Cystitis at women
Cystitis at women – inflammatory defeat mucous (is more rare – submucous and muscular) a layer of a bladder of a sharp or chronic current. Cystitis at women is followed by the painful, speeded-up urination with residual feelings of burning and gripes, pains in a small pelvis, feeling of insufficiently full depletion of a bladder, subfebrilitety, emergence in urine of slime and blood. Diagnosis of cystitis at women includes an urine research (the general analysis, across Nechiporenko, ), survey of the gynecologist with a research of microflora of a vagina, ultrasonography of a bladder, a tsistoskopiya. In therapy of cystitis at women antibiotics, uroseptik, instillations of a bladder, physical therapy are used.
Cystitis at women
Cystitis is one of the most widespread female diseases which is on a joint of urology and gynecology. Statistically, every second woman faces cystitis during life. Pathology mainly comes to light at women of childbearing age (20-40 years); prevalence of cystitis at girls of 4-12 years is also quite high (by 3 times more often than at boys of this age). In 11-21% of cases cystitis gets a chronic current from women, i.e. proceeds with 2 and more aggravations a year.
The cystitis reasons at women
In most cases cystitis at women has infectious character. Features of anatomy of a female urethra (a short and wide urethra), and also topographical proximity of a vagina, back pass and an urethra, facilitate ascending penetration of pathogenic flora into a bladder. Except the urethral (ascending) way of distribution infection of a bladder can come descending (from the top uric ways), limfogenny (from bodies of a basin), hematogenic (from the remote bodies) ways.
As a rule, act as causative agents of cystitis at women colibacillus (70-95%), staphylococcus (5-20%), is more rare - a klebsiyella, proteas, a sinegnoyny stick. Cystitis at women often develops against the background of a colpitis, a vulvit and the uretrit caused by candidiasis, a bacterial vaginosis, mycoplasmosis, gonorrhea, ureaplasmosis, clamidiosis, trichomoniasis, genital tuberculosis, etc. infections.
Traditionally primary episode or exacerbation of cystitis at women are connected with overcooling, a SARS, the beginning of sex life, change of the sexual partner, the beginning of periods, the excessive use of spicy food or alcohol, wearing too close clothes. As the factors provoking cystitis at women pyelonephritis, foreign matters and stones in a bladder, stagnation of urine can also act at diverticulums, striktura of an urethra or rare depletion of a bladder, locks.
Cystitis at girls can develop at unsatisfactory hygiene of genitals, and also at a neurogenetic bladder. Cystitis at pregnant women is caused by haemo dynamic and endocrine gestational changes, transformation of microflora of an urogenital path.
In certain cases development of cystitis in women can be provoked by radiation therapy concerning tumors of a small pelvis, an allergy, toxic influence, exchange violations (diabetes, a giperkaltsiuriya). In the period of a climax cystitis at women develops under the influence of a lack of estrogen and atrophic changes mucous an urogenital path.
Developing of cystitis at women is promoted traumatizing mucous a bladder when carrying out endoscopic manipulations and operations (a kateterization, a tsistoskopiya, a transurethral resection of a bladder, etc.). Chronic cystitis at women, except a slow infection, can be caused by omission of a uterus or vagina, a chronic parametritis.
Classification of cystitis at women
On an etiology women can have bacterial cystitis (infectious) and not bacterial (beam, allergic, chemical, medicinal, toxic, etc.). Depending on the pathogenic activator infectious cystitis, in turn, shares on specific (ureaplazmenny, mikoplazmenna, chlamydial, gonorrheal and so forth) and nonspecific, caused by opportunistic flora.
Taking into account the defined morphological changes in a bladder women can have a catarrhal cystitis, hemorrhagic, cystous, ulcer (ulcer and fibrous), flegmonozny, gangrenous, inlaying, granulematozny, opukholevidny, interstitsialny. On prevalence and localization of an inflammation allocate diffusion (total) cystitis, limited (focal) - cervical cystitis and trigonit (an inflammation of a triangle of Lyeto).
