Cystitis

Abdominal pain with inflammation of the bladder
Cystitis is inflammation of the lining of the bladder.

Cystitis is acute and recurrent, infectious and non-infectious, complicated and straightforward. The most common form of the disease is acute uncomplicated cystitis. Uncomplicated cystitis means cystitis in non-pregnant women without anatomical and functional abnormalities of the urinary system, without serious comorbidities.

Acute cystitis is one of the most common diseases in women. More than 50% of women have had such a diagnosis at least once in their life.

anatomy

Anatomically speaking, the female urethra is much shorter and wider than the male urethra, 2-4 cm long and close to natural sources of infection such as the vagina and anus. In men, the length of the urethra is about 20 cm, anatomically divided into several sections. Before entering the bladder, the urethra passes through the prostate, a natural barrier that prevents infections from entering the bladder.

Predisposing factors

The predisposing factors for developing cystitis are:

  • anatomical and physiological features of the female body, changes in the location of the urethra;
  • excessively active sex life;
  • new sexual partner, frequent change of sexual partner;
  • Use of spermicides;
  • an episode of urinary tract infection (UTI) during childhood;
  • maternal history of urinary tract infections.

In 70-95% of cases, the causative agent of acute cystitis is E. coli - Escherichia coli. Other pathogens such as Staphylococcus aureus, Klebsiella and Protea are significantly less common.

Symptoms of acute cystitis

The most common symptoms of cystitis include:

  • increased painful urination (dysuria);
  • Pain in the lower abdomen;
  • unpleasant smell of urine.

These symptoms occur alone or in combination in 90% of women with acute cystitis. An increase in body temperature above 37. 3 ° C is not typical of a cystitis and may indicate a more serious inflammatory process in the kidneys - acute pyelonephritis.

Blood in the urine - hematuria - usually causes panic in women, but most often it is a sign of an everyday cystitis.

The combination of painful urination and blood in the urine suggests acute cystitis (hemorrhagic cystitis) and not another, more serious urological pathology - for example, a urinary tract tumor, in which dysuria is uncharacteristic.

Blood in the urine can also appear as a result of chronic cystitis, which leads to an increase in the number of blood vessels (hypervascularization) in the submucosal layer of the bladder, its fragility and a tendency to bleed.

Other possible causes of hemorrhagic cystitis include radiation therapy, chemotherapy, and certain medications.

Cystitis, accompanied by mixing of blood in the urine, can occur acutely, with no signs of chronic inflammation and previous factors. The treatment algorithm is usually limited to the same measures as for acute cystitis without hematuria.

diagnosis

The diagnosis of acute cystitis is made based on the patient's symptoms. A general urine test, ideally a urine test with test strips, is used to clarify the diagnosis.

The appointment of treatment for acute cystitis is also possible just based on the patient's discomfort (the so-called empirical therapy), without receiving the results of a urinalysis. Taking urine for culture (bacteriological examination) is optional in patients with uncomplicated cystitis. Urine culture is only required in a number of cases, e. g. B. : pregnancy, suspected acute pyelonephritis, prolonged course of cystitis (more than 2 weeks), atypical course of the diseaseIf bacteria are present in the urine culture - more than 10³ - it is possible to microbiologically confirm the diagnosis of acute cystitis.

Ultrasound or other imaging tests are not part of the diagnostic algorithm for acute cystitis. A certain picture after the ultrasound of the bladder can not be observed. Such ultrasound signs as "thickening of the bladder wall" and "the presence of a suspension of the bladder" do not indicate the obligatory inflammation of the mucous membrane. The most common purpose of ultrasound is to rule out bladder tumors and ureteral stones.

Performing a cystoscopy for acute cystitis is contraindicated.

Differential diagnosis

Vaginitis. . . It is characterized by increased urination combined with vaginal irritation. It manifests as a quenched, sluggish stream. Predisposing factors can be excessive sexual activity, frequent changes of sexual partners (new sexual partners). Blood in the urine, pain when urinating, pain in the lower abdomen is usually absent. When examined, you can find vaginal discharge, the examination of which reveals an inflammatory process.

Urethritis. . . This disease is also characterized by frequent, painful urination, but the severity of the symptoms is usually less than that of acute cystitis. The most common causes of urethritis are gonorrhea, trichomoniasis, chlamydia, and the herpes simplex virus. The disease can also occur as a result of a change in sexual partner. Urethral discharge is more typical of men.

Cystitis treatment

The most important therapy for acute cystitis is antibiotic therapy.

It has been shown that in 90% of women after starting antibiotic therapy, the symptoms of acute cystitis disappear within 72 hours.

Drugs of first choice for acute cystitis are drugs that create a high concentration of the active ingredient in the urine and a low concentration in the blood, that is, drugs that work mainly in the urinary tract.

Fosfomycin. . . Broadband antibacterial substance. Most commonly, it is made in granular form for oral administration. With acute cystitis, it is a single dose - it is enough to drink one dose of the drug (3 g for adults). It is used for the first manifestations of cystitis. If there are signs of a cystitis, another dose can be given over several days (24 hours after the first dose).

