Cystitis with blood: causes, symptoms, diagnosis

Inflammation of the bladder is characterized by frequent and painful urge to urinate. Sometimes you can observe cystitis with blood that appears at the end of the urination act, or is simply present in the urinary fluid, staining it in a reddish or pinkish hue. In the first case, we are talking about acute cystitis, and in the second case, about a more complex problem - hemorrhagic cystitis.

Epidemiology

According to statistics, cystitis with blood is found more often in female patients. This is mainly due to anatomical, physiological and hormonal reasons.

In our country, several million cases of inflammation of the bladder are recorded annually. The disease was diagnosed at least once in a lifetime in 25% of women and 5% of men. In every third patient, cystitis occurs with relapses, and in 10% of cases, acute cystitis with blood becomes chronic.

Hemorrhagic cystitis is often found in children or young people between the ages of 25 and 30, or in women over 55 years of age. Blood in the urine is determined mainly in acute or recurrent cystitis.

Causes of the cystitis with blood

• True cystitis with blood (hemorrhagic) is often the result of an adenovirus infection that penetrates from the blood into the urinary system. A similar pathology is diagnosed mainly in children - especially in boys.
• Blood in the urine may appear during treatment with cytotoxic drugs, which in the human body are converted to acrolein, a component that irritates the inner walls of the bladder.
• Cystitis with blood can be the result of radiation therapy.
• The appearance of blood in women is often associated with microbial lesions - for example, when E. Coli enters the urethra and bladder.

Cystitis with blood occurs under the influence of any cause that can injure or damage the internal mucous tissue of the bladder. In this case, the blood vessels are exposed and blood exits into the lumen of the organ. [1]

The following categories of patients are most at risk of developing cystitis with blood:

• sexually active women and men, especially with an abundance of casual sex;
• patients using specific contraceptive methods - for example, membranes with spermicidal substances;
• women who are in the menopausal period;
• patients who use urinary catheters for a long time or periodically.

Risk factors

Specific factors contributing to the appearance of blood in cystitis can be:

• decrease in the contractile function of the muscles of the walls of the urinary organ;
• the ingress of foreign bodies into the urethra - for example, stones or sand, which damage the mucous tissues and cause an inflammatory process;
• prolonged absence of bladder emptying, which causes circulatory disorders in the organ;
• anatomical disturbances in the excretion of urinary fluid - for example, a narrowed lumen of the bladder, tumor processes.

Pathogenesis

The penetration of a bacterial or viral infection into the urinary system can be carried out in different ways:

• ascending path (it is also urethral, that is, through the urethra);
• hematogenous route (infection comes with blood);
• lymphogenous route (infection enters through the lymphatic vessels).

In women, urethral infection most often dominates, and in children - hematogenous.

An important condition for the development of microbial cystitis with blood is the attraction of pathogenic microorganisms to urothelial cells with their further invasion.

The urothelium is capable of producing and secreting a mucopolysaccharide substance on the walls of the bladder, which forms its internal defense. This substance in its own way can play an anti-adhesive role. The attraction of infection to urothelial cells occurs as a result of damage or modification of the mucopolysaccharide defense: this can be explained by impaired blood circulation in the organ, an increased content of receptors for microbial adhesion. Mechanical injuries of the bladder are also possible, which lead to the exposure of blood vessels and the release of blood into the urinary fluid. [2]

Symptoms of the cystitis with blood

The first signs of cystitis are not at all manifested by the release of blood in the urine. Most often, the following symptoms are found:

• strong and sudden urge to urinate;
• falsity and increased urges;
• a strong burning sensation during the excretion of urine;
• pronounced urge against the background of a small amount of urinary fluid;
• cloudy urine, change in odor;
• feeling of discomfort and pressure in the lower abdomen;
• a slight increase in temperature - up to about 37, less often - up to 38 ° C.

In young children, acute cystitis with blood is often manifested by urinary incontinence, fever, loss of appetite, and sleep disturbance.

An acute attack of cystitis with blood, accompanied by symptoms of intoxication (rapid heartbeat, vomiting, significant fever, chills) is usually typical of a fibro-ulcerative or gangrenous form of the disease. Such forms often develop in patients with obvious immunodeficiency, or with a complication of pyelonephritis.