On character of a current distinguish sharp and chronic (persistiruyushchy) cystitis at women; primary (arisen independently) and secondary (developed against the background of other urological diseases). At sharp cystitis at women in most cases the inflammation mentions an epitelialny and subepitelialny cover mucous a bladder. The endoscopic picture of a catarrhal inflammation is characterized by puffiness and polnokroviy mucous, vascular reaction (expansion, an injection of vessels), existence of a fibrinozny or mucopurulent raid on the inflamed sites. At the progressing course of cystitis at women submucous and even muscular layer of a bladder can be surprised.
The expressed eritrotsitarny infiltration mucous, sites of hemorrhages with rejection of a mucous membrane, bleeding is Tsistoskopichesky signs of hemorrhagic cystitis at women at contact. The ulcer form of cystitis at women quite often develops at radiation injury of a bladder. Ulcers can have single or multiple character, mention all layers of a puzyrny wall (pan-cystitis), lead to bleeding, formation of fistulas of a bladder. When scarring ulcers fibrous and sclerous changes of a wall of a bladder develop that leads to its wrinkling.
At flegmonozny cystitis at women diffusion infiltration is noted by leukocytes of a submucous layer. The purulent inflammation extends to a serous cover (peritsistit) also surrounding cellulose (paracystitis). In fabrics about a bladder the abscesses causing diffusion defeat of all cellulose can be formed.
Gangrenous cystitis at women affects all puzyrny wall with development of a partial or full necrosis mucous, is more rare – a muscular layer of a bladder with perforation of a wall with development of peritonitis. The become lifeless mucous and submucous layers of a bladder can be torn away and come through an urethra to light. The sklerozirovaniye and wrinkling of a bladder is a consequence of gangrenous cystitis.
Endoscopic chronic cystitis at women is characterized by puffiness, hyperaemia, a thickening or an atrophy mucous and decrease in its elasticity. In some cases in a mucous and submucous layer microabscesses and ulcerations can be formed.
It is long not healing ulcers can be inlaid with salts, causing development of the inlaying cystitis. Prevalence of proliferative processes involves growth of granulyatsionny fabric from formations of granular or polipoidny growths (granulematozny and polipoidny cystitis). Less often in a bladder the cysts acting over a surface mucous odinochno or groups in the form of the small hillocks representing a submucous congestion of lymphoid fabric (cystous cystitis) can be formed.
At interstitsialny cystitis at women characteristic existence of glomerulyation (submucous hemorrhagic educations), the single ulcer of Gunnar having the linear form with the bottom covered with fibrin, inflammatory infiltrates is defined. As an outcome of interstitsialny cystitis at women serves wrinkling of a bladder and reduction of its capacity.
Cystitis symptoms at women
Sharp cystitis at women demonstrates suddenly, as a rule, after influence of one or several provocative factors (overcooling, an infection, a trauma, a koitus, tool intervention and so forth). Displays of cystitis at women include a classical triad: dizuriya, leykotsituriya (piuriya), terminal gematuriya.
Violations of an urination are caused by the increased neuro and reflex excitability of a bladder under the influence of an inflammation, hypostasis and a sdavleniye of the nervous terminations that leads to increase in a tone of a puzyrny wall. Dizurichesky frustration at cystitis at women are characterized by a pollakiuriya (increase by an urination), constant desire to urinate, need of effort to start a miktion, gripes in a bladder, pain and burning in an urethra, nikturiy.
Symptoms of sharp cystitis at women accrue quickly. Desires on an urination arise each 5-15 minutes, have imperative character, at the same time the volume of a separate portion decreases. Spastic reductions of a detruzor lead to urine not deduction. The expressed morbidity accompanies the beginning and the termination of an urination; out of a miktion pain, as a rule, remains in a crotch and pubic area.
