Let's figure out why cystitis with blood appears in women. What is this disease? Ordinary inflammation differs from hemorrhagic cystitis in that with such a disease, blood impurities are present in the urine. This is the same cystitis, but the blood in the urine indicates a significant depth of damage to the stratified epithelium of the mucous membrane of the bladder, as well as the spread of the pathological process to the capillary endothelium of its microvasculature.
The disease has an ICD-10 code N 30. The causes of cystitis with blood in the urine in women must be found out.
Epidemiology
Urinary tract infections affect approximately 150 million people each year. According to scientific studies, hemorrhagic infectious cystitis occurs much more often in women than in men. This happens especially often during menopause, because due to a decrease in the concentration of estrogen inblood, the protective properties of the mucous membranes begin to decrease. To date, the causes of cystitis with blood in women, which determine its varieties, are divided into non-infectious and infectious.
Infectious causes of disease development
In most cases, acute hemorrhagic cystitis of bacterial etiology occurs due to infection of the inner surface of the bladder with Escherichia coli, uropathogenic strains, Proteus bacilli, saprophytic staphylococcus, or opportunistic microorganisms Klebsiella oxytoca.
The pathogenesis of the lesion is due to the ability of Escherichia (representing the synanthropic intestinal flora, but with cystitis they find themselves in the urinary tract) to act as intracellular opportunistic pathogens. With the help of adhesion organelles, these microbes penetrate the cells and colonize the mucous membrane of the bladder and urethra. Here, they consume iron compounds extracted from cells and produce toxins that destroy red blood cells, which causes inflammatory reactions and a response from urothelial effector cells. What are other causes of cystitis with blood in women? The symptoms of the disease will be discussed below.
Often this pathology is caused by ureaplasmas, mycoplasmas, trichomonas, chlamydia, gardnerella, gonococci. Primary fungal cystitis is rare and is caused by therapy for bacterial cystitis: suppression of the commensal microflora of the vagina with antibiotics allows lactobacilli and Candida fungimultiply freely.
Non-infectious causes
Cystitis with blood in women of non-bacterial origin, according to urologists, can develop due to the presence of calculi in the bladder - especially urate stones with the development of uric acid diathesis - when the mucous membrane of the bladder is injured, and microdamages under the influence of excessively acidic urine become deeper. Many domestic doctors call such cystitis with blood in the urine ulcerative.
In addition, such types of hemorrhagic cystitis as radiation (radiation) or chemically induced are not associated with infectious tissue damage. Radiation inflammation of the bladder mucosa often develops after therapy for malignant neoplasms located in the small pelvis. In this case, the pathogenesis of the disease is due to the fact that irradiation provokes a break in DNA chains. In addition, radiation penetrates into the deep layers of the muscle fibers of the bladder, which reduces the impermeability of the vascular walls.
Chemically induced cystitis with blood in the urine in women is the result of intravenous administration of anti-cancer drugs - cytostatics, such as ifosfamide, cyclophosphamide, doxorubicin and bleomycin.
Hemorrhagic cystitis in women can develop when intravaginal agents enter the bladder through the lumen of the urethra. This can happen, for example, when douching with the drug "Gentian violet", intended for the treatment of vaginal candidiasis, as well as spermicidal agents, tofor example, such as Nonoxynol.
Hormonal failures
Another non-infectious reason for the development of this pathology in women can be hormonal disruptions in the body, taking oral contraceptives. The mechanism of the development of the disease in this situation is due to the fact that when the balance of hormones is disturbed, the composition of the microflora of the mucous membranes changes, and this leads to a weakening of the natural barrier against the penetration of pathogenic bacteria into the body. So the causes of cystitis with blood in women are very diverse.
Risk factors
The main risk factors for hemorrhagic cystitis are due to:
- decrease in immune defense;
- the presence of latent urogenital infections or oncological diseases in a woman's body;
- Urolithiasis and urinary stasis;
- thrombocytopenia (low platelets in the blood);
- non-compliance with asepsis rules during urological and gynecological manipulations;
- violation of genital hygiene.
Symptoms of disease
In most cases, the initial signs of the development of cystitis with blood in women are manifested in the form of pollakiuria - more frequent urge to urinate with a simultaneous decrease in the amount of fluid released. Almost simultaneously with this symptom, there is an addition of such a characteristic sign of an early stage of inflammation as multiple urges to empty the bladder (more often at night), as well as acute pain and burning at the end of the act.urination.
Other clinical manifestations
In addition, there are such clinical manifestations of hemorrhagic cystitis:
- pain in the pubic area;
- pain in the pelvis, radiating to the groin and lower back;
- turbidity and change in the smell and color of urine (from pink to bright red);
- may experience uncontrolled urination (urinary incontinence).
The patient's general condition worsens significantly - she develops severe weakness, reduced appetite, feverish syndrome and fever.
