Acute cystitis

Acute cystitis is an inflammatory process of mainly infectious origin that is localized in the mucous membrane of the bladder and is clinically manifested by frequent and painful urination, mild 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

The infection enters the bladder mainly in an ascending (through the urethra) or descending (from the kidneys) manner. Pathogenic microorganisms enter the bladder via the hematogenous route much less frequently, ie they are brought into the bladder with the blood stream from the source of the primary infection or through contact through the bladder wall.

Against the background of the inflammatory process, the blood vessels of the wall of the bladder expand, their permeability increases. The mucous membrane becomes hyperemic and swells. Subsequently, at the focal point of the inflammation, erythrocytes sweat, which leads to hemorrhagic phenomena. If the disease is severe, the inflammation can spread to the deeper layers of the bladder.

Most often the development of acute cystitis is caused by a gram-negative microbial flora (Escherichia coli, Klebsiella, Proteus). Gram-positive microorganisms (Staphylococcus, Proteus) and microbial associations cause inflammation in around 20% of cases.

acute cystitis with inflammation of the bladder lining

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

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

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

  • Trauma to the inner layer of the bladder (urethroscopy, cystoscopy, urinary 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 chemical and toxic substances;
  • Decrease in general and local immunity due to frequent viral infections, states 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 pathology (phimosis, urethral stenosis, neurogenic dysfunction, diverticulum or bladder neck stenosis).

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

If you are predisposed to acute cystitis, it is recommended that cranberry juice be included in your daily diet, as cranberries contain benzoic acid, an antiseptic that is excreted in the urine.

Forms of disease

According to the clinical picture, a distinction is made between catarrhal and hemorrhagic acute cystitis. The hemorrhagic form of the disease is characterized by micro- or macrohematuria (an admixture of blood in the urine).

According to the degree of spread of the inflammatory process:

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

Depending on the type of pathogen:

  • specific (tuberculous, gonorrhoeic, chlamydial, Trichomonas);
  • unspecific.

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

Symptoms of acute cystitis

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

  • Imperative (occurring suddenly, strongest, often with the impossibility of restraint) to urinate;
  • Passing urine (micturition) in small portions;
  • Pain and cramps that occur at the end of urination;
  • terminal hematuria (an admixture of blood that occurs in the urine towards the end of urination);
  • Change in the transparency and color of the urine (cloudy, sometimes reddish);
  • Pain, sometimes very intense, in the bladder, anus, in the perineum.
Pain in the lower abdomen with acute cystitis

Acute cystitis is characterized by severe pain and frequent urination.

In acute cystitis, the urge to urinate occurs when a small amount of urine (less than 150 ml) has accumulated in the bladder, which is due to a 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 neck of the bladder:

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

diagnosis

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 examination, including:

  • general urinalysis (bacteriuria, leukocyturia, erythrocyturia, a significant amount of mucus and squamous 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 an uncomplicated course of acute cystitis, as a rule, no changes are detected, the analysis is carried out to determine the general state of health and identify a possible accompanying pathology);
  • Ultrasound of the bladder against the background of physiological filling (in the bladder cavity there is an echo-negative suspension, a thickening of the inner walls of the organ);
  • urodynamic examination (performed in complex acute cystitis and aimed at identifying possible neurogenic dysfunction of the bladder);
  • Examination of the secretion of the prostate, bacteriological sowing of discharge from the urethra, ultrasound of the prostate (with acute cystitis in men).
  • gynecological examination, microscopy and bacteriological examination of the discharge from the vagina, urethra and cervical canal, PCR examinations for sexually transmitted diseases (in acute cystitis in women).

Acute cystitis is one of the most common urological diseases.

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

Ultrasound of the bladder in acute cystitis

Ultrasound examination 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 given bed rest, a frugal milk-vegetable diet and plenty of drinking (2. 5-3 liters of fluid per day). Sex life is excluded for the entire duration of therapy. Daily bowel movements are important for successful treatment.

In the treatment of acute cystitis, local thermal procedures (warm Sitz baths with decoctions of herbs, dry heat in the bladder area) are often used, which help to alleviate the symptoms of the disease. However, hot baths and bladder irrigation in the acute phase are strictly contraindicated.

Medical treatment for acute cystitis consists of the use of antibacterial, uroseptic, 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 available, broad-spectrum antibiotics, which are mainly excreted in the urine, as well as preparations from the nitrofuran range will be used.

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

dry heat in 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. Pharmacy preparations made from medicinal herbs with anti-inflammatory, antiseptic, tanning and diuretic properties are recommended.

After the symptoms of acute cystitis have been relieved, physiotherapeutic procedures are prescribed (inductothermia, UHF, electrophoresis, magnet and / or laser therapy).

Possible consequences and complications

The most common complications of acute cystitis are:

  • the transition of the inflammation into a chronic form, characterized by a persistent, therapy-resistant course with periods of remission and exacerbations;
  • interstitial cystitis - the inflammatory process affects not only the mucous membrane, but also the deeper layers of the wall of the bladder (submucosa, muscular);
  • paracystitis - the release of the inflammatory process outside the bladder with damage to the surrounding fiber;
  • zystalgie - 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 invades the kidneys and causes inflammation there;
  • Gangrenous cystitis is a serious complication that threatens to rupture the bladder and develop 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 ability to regenerate, therefore, with timely treatment, acute cystitis ends in most cases with full recovery within 7-14 days. The prognosis worsens with the development of complications.

prevention

Prevention of acute cystitis includes the following measures:

  • emptying the bladder regularly to prevent urinary obstruction;
  • correct water regime with adequate 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;
  • Increasing the general immunity of the body (proper nutrition, rejection of bad habits and promiscuous sex life, playing sports, adhering to the daily schedule);
  • the gentlest and gentlest execution of urological operations and manipulations on the bladder.

If you are predisposed to acute cystitis, it is recommended that cranberry juice be included in your daily diet, as cranberries contain benzoic acid, an antiseptic that is excreted in the urine.