.
2. Persistent - manifested less acute, 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 symptomatology is stable. There are no strong urge to urinate.
3. Interstitial - has a pronounced symptomatology and is the most severe stage of the disease. It is accompanied by severe acute pains in the lower abdomen and significant violations of the accumulative function of the affected organ. Is 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.

[27], [28]

Forms

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

• Acute (uncomplicated)

Infection penetrated the urethra and caused inflammation. Against this background, the first symptoms appear: weakness, painful urination, increased drowsiness, lethargy, abdominal pain. In this case, a symptom of a pathology is the problem with urination. If you do not seek medical help in a timely manner, the illness will go to chronic.

• Chronic

Most often this type of inflammation is detected in women. It can arise because of the action of various viruses, pathogens and bacteria. 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 doctor's visit is constantly postponed. To determine the disease, cystoscopy is shown (an effective but painful diagnostic method).

If we consider the types of cystitis by morphological changes, then distinguish such types: necrotic, catarrhal, cystic, encrusting, polyposis and ulcerative.

[29]

Acute cyst cystitis

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

It is characterized by such symptoms:

• Sharp and sharp pains in the lower abdomen.
• Severe burning and itching when urinating.
• Impurity of blood or pus in urine.

The onset of the disease is acute, with a violation of overall well-being and an increase in temperature. A distinctive sign of acute cervical cystitis is a marked violation of urination, up to incontinence of the fluid.

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

[30], [31], [32]

Chronic cystic cystitis

Most often, the excretory system of women is affected by chronic cervical cystitis. This is due to circulatory disorders, for example, when the front wall of the vagina is lowered or the uterus is not positioned correctly. Very often it occurs with the attachment of a secondary infection.

The disease can be without any severe symptoms, so many patients do not know that they need treatment. That is, pain in the lower abdomen, discomfort and soreness with urination can be mistaken for the manifestations of premenstrual syndrome. Because of this, the doctor's appointment is postponed. At this time, the urinary mucosa gradually swells and becomes loose, the pathological inflammatory process affects other organs.

To diagnose the chronic form of the disease, cystoscopy is shown, that is, examination of the internal surface of the organ with the help of a special apparatus. This study reveals signs of the pathological process, which allows you to choose an effective treatment.

[33], [34], [35]

Complications and consequences

Trigonitis, like any other disease left without medical care and proper treatment, causes various consequences and complications. Neck cystitis is characterized by such 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.
• Bladder-ureter reflux (urine discharge from the bladder into the ureters).
• Pyelonephritis (infectious and inflammatory diseases of the kidneys).
• Necrosis of the tissues of the bladder.
• Violation of the menstrual cycle.
• Infertility.
• Ectopic pregnancy.
• Cysts, polyps, tumors in the lesion.

Chronic form of 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 fat, which significantly increases the risk of purulent foci and the transfer of infection to the pelvic organs.

If the infection that caused paracystitis penetrates lymphatic or hematogenous way into the uterine cavity or fallopian tubes, this leads to salpingitis and adnexitis. In this case, there are pulling pains in the lower abdomen, which are given to the pelvic region and waist.

[36], [37], [38], [39]

Diagnostics of the cervical cystitis

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

The survey consists of:

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

After the above studies, the patient is assigned a set of laboratory and instrumental diagnostic procedures. They allow you to confirm the diagnosis.

[40], [41], [42], [43], [44]

Analyzes

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

• General blood analysis.
• General analysis of urine (leukocytes, erythrocytes, mucus, bacteria, transitional epithelium).
• Urinalysis by Nechiporenko (leukocytes and erythrocytes).
• Three-glass urine sample (the number of white blood cells in all portions).
• Determination of sensitivity of microflora to antibacterial drugs.

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

• PCR-diagnostics (polymerase chain reaction) for detection of infectious agents.
• Analysis of microflora for dysbiosis.
• Bacteriological culture of urine for detection of conditionally pathogenic microflora.

To carry out the diagnosis if you suspect a disorder of the genitourinary system, you can also use express tests. They simplify the diagnosis and give reliable results for confirming or eliminating the disease several times faster.

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

To obtain reliable test results, it is very important to properly take the material for the study. Thus, non-observance of hygiene rules can significantly distort the results of diagnosis. Therefore, before taking a urine, you should conduct an intimate hygiene. The first portion of the liquid descends into the toilet, and then the analytical container is filled, which should be delivered as soon as possible to the laboratory.

[45], [46]

Instrumental diagnostics

In addition to general and laboratory studies, patients are shown and instrumental diagnostics. It is necessary to detect changes in the mucosa and sphincters. It consists of such methods:

• Cystography (X-ray study) - determines the overall functional state of the kidneys, ureters and adjacent organs. It is performed when the body is filled with X-ray contrast materials, which allow to evaluate the shape, size and position of the bladder.
• Ultrasonography - is performed to exclude diseases of the kidneys and genitals. Detects thickening and heterogeneity of the mucosa, the presence of urinary stones.
• Excretory urography.
• Biopsy.
• Cystoscopy.

Particular attention is paid to cystoscopy. This diagnostic method is quite traumatic and painful. It is carried out with the help of an endoscope, which performs a morphological study of the walls of the bladder. It allows to detect tumoral neoplasms, ulcerous changes, fistula, 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 diagnosis is necessary to determine the real cause of the pathological condition. First of all, cervical cystitis is differentiated with a number of other diseases that can occur with dysuria:

• Hyperactivity of the bladder.
• Prostatitis (acute, chronic).
• Stones of the bladder.
• Diseases of the genital organs.
• Tumor, including malignant neoplasms.

If the inflammatory process does not respond well to treatment and the disease takes a chronic form, then differential diagnosis is carried out with such pathologies:

• Tuberculosis.
• Ulcer.
• Cancer of the bladder.
• Prostate adenoma.
• Diverticulum of the bladder.
• Neurogenic dysfunction.
• Infravesical obstruction.

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

Treatment of the cervical cystitis

Complex therapy is shown to eliminate trigonitis. Treatment of cervical cystitis practically does not differ from methods of removing inflammation of the bladder. Patients are prescribed antibiotics, according to the type of inflammation, pain medications and vitamin complexes. All medications are prescribed by a doctor, only after receiving the results of the diagnosis.

Prevention

To reduce the risk of inflammation of the genitourinary system, you should lead a healthy lifestyle and seek medical help in a timely manner to treat any diseases. Prevention of cervical cystitis consists in following such simple recommendations:

• To exclude hypothermia of an organism.
• Monitor the timely emptying of the bladder and intestines.
• Exclude a sedentary lifestyle.
• Do not abuse salty, sour, fried and smoked food, spicy spices and seasonings.
• Wear comfortable underwear made of natural fabrics.
• Daily drink at least two liters of clean water.
• Observe the rules of intimate hygiene.
• Exclude casual sex.
• In time, treat gynecological diseases and pyelonephritis.
• Take vitamin complexes.
• Adhere to a healthy diet.

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

[47], [48], [49],

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 has been performed, the risk of complications or the transition of inflammation to a chronic form is minimal.

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

[50], [51]