Cystitis at children - the uric infection causing an inflammation of a mucous membrane and a submucous layer of a bladder. Cystitis at children proceeds with pains and gripes at an urination, frequent desires on a pot with allocation of small portions of urine, an urine incontience; at younger age intoxication and fever is quite often noted. Diagnosis of cystitis at children assumes an urine research (the general analysis, a bakposev, dvukhstakanny test), performing ultrasonography of a bladder, at chronic cystitis - a tsistoskopiya. In the course of treatment of cystitis at children the diet and the strengthened drinking mode, medicamentous therapy (uroseptichesky, antibacterial, spazmolitichesky means), phytotherapy is appointed.
Cystitis at children
Cystitis at children – the most frequent infection of urinary tract which is found in practice of pediatrics and children's urology. Cystitis is widespread among children of any age and a floor, however by 3-5 times meets at girls of preschool and younger school age (from 4 to 12 years) more often. High incidence of girls of cystitis will be explained by features of a structure of a female urinary system: existence of a wide and short urethra, proximity of an anus, frequent infections of genitalia and so forth. Cystitis at children can proceed in the form of the isolated or combined infection (a tsistouretrit, a tsistopiyelonefrit).
The cystitis reasons at children
The following conditions are necessary for development of cystitis in the child: bacterial obsemenennost of a bladder, violation of its anatomical structure and function.
Normal clarification of a bladder comes from microflora at its regular depletion by means of urine current. The mucous membrane of a bladder has resistance to an infection thanks to activity of the periuretralny glands producing slime and local factors of immunological protection (to sekretorny immunoglobulin A, interferon, a lizotsim, etc.). Thus, anatomic integrity of an epithelium, functional full value of a detruzor, lack of morphological changes of a bladder and its regular depletion provide high degree of protection against an infection, and at weakness of one of links cystitis at children easily develops.
Most often in bacteriological crops of urine at cystitis at children uropatogenny strains of colibacillus are sowed; in smaller number of cases – a klebsiyella, proteas, epidermalny staphylococcus, a sinegnoyny stick, microbic associations. In a quarter of cases at cystitis at children diagnostic the significant bakteriuriya is not defined.
The role of viruses in a cystitis etiology at children remains until the end of not studied (except for hemorrhagic cystitis). Nevertheless, among urologists the fact that activators parainfluenzal, adenoviral, herpetic and other viral infections contribute to violation of microcirculation in a bladder is conventional and create a favorable background for the subsequent development of a bacterial inflammation.
The cystitis caused by a hlamidiya, a mycoplasma, an ureaplasma occurs at children. In these cases, as a rule, infection occurs in the presence of clamidiosis at parents, non-compliance with hygienic norms, visit of saunas, pools and so forth. Specific gonorrheal and trikhomonadny cystitis is more characteristic of the adults or teenagers leading sex life. Cystitis of a fungal etiology occurs at children with an immunodeficiency, anomalies of development of urinogenital system, is long receiving antibiotic treatment.
Penetration of causative agents of an infection into a bladder can come descending (from kidneys), ascending (from an urethra and an anogenitalny zone), limfogenny (from other pelvic bodies), hematogenic (from the remote septic centers), contact (through the damaged bladder wall) ways.
Violation of natural process of self-cleaning of a bladder can develop at a rare or incomplete urination (is more often at a neurogenetic bladder at children), a puzyrno-mochetochnikovy reflux, urethra striktura, a fimoza at boys, bladder diverticulums. As risk factors of development of cystitis in children the urolithic disease, foreign matters of a bladder, invasive researches serve a nephropathy in urology (a tsistografiya, a tsistoskopiya, etc.), treatment by nefrotoksichny medicines dismetabolichesky (cytostatics, sulfanylamides, etc.). The bacterial invasion of a bladder is promoted by dysbacteriosis, helminthoses, intestinal infections, gynecologic diseases at girls (a vulvita, a vulvovaginita), pyoinflammatory processes (omfalit at newborns, quinsies, abstsediruyushchy pneumonia, stafilodermiya) and so forth.
A certain part in pathogenesis of cystitis at children is assigned by endocrine dysfunctions (diabetes), hypovitaminoses, change of pH of urine, influence of physical factors (overcooling, radiation), to violation of the rules of personal hygiene.
Classification of cystitis at children
It is standard to classify cystitis at children by a current, a form, morphological changes, prevalence of inflammatory process and existence of complications.
On a current sharp and chronic cystitis occurs at children. Sharp cystitis at the child proceeds with an inflammation of mucous and submucous layers; can be followed by catarrhal or hemorrhagic changes of a wall. At chronic cystitis at children morphological changes affect a muscular layer and can carry the bullous, granular, flegmonozny, gangrenous, necrotic, interstitsialny, inlaying, polipozny character.
In a form distinguish primary (arising without structurally functional changes of a bladder) and secondary cystitis at children (arising against the background of incomplete depletion of a bladder owing to its anatomic or functional inferiority).
