Acute cystitis

Acute cystitis is an inflammatory process mainly of infectious origin, localized in the mucous membrane of the bladder and clinically manifested by frequent and painful urination, low-grade fever, the appearance of blood or pus in the urine.

Acute cystitis is one of the most common urological diseases.

healthy bladder and acute cystitis

Acute cystitis is inflammation of the lining of the bladder.

Causes and risk factors

Infection enters the bladder primarily ascending (through the urethra) or descending (from the kidneys). Much less often pathogenic microorganisms enter the bladder by the hematogenous route, that is, they are introduced with the bloodstream from the source of the primary infection or by contact through the bladder wall.

Against the background of the inflammatory process, the blood vessels of the bladder wall expand, their permeability increases. The mucosa becomes hyperemic and swells. Subsequently, in the center of inflammation, erythrocyte sweating occurs, which leads to hemorrhagic phenomena. In a severe form of the disease, inflammation can spread even to the deeper layers of the bladder.

Most often, the development of acute cystitis is caused by gram-negative microbial flora (Escherichia coli, Klebsiella, Proteus). Gram-positive microorganisms (staphylococcus, proteus), as well as microbial associations, cause inflammation in about 20% of cases.

acute cystitis with inflammation of the mucous membrane of the bladder

Predisposing factors for the development of acute cystitis are parainfluenza, adenovirus infection, which cause disturbances in the innervation and blood supply to the bladder wall, which creates favorable conditions for the development of bacterial flora.

Normally, a person's urinary tract is constantly cleaned by a stream of urine. In addition, the cells of the uroepithelium synthesize a special mucopolysaccharide substance, which covers the inner surface of the bladder, thus protecting it from infections. The production of a protective substance is regulated, among other things, by the female sex hormones - progesterone and estrogen. It is in connection with the change in the level of these hormones in women that acute cystitis is more common in the postmenopausal period.

Any damage to the protective mucous layer creates the prerequisites for the development of acute cystitis. Such damage can be caused by:

  • trauma to the inner layer of the bladder (urethroscopy, cystoscopy, bladder catheterization);
  • violations of urodynamics, that is, the correct flow of urine (neurogenic bladder);
  • metabolic diseases, accompanied by the development of crystalluria;
  • exposure to ionizing radiation, aggressive and toxic chemicals;
  • decrease in general and local immunity due to frequent viral infections, conditions of hypovitaminosis.

In girls and women, acute cystitis most often develops against the background of vaginal dysbiosis (dysbiosis) or as a result of a violation of the rules of personal hygiene. The development of acute cystitis in men and boys is often associated with the presence of anatomical and functional pathologies (phimosis, urethral stricture, neurogenic dysfunction, diverticulum or stenosis of the bladder neck).

An important role in the pathological mechanism of the development of the disease is played by the stagnation of blood in the small pelvis.

With a predisposition to acute cystitis, it is recommended to introduce cranberry juice into the daily diet, since cranberries contain benzoic acid, an antiseptic that is excreted in the urine.

Forms of the disease

In accordance with the clinical picture, acute catarrhal and hemorrhagic cystitis are distinguished. The hemorrhagic form of the disease is characterized by micro or macrohematuria (an admixture of blood in the urine).

By the degree of spread of the inflammatory process:

  • focal (trigonitis, cervical);
  • total (diffuse).

Depending on the type of pathogen:

  • specific (tuberculous, gonorrhea, chlamydia, trichomonas);
  • not specific.

The risk of developing specific acute cystitis in men and women increases with active sexual activity with frequent changes in sexual partners.

Symptoms of acute cystitis

The clinical picture of acute cystitis is very bright, it is characterized by:

  • imperative (which arises suddenly, stronger, often with the inability to restrain) need to urinate;
  • excretion of urine (mition) in small portions;
  • pain and cramps that occur at the end of the act of urination;
  • terminal hematuria (a mixture of blood that appears in the urine towards the end of urination);
  • change in transparency and color of urine (cloudy, sometimes with a reddish tinge);
  • pain, sometimes very intense, in the bladder, anus, perineum.
pain in the lower abdomen with acute cystitis

Acute cystitis is characterized by intense pain and frequent urge to urinate.

In acute cystitis, the urge to urinate also occurs when a small amount of urine (less than 150 ml) has accumulated in the bladder, due to the reflex contraction of the detrusor. The frequency of urination is determined by the severity of the inflammatory process and can be up to 3-4 times per hour.

Symptoms of acute cystitis with localization of the pathological process in the bladder neck:

  • constant sharp pain radiating to the glans penis, anus;
  • acute reflex urinary retention due to spasm of the muscles of the pelvic floor and external sphincter under the influence of intense painful irritation.

