According to the academic definition, chronic cystitis is a sluggish, recurrent inflammation leading to structural and functional changes in the bladder. Over time, relapses occur more often and take longer.
Chronic inflammation is usually called a process that lasts months, and in which the damaging factor, changes and scarring of tissues occur simultaneously. An inflammatory process is considered to be chronic for a period of more than 60 days from the moment of onset. In fact, this collective diagnosis hides a whole spectrum of problems that can be divided into two categories: the source of bacteria in the body, causing a recurrence of the infection, and the disruption of the natural defense mechanisms of the bladder.
Let's take a closer look at both categories.
Causes of chronic cystitis
Since this pathology, like acute cystitis, affects mainly women 20-40 years old, we will consider it on the example of the female body.
The source of a bacterial infection causing a relapse can be:
- Anatomical features . Abnormally deep location of the urethra or its protrusion is the main cause of postcoital cystitis. During intercourse, the urethra is open to a huge amount of bacteria from the surface of the penis. And since sex is a fairly regular process, the recurrence of infection, in this case, is also regular;
- Kidneys . Pyelonephritis, hydronephrosis (infected), large calculi in the kidneys are conditions that can be a regular “supplier” of bacteria to the bladder downstream;
- Diverticula and stones directly in the bladder. Both in the cavity of the diverticulum and on the surface of the stone, there are simply "greenhouse" conditions for the reproduction of bacteria.
The second group, which summarizes the causes of chronic cystitis, is a violation of the natural defense mechanisms of the lower urinary tract.
We are not talking about generalized immune suppression, but about the bacteriostatic activity of the bladder tissues towards infectious agents.
These may be:
- Viral tissue damage. For example, HPV, genital herpes, etc .;
- Hormonal changes, in particular - hypoestrogenism;
- Polyps of the urethra and bladder;
- Adhesion process in the bladder itself or adjacent organs;
- Cancer neoplasms and the process of metastasis in organ tissue.
The following types of chronic cystitis are distinguished by the degree of damage to the walls of the bladder:
- Bullous fibrinous;
Symptoms of chronic cystitis
The clinical picture and symptoms of chronic cystitis for women and men are the same and are in many ways similar to acute cystitis, but there are some differences:
- Frequent urination and inconclusive urge;
- Discomfort and obsessive "heaviness" in the lower abdomen ;
- Blood, sometimes pus in urine;
- Regular and frequent relapses of acute inflammation;
- Poor performance antibiotic therapy and sanitation;
- Urinary incontinence.
Complications occurring in the bladder, with chronic cystitis in women, may be:
- Salpingitis and oophoritis followed by infertility. The infection spreads outside the organ, affecting the other organs of the small pelvis by the lymphatic pathway;
- Cicatricial changes inside the organ, which lead to a significant decrease in its capacity (20-50 ml);
- Malignant neoplasm as the result of multiple calculi in the organ cavity.
Appropriate tests and studies help to diagnose the symptoms of this disease :
- General urinalysis, CBC, culture of urine (culture) and vaginal mucus;
- Examination on a gynecological chair for exclusion of anatomical anomalies of the urethra and inflammation of the periurethral glands, assessment of the condition of the genitals;
- Ultrasound examination of the pelvic organs and urinary system;
- Cystoscopy is mandatory to visually assess the condition of the urethra, as well as urinary epithelial cells bubble, exclusion, or confirmation of diverticum catches, calculi, polyps, leukoplakia, neoplasms or metastases;
- Based on the results of cystoscopy, X-ray studies or CT/MRI.
In addition , the diagnosis of chronic cystitis requires differential diagnosis with such diseases:
- Hormonal disorders provoked by the reproductive system;
- Adhesion processes after surgery on intestines or pelvic organs;
- Sexually transmitted diseases or sexually transmitted infections (eg, genital tuberculosis);
- Neoplasms in other organs with metastasis to the bladder;
- Lumbosacral radicular syndrome, which canprovoke pain syndrome and urinary incontinence.
Treatment of chronic cystitis
Methods aimed at treating chronic cystitis should be aimed at combating chronic inflammation by identifying the source of recurrent infection with its subsequent elimination.
How is chronic cystitis treated?
- < li> The use of TUR (Transurethral resection) of polyps and leukoplakia;
From general to specific
Let's consider in more detail what leukoplakia is and why it is so important determine its presence or absence in the status of chronic cystitis.
Leukoplakia is a violation of the integrity of the layers of the epithelial layers of the bladder. The cells of the healthy transitional epithelium are replaced by the cells of the squamous keratinizing epithelium.
The healthy mucosa closes the underlying wall, in which the nerve tissues are concentrated, from the aggressive effects of urine.
As a result of prolonged inflammatory processes, this protection is violated, the above occurs replacement of the epithelium, the underlying walls of the bladder are exposed to the aggressive influence of urine, which irritates the nerve endings and causes discomfort, numerous urges and pain.
In addition to irritation of the nervous tissue, leukoplakia is dangerous because of the loss of resistance due to several antibacterial mechanisms that are effective and constantly protect the bladder in healthy women.
Its bacterial invasion is not the main condition for the onset of inflammation, which is confirmed by scientific research. Going to the toilet regularly prevents infection. Even infected urine, with its timely release, is not a source of inflammation.
The normal mucous membrane of the bladder is bacteriostatic, that is, infectious agents entering the organ are enveloped in mucus and excreted in the urine. With leukoplakia, the integrity is violated and, over time, the surface of the epithelium, which produces mucus, decreases, and the fringes that appear, on the contrary, are a surface for fixing bacteria and increasing their colonies.
Summing up, we can confidently state that the treatment chronic cystitis in women and men is a long and painstaking process, but it is not a sentence to "chronic" treatment.
This is a reason to conduct a complete step-by-step examination,identify a clear specific cause and eliminate it, thereby saving yourself from this disease, diagnosis and all its attendant problems.