Nitrofurantoin macrocrystalline. . . A substance with a similar chemical composition is furazidin potassium salt. Antimicrobial agent with a wide spectrum of activity, belongs to the group of nitrofurans. It has improved absorption, a higher concentration of active ingredients and fewer side effects. Dosage regimen for acute cystitis: 100 mg 3 times a day for 5 days.

Systemic antibacterial drugs, are not recommended as first-line drugs for the treatment of acute uncomplicated cystitis, but can only be used aspossible alternative. . .

Cephalosporins. . . A group of broad spectrum antibiotics which, unlike other similar active substances, contribute to the formation of a high concentration of the active substance not only in the urine but also in the blood. There are 4 generations of cephalosporins. They are used in various diseases: from sinusitis to peritonitis. Tableted forms of the antibiotic are most commonly used in the treatment of acute cystitis. Dosage regimen: 400 mg (1 tab. ) X 1 time per day for 3-5 days.

Alternative antibacterial drugs:

Fluoroquinolones. . . A highly effective group of antibiotics that are widely used in urological practice. They are used in the treatment of acute cystitis, but are currently not recommended for empirical therapy due to the increasing resistance in patients. They are prescribed according to the results of bacteriological urine culture in case of sensitivity to them, they are more often used in the treatment of pyelonephritis and prostatitis. Contraindicated for use in pregnant women and patients under 18 years of age. Dosage regimen: 250 mg x 2 times a day for 3-5 days.

Penicillins. . . The very first artificially synthesized group of antibiotics. Not recommended for the empirical treatment of acute cystitis due to the globally increased E. coli resistance. In some cases, however, a combination of the antibiotics penicillin and clavulanic acid can be used, for example in the case of inflammation of the bladder lining in pregnant women. Dosage regimen: 625 mg x 3 times a day for 7 days.

The backbone of treatmentCystitis in pregnant womenAntibiotic therapy is also prescribed, but not all drugs are approved for use. It is permissible to prescribe a penicillin series antibiotic or a group of cephalosporins.

The use of other drugs, herbal supplements, and dietary supplements in the treatment of acute cystitis will be ineffective, as there is a high likelihood that the pathogen will linger and relapse of the disease will occur.

Before that, there were recommendations on the use of a natural uro-antiseptic - cranberries (a large amount of cranberry juice). Several studies have shown evidence of the effectiveness of cranberry supplementation in reducing the incidence of urinary tract infections in women. However, in a meta-analysis of 24 studies and 4, 473 patients it was shown that foods containing cranberriesstatistically not significantly reducethe incidence of urinary tract infections, including acute cystitis in women.

If for any reason the patient shows an aversion to the consumption of antibiotics, anti-inflammatory drugs and analgesics are allowed to be prescribed to reduce the severity of the dysuria and discomfort in the lower abdomen.

Phenazopyridine hydrochloride- an analgesic substance. Refers to analgesics used to relieve pain in inflammatory diseases of the bladder and urinary tract. It is excreted in the urine and has a local anesthetic effect on the mucous membrane of the urinary tract. Does not remove bacteria by itself or damage the mucous membranes, it is usedjust to relieve the symptoms. . . Can be used with antibacterial drugs to relieve discomfort. It is recommended not to use more than 2 days, as prolonged treatment with drugs containing this substance can mask the symptoms of the disease. It is also used to relieve discomfort, cuts when urinating after catheterization of the bladder, during endoscopic procedures and operations on the urethra. Available in tablet form.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)- have a pronounced anti-inflammatory, analgesic and moderately antipyretic effect. They are widely used in urological practice, often in the form of rectal suppositories. In special cases, without the possibility of taking an antibiotic and the presence of recurrent cystitis, they can serve as the main drug for a short period of time.

Cystitis in men

It happens very rarely. This is due to a longer urethra than in women, fewer bacteria in the periurethral zone, and the presence of antibacterial components in the secretion of the prostate. Factors that contribute to the occurrence of cystitis in men are diagnostic manipulations and surgical interventions on the urinary tract, radiation therapy, chemotherapy, unprotected anal sex. Treatment is carried out with antibacterial drugs, which are also used in the treatment of prostate inflammation: 500 mg x 2 times a day, for at least 7 days.

After an episode of acute cystitis. Precautions

Additional examinations are not required after adequate treatment of acute cystitis. Adequate hydration, avoidance of hypothermia, personal hygiene, sexual hygiene, timely treatment of gynecological diseases, sexually transmitted infections are recommended. Prophylactic use of a drug after a single episode of acute cystitis is not indicated.

If symptoms of cystitis appear within two weeks after treatment, a urine culture should be carried out in the absence of a therapeutic effect in order to determine the sensitivity of the isolated pathogens to antibiotics (donate urine for culture). According to the results of bacteriological culture, it is recommended to prescribe an antibacterial drug according to the sensitivity of the pathogen.

How is acute cystitis treated in the clinic?

The clinic's urologists will prescribe the necessary examinations and only effective treatment. The diagnosis of acute cystitis is made on the basis of the patient's complaints and the medical history, and antibiotic therapy with first-line drugs is prescribed. Additional studies are carried out only if there are indications - the lack of the effect of therapy.

It is important to know:In the case of ineffectiveness of the therapy or frequent relapses, the cystitis is classified as recurrent, which can be simply referred to as "chronic".