Causes of cystitis and methods of its treatment

According to statistics, every year 11% of women suffer a urinary tract infection. The most common is cystitis. Patients usually complain of urgent urge to urinate, frequent painful urination, pain in the lower abdomen, blood in the urine, subfebrile temperature is possible.

Provoking factors can be hypothermia, alcohol and intake, spicy or salty foods. In young women, cystitis is often associated with the onset of sexual activity. In postmenopausal women, cystitis occurs against the background of developing atrophic processes caused by hormonal changes.

Cystitis is often perceived by women as a non-serious disease that can be treated with home remedies. Warming up and herbal preparations really give relief, sometimes even completely remove the symptoms, but you need to understand that these measures do not kill the pathogen, but only reduce pain and the inflammatory response. At the next provocation, the remaining bacteria can again cause a new exacerbation. We strongly recommend that you do not self-medicate or use someone else’s advice, but contact a specialist who will select the right treatment and monitor its effectiveness.

After treatment, a control urine test must be performed. In chronic inflammation, it is advisable to perform urine cultures, further therapy should be selected in accordance with the results of this analysis.

The result of self-treatment or improper treatment of acute cystitis can be a chronic process, as well as the spread of infection up the urinary tract with the development of pyelonephritis. In addition, other diseases of the urinary system, anatomical anomalies of the urinary tract, diseases of neighboring organs can be the cause of chronic inflammation. Diagnosis of these conditions, as a rule, requires an in-depth examination of the patient.

The most common source of bacteria entering the bladder are gynecological organs. Colpitis, vaginitis are diseases that support the inflammatory process in the bladder. Even vaginal dysbacteriosis, a common condition at present, contributes to the appearance of cystitis due to increased colonization of the vagina by opportunistic flora, which comes in place of lactobacilli. Almost all sexually transmitted infections can infect the urethra and bladder and keep the lining of the bladder inflamed. For their detection, sometimes only gynecological smears are not enough; urine cultures on special media are required.

Very often, patients complain about the connection of exacerbations of cystitis with sexual life, which occur the next day or a day after intercourse. Such patients can be advised to exclude all inflammatory processes in the gynecological area and adhere to the following rules: intimate hygiene and urination before and after intercourse, perineal antiseptic treatment. If these measures are ineffective, one can think about drug postcoital prevention of cystitis. There is also a category of patients in whom the opening of the urethra and the vagina are anatomically close. This situation requires surgical correction.

Treatment of diseases of other pelvic organs should be carried out by specialists of related specialties: proctologist, gastroenterologist, surgeon.

In addition, changes in the bladder mucosa itself can serve as the basis for maintaining the inflammatory process. They cannot be diagnosed by ultrasound. To identify them, it is advisable to perform cystoscopy – examination of the bladder mucosa from the inside with the help of an instrument. Usually, 2 types of changes are identified that support the inflammatory process.

The first type of pathology has the general name “proliferative cystitis”. This refers to the excessive growth of the mucosa in the form of pseudocysts, hyperplasia, bullae. In the urethra, the inflammatory reaction most often manifests itself in the form of pseudopolyps. These changes persist even after the exacerbation subsides. Since low-grade inflammation is present in the thickness of the mucosa itself, urinalysis and culture may be completely normal. The use of antibiotics in this case is ineffective, intravesical administration of drugs (instillations into the bladder) is necessary, physiotherapeutic procedures are possible: drug electrophoresis, laser therapy. In the absence of the effect of conservative treatment, coagulation of areas of the altered mucosa is recommended.

Another common finding in women with chronic cystitis is mucosal metaplasia. This is the name given to the change in the type of epithelium characteristic of a normal bladder to another type, usually found in the vagina. The reasons for these changes are not yet fully understood. Some authors attribute these changes to the peculiarities of the anlage of the bladder neck epithelium, which is common with the vagina. There is a dishormonal theory of the occurrence of metaplasia.

In Russia, metaplasia is considered a form of chronic cystitis and is often erroneously referred to as leukoplakia based on visual detection of areas of whitish mucosa. In fact, true leukoplakia is quite rare, characterized by keratinization of the mucosa and is a purely histological diagnosis, that is, it is only revealed after a biopsy. Despite this reservation, the treatment of “*simple” metaplasia in some cases makes sense.

The fact is that in the area of metaplasia there is no protective layer covering the inside of a normal bladder. Its absence leads to direct contact of the inflamed mucosa with the aggressive environment of urine and the appearance of pain. This type of change does not respond well to conservative treatment. In this case, cauterization of the bladder mucosa is an effective measure. Previously, electrocoagulation of altered areas or TUR (transurethral resection) of the bladder wall was performed.

In modern operating rooms, laser ablation of the mucosa is used. Laser radiation injures the mucous membrane less, there are no scars after it, the recovery period after treatment is shorter and easier. At the Medical Center “XXI century” we perform such operations using a holmium laser. This is the latest generation laser, the penetrating power of the holmium laser beam is very small, therefore, trauma to the bladder mucosa is minimal. The operation is performed under general anesthesia, usually intravenous. It can be performed on an outpatient basis, after which the patient stays in the postoperative ward for several hours under the supervision of an anesthesiologist.

In the treatment of acute and chronic cystitis, it is advisable to consult a urologist who will conduct an examination aimed at identifying the diseases that served as its basis and select an adequate therapy.