Blood in chronic cystitis can be detected only during an exacerbation. Additional symptoms are general anxiety, painful palpation in the suprapubic area. [3]

Cystitis with blood in women

Cystitis in women happens often, and even sometimes acquires a chronic course. The reason for this is self-treatment, a frivolous attitude to the disease, ignoring a visit to the doctor. Other reasons may be:

• a sharp weakening of the immune system;
• sedentary lifestyle, prolonged sitting position, prolonged retention of urine in the bladder;
• the use of sweets, spicy and fried foods, low fluid intake;
• untreated gynecological problems;
• constant stress, chronic fatigue;
• non-compliance with the rules of personal and intimate hygiene;
• promiscuous sex life, unprotected sexual contacts.

The risk of an inflammatory process is significantly increased if a woman:

• practices combined anal-vaginal intercourse;
• wiped after defecation not from front to back, but vice versa;
• regularly uses pads or tampons (including daily ones) and rarely changes them;
• wears underwear made of synthetic dense fabrics;
• often tries to suppress urination.

Especially often in women, the disease develops against the background of hormonal changes - for example, with the onset of menopause, or during pregnancy.

Cystitis with blood during pregnancy

The inflammatory process makes itself felt during pregnancy quite often, and there is an explanation for this. First, the uterus enlarges and puts pressure on the ureters and bladder. This causes a violation of blood circulation in the organs, prevents an adequate outflow of urine, and contributes to the development of a bacterial infection. Secondly, in pregnant women, the quality of immune protection decreases: the body does this on purpose so that the uterus does not reject the baby, mistaking new tissues for a foreign body. Thirdly, strong hormonal changes also contribute to the development of the disease.

If a woman has previously had problems with the urinary tract, then during pregnancy they are likely to worsen.

It should be noted that cystitis with blood in a pregnant woman requires a special and serious attitude. Hoping that “it will pass by itself” and drinking only cranberry juice is at least unreasonable. Seeking medical help should be not only mandatory, but also immediate. If timely high-quality treatment is not carried out, then the risk of spontaneous abortion, premature birth and impaired intrauterine development of the baby increases.

Blood with cystitis in a child

Inflammation of the bladder is the most common infection of the urinary system, which occurs in pediatric and pediatric urological practice. The disease occurs in children of all ages, but is approximately 4 times more common in girls aged 4-12 years. This trend in incidence is associated with the features of the anatomy of girls: wide and short urethra, close proximity to the anus, etc.

Blood in the urine can be observed with an isolated or combined inflammatory process (for example, with cystourethritis, cystopyelonephritis).

When carrying out bacterial culture of urinary fluid in children, predominantly uropathogenic strains of Escherichia coli are sown, less often - Proteus, Klebsiella, Pseudomonas aeruginosa, Staphylococcus epidermidis. In about one in four cases, bacteria in the urine are not detected diagnostically.

Acute cystitis in childhood most often ends in recovery. The chronic form of the disease develops in the presence of anatomical functional prerequisites for delaying and multiplying the infection. Children with a chronic form should be under the supervision of a urologist, regularly give urine for tests and be examined.

Blood with cystitis in men

Cystitis is not as common in men as in women. However, not many people know that inflammation in male patients is more severe, with severe symptoms and blood in the urine. Moreover, the disease is mainly associated with a problem in the prostate.

The disease can develop after the microbial pathogen Escherichia coli, which normally “lives” in the intestine, enters the urinary tract. But cystitis is more often secondary, since the prostate gland first becomes inflamed. The urethra narrows, the bladder is not completely emptied, which leads to an increase in the likelihood of developing an infectious process.

Treatment of the disease in men involves a primary impact on the inflammatory response in the prostate, after which drug therapy for cystitis is prescribed - in particular, antibiotics are required. In addition, it is necessary to follow a diet, drink plenty of fluids: this allows you to speed up the removal of bacteria from the urinary system and potentiate the healing of damaged tissues.

Cystitis with blood after intimacy

This kind of disease is called postcoital, since inflammation develops throughout the day after sexual contact. In this case, sexual intercourse becomes a provoking factor in the painful process.