If at any stage of the pathological process the patient feels difficulty during urination, then this indicates tamponade - blocking the opening of the bladder with blood clots.
Diagnosis
Diagnosing cystitis with blood in women is usually easy. In this case, it is necessary to differentiate urethritis, acute cystitis and bladder diverticulum. Additional examination includes:
- performing a general urine test;
- Ultrasound of the bladder;
- cystoscopy;
- vaginal swabs for flora;
- urine culture.
Treatment of pathology
The main thing is to recognize the symptoms of cystitis with blood in women in a timely manner. Treatment should also be comprehensive. It is important to understand that the complete restoration of the mucous membrane of the bladder is possible only with the use of potent medications. It should be noted that the chances of a completerecovery increases with timely diagnosis of the diagnosis and the use of antibiotics of the appropriate sensitivity group. Late treatment of cystitis with blood in the urine in women and the appointment of drugs that only eliminate the symptoms of the disease without affecting the pathogenic environment can lead to the transition of a hemorrhagic disease into a chronic form.
The main task facing the specialist is the destruction of pathogenic microorganisms that have entered the cavity of the bladder and caused inflammation of the mucous layer.
Medications
The choice of means for antibacterial treatment of cystitis with blood in women is determined by such parameters as the severity of symptoms and the duration of the disease. In addition, the selection of drugs takes into account the likelihood of side effects, the presence of concomitant pathologies, etc.
In the acute form of cystitis, antibacterial drugs, antispasmodics, herbs with a diuretic effect are prescribed. With a pronounced pain syndrome, it is recommended to take drugs that relieve spasm of the muscle fibers of the bladder ("Papaverine", "Drotaverine"). They can be used both in the form of tablets and rectal suppositories. Applying a heating pad to the lower abdomen helps to eliminate severe pain.
Diuretic herbs such as bearberry, kidney tea, lingonberry leaf are widely used in acute cystitis with blood in women. There are also ready-made phytopreparations - Cyston, Canephron, Fitolizin. A prerequisite for a quick recovery is a plentiful warm drink.
One of the main means of combating the disease is the drug substance fosfomycin, on the basis of which the popular medicine for cystitis "Monural" is produced. It is a broad-spectrum antibiotic, which is a derivative of phosphonic acid. The drug has a bactericidal effect, the mechanism of which is due to the suppression of the synthesis of the bacterial wall. The medicine can be used simultaneously with other antibiotics.
Metronidazole is widely used in the treatment of cystitis with blood in the urine. It, along with the main antibiotic, can be prescribed intravenously or orally. The drug is an effective antiprotozoal and antibacterial synthetic medical preparation with a wide spectrum of effects. An antibiotic is selected as the main drug. Most often, they are some kind of cephalosporin medication - Ceftriaxone, Cefotaxime, etc.
Fluoroquinolones are very effective for cystitis, for example, Norfloxacin (Nolicin, Norbactin, Bactinor, Urobacil).
"Norfloxacin" is recommended to be taken within two weeks. It should be borne in mind that this drug for the treatment of cystitis with blood in women is contraindicated in kidney disease, pregnancy and epilepsy.
Consequences of this pathology
Main complications of hemorrhagic cystitis include:
- violation of urine outflow processes (as a result ofthe aforementioned tamponade via a blood clot), which can lead to the development of urosepsis, kidney failure and bladder rupture;
- damaged areas of the urothelium can become permeable to infections and provoke their entry into the systemic circulation;
- violation of the integrity of the vessels of the bladder can threaten severe blood loss and the occurrence of iron deficiency anemia, especially if the patient is diagnosed with chronic hemorrhagic cystitis;
- open ulcers on the inner surface of the bladder gradually heal, but scars form in their place, provoking sclerotic changes in the walls, deformation of the bladder and a decrease in its size.
Surgical intervention for this pathology
Surgical treatment is required for refractory hemorrhagic cystitis. In addition to cystoscopy with electrocoagulation, selective embolization of the hypogastric branch of the artery is possible. In some cases (with severe scarring of the walls and deformation of the bladder), a cystectomy (removal of an organ) is indicated. Surgical intervention is extremely rare, in most cases, cystitis with blood in women is cured with medication.
Folk methods
Methods of alternative medicine are appropriate not only after radiation therapy, but also as an auxiliary treatment for acute cystitis, prone to relapse. In the fight against blood in the composition of urine, decoctions of medicinal herbs, which must be taken in full, effectively help. Here are proven folk recipes:
- Chop dried parsley. Pour 1 tbsp. l. raw materials 2 tbsp. cold water. Infuse the composition for 8-10 hours, and then drink in several doses throughout the day.
- 1 tbsp l. lingonberry leaves pour 1 tbsp. boiling water, insist. Take orally half a glass 3 times a day before meals.
- Crush fresh cranberries to make berry puree to be consumed daily at breakfast.
