Cystitis is an inflammation of the bladder wall.
Etiology of cystitis
Cystitis is caused by Escherichia coli, staphylococcus, streptococcus, Pseudomonas aeruginosa, vulgar protea. Cases of the development of cystitis after taking certain drugs, the use of antibiotics (candida cystitis), with vitamin deficiency and under the influence of radiation are described.
The pathogenesis of cystitis
In early childhood, the infection enters the bladder mainly through the hematogenous route; in preschool and school – often in an ascending way. Infection can be introduced downward from the upper urinary tract, as well as lymphogenous. The development of the inflammatory process in the bladder occurs in the presence of a massive virulent infection and contributing factors (urinary retention, impaired barrier function of the epithelium of the mucous membrane of the bladder, decreased immunological reactivity of the body). The outflow of urine is often disturbed with injuries, tumors, congenital and acquired ropatii. The barrier function of the epithelium of the mucous membrane of the bladder can be disturbed if it is damaged by stone, sand, the toxic effects of certain drugs, etc. Deep changes in the mucous membrane of the bladder are observed with local circulatory disorders as a result of infectious and inflammatory processes in the pelvis, cooling , injuries, tumors, etc.
Pathomorphology of cystitis
The nature and degree of morphological changes distinguish catarrhal, hemorrhagic, purulent, ulcerative fibrinous and gangrenous cystitis.
Classification of cystitis
Primary cystitis (as a result of infection) and secondary (develop against a background of uropathy) are distinguished. By the nature of the course, cystitis can be acute and chronic; by prevalence – focal and diffuse.
Clinic of acute cystitis
The clinic of acute cystitis is manifested by frequent urination (every 20 – 40 minutes), painful urge to urinate, followed by the development of urinary incontinence, pain in the lower abdomen, in the perineum or head of the gently sloping penis, due to the filling of the bladder and stretching of its wall. Often pain occurs at the beginning and during urination as a result of irritation of the neck of the bladder, rich in nerve endings. The most severe pain is noted at the end of urination due to a reduction in the region of the urinary bubble, equipped with a dense network of interoreceptors. A sharp, severe pain can reflexively cause a spasm of the sphincter of the urethra and cessation of urination, complete retention of urine develops (it happens more often in young children). The general condition with primary acute cystitis suffers little. Symptoms of general intoxication are weak, body temperature is often normal. This is due to a good outflow of pathological products of inflammation in the urine and low absorption capacity of the mucous membrane of the bladder. An increase in body temperature and the appearance of symptoms of intoxication (headache, nausea, vomiting, toxicoexicosis, diarrhea, etc.) indicate an ascending urinary tract infection, the development of complications (more often pyelonephritis). Important diagnostic signs of acute cystitis are a change in the color and transparency of the urine, terminal hematuria, manifested towards the end of urination with a few drops of blood or urine stained with blood.
Clinic of chronic cystitis
Chronic cystitis is usually manifested by a clinic of acute inflammation, which, under the influence of unfavorable factors (frequent infections, dystrophy, rickets, congenital and acquired uropathy), acquires a protracted, then chronic (often recurring) course involving the pyelocaliceal system and stratification of the symptoms of pyelonephritis.
Neutrophilic white blood cells predominate in the urine. Sometimes it contains a purulent precipitate, giving clouding. In addition, fresh red blood cells or even blood clots, epithelial cells, protein (up to 100-120 mg / day), sometimes single hyaline cylinders are found in the urine. Bacteriuria is possible (more than 100 thousand microbial bodies in 1 ml of urine). In the study of blood – leukocytosis, increased ESR.
Diagnosis of cystitis
The diagnosis is based on characteristic clinical and laboratory data and in typical cases is not difficult. Differential diagnosis is carried out with pyelonephritis, uric acid diathesis and kidney stone disease, congenital and acquired uropathy, gynecological diseases. In such cases, cystoscopy, excretory urography, cystography, radioisotope renography, etc. are of differential diagnostic value.
The course and outcome of cystitis
With timely rational treatment of patients with primary acute cystitis, recovery occurs within 2 to 3 weeks. Untreated and late diagnosed cases of acute cystitis can be complicated by chronic pyelonephritis. Secondary acute cystitis acquires a chronic course if congenital or acquired uropathy is not diagnosed and eliminated. Chronic cystitis amid uropathy is characterized by an unfavorable course, while conditions are created for the development of chronic pyelonephritis, chronic kidney failure. Complications – paracystitis, pyelonephritis, peritonitis, wrinkling of the bladder.
In the acute period of the disease – bed rest (rest, uniform heat) reduces the severity of dysuria and contributes to a more rapid normalization of the function of the bladder. The diet should be complete, with the exception of substances that irritate the urinary tract (pickles, spicy sauces, mustard, radish, radish, spinach, sorrel, horseradish, garlic, canned food). An abundant drink of liquids (up to 2 liters) is recommended, it is better in a warm form for the purpose of diluting urine, washing out pus, bacteria, etc. Antibacterial therapy is necessary, and sanatorium treatment is effective. With secondary chronic cystitis, it is necessary to eliminate the cause that supports the inflammatory process (radical elimination of uropathy).
Prevention of cystitis provides for the prevention and timely treatment of acute infectious diseases, early diagnosis and treatment of congenital and acquired uropathy, compliance with sanitary and hygienic standards, increasing the immunological reactivity of the body, applying hardening procedures, regulating the function of the intestines and bladder.