Diagnostics

The diagnosis of acute cystitis is based on the characteristic clinical manifestations of the disease. The diagnosis is confirmed by the results of laboratory and instrumental tests, including:

  • general urine analysis (bacteriuria, leukocyturia, erythrocyturia, a significant amount of mucus and squamous epithelial cells are characteristic);
  • bacteriological examination of urine - allows you to identify the causative agent of the disease and determine its sensitivity to antibacterial drugs;
  • a general blood test (with a simple course of acute cystitis, changes are usually not detected, the analysis is performed in order to determine the general state of health and detect any concomitant pathologies);
  • Ultrasound of the bladder against the background of physiological filling (an echo-negative suspension is found in the bladder cavity, a thickening of the internal walls of the organ);
  • urodynamic examination (performed with complicated acute cystitis and aimed at identifying possible neurogenic dysfunctions of the bladder);
  • study of the secretion of the prostate gland, bacteriological seeding of secretions from the urethra, ultrasound of the prostate gland (with acute cystitis in men).
  • gynecological examination, microscopy and bacteriological examination of secretions from the vagina, urethra and cervical canal, PCR studies for sexually transmitted diseases (with acute cystitis in women).

Acute cystitis is one of the most common urological diseases.

After the acute inflammatory process subsides, cystography and cystoscopy are performed to clarify the cause of the disease.

ultrasound of the bladder with acute cystitis

Ultrasound of the bladder is included in the complex diagnosis of acute cystitis.

Acute cystitis requires differential diagnosis with urolithiasis and bladder tumors, acute paraproctitis, acute appendicitis, acute pyelonephritis.

Treatment of acute cystitis

In acute cystitis, the patient is assigned to bed rest, a sparing diet of milk and vegetables, and a lot of drinking (2. 5-3 liters of fluid per day). Sex life is excluded for the entire therapy period. For the treatment to be successful, it is important to have a daily bowel movement.

In the treatment of acute cystitis, local spa procedures are widely used (gloomy warm sitz baths with decoctions of herbs, dry heat in the bladder area) that help reduce the symptoms of the disease. However, hot baths and rinsing of the bladder in the acute phase are strictly contraindicated.

Medical treatment of acute cystitis consists in the use of antibacterials, uroseptics, antihistamines and pain relievers. Antibacterial drugs are prescribed taking into account the type of pathogen and its sensitivity to antibiotics. Until the results of bacteriological research are obtained, broad-spectrum antibiotics are used, which are mainly excreted in the urine, as well as preparations of the nitrofuran series.

For uncomplicated acute cystitis in adults, fluoroquinolones are used, and in children nalidixic acid, cephalosporins. The choice of antibiotic is strictly carried out by the attending physician. Antibiotic therapy lasts 7-10 days.

dry heat for acute cystitis

Dry heat in the bladder area helps with acute cystitis.

The treatment regimen for acute cystitis can be supplemented by taking herbal remedies. Medicinal herbal pharmaceutical preparations with anti-inflammatory, antiseptic, tanning and diuretic effects are recommended.

After the relief of symptoms of acute cystitis, physiotherapeutic procedures are prescribed (inductothermia, UHF, electrophoresis, magnetic and / or laser therapy).

Potential consequences and complications

The most common complications of acute cystitis are:

  • the transition of inflammation to a chronic form, characterized by a persistent course, resistant to therapy, with periods of remission and exacerbations;
  • interstitial cystitis - the inflammatory process affects not only the mucous membrane, but also the deeper layers of the bladder wall (submucosa, muscle);
  • paracystitis - the release of the inflammatory process outside the bladder with damage to the surrounding fiber;
  • cystalgia - painful and frequent urination, not accompanied by the development of pyuria (often develops in women);
  • acute pyelonephritis - an infection from the bladder through the ureters enters the kidneys, causing inflammation in them;
  • gangrenous cystitis is a serious complication that threatens rupture of the bladder and the development of peritonitis.

In girls and women, acute cystitis most often develops against the background of vaginal dysbiosis (dysbiosis) or as a result of a violation of the rules of personal hygiene.

Forecast

The mucous membrane of the bladder has a high regenerative capacity, therefore, provided that the treatment is started on time, in most cases, acute cystitis ends with a full recovery within 7-14 days. The prognosis worsens with the development of complications.

Prevention

Prevention of acute cystitis includes the following measures:

  • regular bladder emptying to prevent urinary stagnation;
  • correct water regime, providing sufficient diuresis (1-1, 5 liters per day);
  • compliance with the rules of personal hygiene;
  • adequate and timely treatment of genital infections and other infectious diseases;
  • increase the general immunity of the body (proper nutrition, rejection of bad habits and promiscuous sex life, playing sports, adherence to the daily regimen);
  • the most delicate and delicate execution of urological operations and manipulations on the bladder.

With a predisposition to acute cystitis, it is recommended to introduce cranberry juice into the daily diet, since cranberries contain benzoic acid, an antiseptic that is excreted in the urine.