Character and intensity of pain at cystitis at women can vary from weak discomfort to intolerable gripes. Little girls against the background of pain can have a sharp delay of urine. At cervical cystitis at women the dizuriya is expressed stronger. Extremely painful manifestations are noted at interstitsialny cystitis, and also the inflammation caused by chemical and radiation factors.
The leykotsituriya in this connection urine gains muddy purulent character is an obligatory and constant sign of cystitis at women. Gematuriya has microscopic character more often and develops at the end of an urination. The exception makes hemorrhagic cystitis at women at which the makrogematuriya makes the leading manifestation. At sharp cystitis at women body temperature can increase to 37,5-38 °C, the general health and activity sharply suffers.
Feature of a course of cystitis at women is the frequent retsidivirovaniye of a disease: more than at a half of patients a recurrence happens within a year after the first episode of a disease. At the repeated attack of cystitis which developed within a month after completion of therapy it is necessary to think of preservation of an infection; after 1 month – about a reinfektion.
Displays of chronic cystitis at women are similar to that at a sharp form, but are expressed not so sharply. Pains at depletion of a bladder have moderate character, and the frequency of an urination allows not to lose working capacity and to adhere to a habitual way of life. The clinic of an acute/subacute inflammation develops in the periods of exacerbations of cystitis at women; during remission clinical and laboratory data about active inflammatory process, as a rule, are absent.
Diagnosis of cystitis at women
Recognition of cystitis at women is based on clinical laboratory data and data of ekhoskopichesky and endoscopic inspection. The palpation of nadlobkovy area is sharply painful. In the general analysis of urine substantial increase of leukocytes, erythrocytes, protein, slime, salts of uric acid is defined. At bacterial cystitis at women urine it is characterized by the plentiful growth of pathogenic flora. Planned inspection of women with cystitis surely has to include consultation of the gynecologist, survey of the patient on a chair, microscopic, bacteriological and the PTsR-research of gynecologic dabs.
In diagnosis of recurrent cystitis at women the role of a tsistoskopiya and a tsistografiya is big. Tsistoskopiya allows to define a morphological form of damage of a bladder, existence of tumors, uric stones, foreign matters, diverticulums of a bladder, ulcers, fistulas, to execute a biopsy. Ultrasonography of a bladder indirectly confirms presence of cystitis at women on characteristic changes of walls of a bladder, existence of a "ekhonegativny" suspension.
Treatment of cystitis at women
Treatment of cystitis at women has to take place under control of the gynecologist and urologist. Knocking over of a sharp form of cystitis at women usually makes 5-7 days. Antibiotics from group of ftorkhinolon (ciprofloxacin, ), a fosfomitsina, tsefalosporin, nitrofurans are used. At detection of specific microflora the corresponding antimicrobic, antiviral, antifungal medicines are applied.
For removal of pain NPVP (, diclofenac), spazmolitik are appointed (a papaverine, ). In addition to the main medicamentous therapy phytoteas (infusions of a bearberry, field horsetail, sporysh, leaf of cowberry, etc.), vegetable pharmaceuticals can be recommended. At sharp cystitis women are recommended to adhere to the sparing, mainly dairy and vegetable diet, to increase water loading.
At recurrent cystitis at women, except the above-named etiotropny and symptomatic therapy, instillations of a bladder, vnutripuzyrny , UVCh, an induktotermiya, magnetolaser therapy, magnetotherapy are shown. If recurrent cystitis is diagnosed for the woman in a menopause, intravaginalny or periuretralny use of estrogensoderzhashchy creams is recommended. At development of a rough giperplaziya of a neck of a bladder resort to a transurethral resection - the TOUR of a bladder.
Prevention of cystitis at women
In a question of the prevention of cystitis at women the importance is attached to respect for personal and sexual hygiene, timely treatment of gynecologic and urological diseases, cooling prevention, regular depletion of a bladder. Strict observance of an asepsis when carrying out endovezikalny researches and a kateterization of a bladder is necessary. Decrease in probability of a recurrence of cystitis at women requires increase in immunity, carrying out preventive courses of treatment in the fall and in the spring.