Taking into account prevalence of inflammatory changes cystitis at children is subdivided into focal and diffusion (total). When involving a neck of a bladder speak about cervical cystitis, at localization of an inflammation in the field of Lyeto's triangle – about development of a trigonit.
Cystitis symptoms at children
The clinic of sharp cystitis at children is characterized by bystry development and a rapid current. As the main manifestation of an acute inflammation serves the uric syndrome which is followed by the imperative desires to an urination arising each 10-20 minutes. Dizurichesky frustration are connected with the increased reflex excitability of a bladder and irritation of the nervous terminations. Children complain of pains in nadlobkovy area which irradiate in a crotch, amplify at a palpation of a stomach and insignificant filling of a bladder.
The urination is complicated, urine is emitted in the small portions, causing gripes and pain. Quite often at cystitis children have false desires to an urination or an urine incontience; at the end of the act of an urination the terminal gematuriya (allocation of several drops of blood) is noted.
At children of chest and early age cystitis can be shown by the general concern (amplifying at an urination), crying, refusal of food, excitement or slackness, temperature increase of a body to febrilny values. Small children sometimes have a spasm of an external sphincter of an urethra and a reflex delay of an urination.
If I wet the child to collect in a glass vessel, then it is possible to notice change of its coloring and transparency: urine becomes muddy, quite often dark, contains a deposit and flakes, sometimes unpleasantly smells. At hemorrhagic cystitis owing to a gematuriya urine gains color of "meat slops" from children.
At sharp cystitis usually the health of the child improves on the 3-5th days, and in 7-10 days children completely recover.
Chronic cystitis at children, as a rule, is secondary in a form. Symptoms of an inflammation amplify during an exacerbation of cystitis and are usually presented by the speeded-up urination, discomfort in the bottom of a stomach, a night and day incontience of urine.
Diagnosis of cystitis at children
The basis of diagnosis of cystitis at children is made by the complex of laboratory researches including the general analysis of urine, bacteriological crops of urine on flora, definition of pH of urine, conducting dvukhstakanny test. Changes of urine at cystitis at children are characterized leykotsituriy, gematuriy various degree of expressiveness, presence of a large amount of slime and a transitional epithelium, bakteriuriy. Most often the urine intake is made for a microbiological research at a free urination (after a toilet of genitalia and cleaning of a preputsialny bag at boys), however at a sharp delay of urine it is necessary to resort to a bladder kateterization.
At cystitis at children ultrasonography of a bladder with assessment of a condition of a detruzor before and after a miktion is carried out. Ekhoskopicheski usually is found a thickening mucous a bladder and a large number of ekhonegativny inclusions.
Carrying out a tsistografiya and tsistoskopiya is shown only at chronic cystitis at children during subsiding of an inflammation; as a main objective of researches serves identification of degree and the nature of change mucous. The pediatrician and the children's urologist participate in carrying out diagnostic search.
Sharp cystitis at children should be differentiated with an acute appendicitis, paraproktity, pyelonephritis, bladder tumors, gynecologic pathology. For this purpose the plan of inspection can include consultations of the children's surgeon and the children's gynecologist.
Treatment of cystitis at children
For reduction of the dizurichesky phenomena in a sharp stage of cystitis absolute rest and a bed rest, dry heat on area of a bladder, warm "sedentary" trays with broths of herbs (is shown to the child at a temperature of +37,5 °C). At cystitis the dairy and vegetable diet, an exception of the irritating food (hot, spicy dishes, spices), increase in the drinking mode by 50% of usual norm due to the use of alkalescent mineral waters, fruit drinks, compotes and so forth is recommended to children. The strengthened water loading at cystitis at children promotes increase in a diuresis and washing away from a bladder of bacteria and products of an inflammation.
Medicamentous therapy at cystitis at children includes reception of antibacterial means of spazmolitik, uroantiseptik, physical therapy. At children the protected penicillin (amoxicillin), tsefalosporina (tsefuroksy, a tsefaklor, ), derivatives of phosphonew acid (), the combined sulfanylamides by a course of treatment of 7 days with the subsequent repeated bacteriological control is applied to etiotropny antimicrobic therapy of cystitis.
For reduction of a pain syndrome it is used , a papaverine. In addition to the main treatment at cystitis at children phytotherapy is appointed (infusions of a camomile, a plantain, St. John's Wort, horsetail field). After subsiding of an inflammation to destination the physiotherapist the electrophoresis, the microwave oven, magnetotherapy on nadlobkovy area, etc. is carried out.
The forecast and prevention of cystitis at children
Sharp cystitis at children usually comes to an end with an absolute recovery. Chronic forms of cystitis develop at the children having anatomo-functional prerequisites for an infection persistirovaniye.
Prevention of cystitis at children is promoted by the correct hygiene of genitals, observance of the mode of an urination, treatment of the centers of an infection, carrying out expulsion of helminths, sufficient reception of liquid, correction of exchange violations, an exception of overcoolings. Children with chronic cystitis have to be observed at the children's urologist, periodically make control tests of urine.