There may be several reasons:

• too rough sex, or an insufficient amount of natural lubrication leads to damage to the tissues of the genital organs and urethra;
• diseases of the genital area that cause pain during sexual contact;
• a low level of sex hormones in the female body (in particular, estrogen);
• frequent and promiscuous sexual intercourse;
• combination of anal and vaginal intercourse.

Also, the “culprits” may be the anatomical features of the genital organs - for example, if the distance between the urethra and anus is less than 4.5 cm.

Radiation cystitis with blood

During the treatment of oncology, most patients undergo radiation therapy. The difficulty lies in the fact that, in addition to the malignant focus, other, healthy organs are also exposed to radiation. Among them is the bladder: the rays affect its tissues, which causes the development of radiation cystitis.

If the urothelium, the natural protective layer of the bladder, is damaged, the elements of the urinary fluid begin to irritate the mucous tissue, affecting the exposed nerve endings. With long-term radiation therapy, the urothelium can become covered with ulcers, which further aggravates the situation. Ulcers begin to bleed, blood appears in the urine.

With such a problem, intravesical treatment often becomes the only right solution: hyaluronate or sodium alginate, chondroitin sulfate are prescribed, that is, substances that can restore the protective layer and correct autoimmune reactions.

Radiation cystitis with blood is a serious complication of a specific type of therapy. However, you should not despair: modern remedies can help the patient and cure the insidious disease. [4]

Complications and consequences

If, after the first signs of cystitis with blood, the treatment followed quickly and turned out to be competent, then complications in this case develop extremely rarely. But if the treatment is not timely, the condition may worsen with the development of serious and adverse consequences. [5]

The most likely complications include, first of all, pyelonephritis - an infectious inflammatory lesion of the kidneys. The infectious process from the main focus of inflammation - the bladder - is transported to the kidneys in an ascending way, which leads to pyelonephritis or even to irreversible changes in the tissues of the kidneys.

Young children and the elderly have the highest risk of kidney damage due to infectious cystitis. And regular and even more prolonged hematuria most often leads to the development of anemia, with symptoms characteristic of this condition: dizziness, the appearance of dark circles under the eyes, pallor of the skin, weakness, fatigue, etc. [6]

Diagnostics of the cystitis with blood

The first diagnostic stages that the patient will have to go through at the doctor's appointment are a survey and a physical examination. Only after listening to the patient's complaints, examining him for external pathological signs, the doctor will be able to recommend certain laboratory tests and tests, for example:

• a general urine test helps to identify leukocyturia, erythrocyturia, as well as nitrites, indicating the presence of a bacterial infection in the urinary system;
• a urine test for sterility is performed if infectious processes in the urea are suspected and helps to identify the type and number of pathogenic microorganisms;
• a general blood test for cystitis demonstrates nonspecific inflammatory changes and is able to give an indirect idea of the presence and severity of the infectious process in the urinary tract.

Blood in the urine with cystitis is not necessarily detected only by laboratory methods: sometimes it can be seen on its own - for example, at the end of the urination act (the so-called "last drops" of urine). Often the urinary fluid turns reddish or pinkish, which also indicates the presence of blood in it. It is especially dangerous if the color becomes red or "rusty", strands and clots appear, which indicates the presence of a large amount of blood in the urine. [7]

Leukocytes in cystitis in the blood are considered one of the markers of the inflammatory process in the body. The main function of these cells is to counteract the penetration of viruses, bacterial infection. The presence of inflammation can be indicated by both a strong increase in the level of leukocytes and a significant decrease in their number.

Instrumental diagnosis usually includes cystoscopy, abdominal radiography, or ultrasonography of the retroperitoneal organs. If necessary, radiography with contrast, cystography or intravenous urography is prescribed.

The use of a cystoscope is sometimes associated with taking a small piece of tissue (biopsy) for further histological examination.

Differential diagnosis

Differential diagnosis is usually directed to the exclusion of secondary cystitis, and the likelihood of developing such primary diseases as bladder stones, tumor processes, neurogenic urinary dysfunction, and preinvasive cancer. In addition, it is necessary to separate special forms of inflammation (for example, the tuberculous type), to determine the stage and extent of the pathological reaction in the urinary system. [8]

Treatment of the cystitis with blood

Before prescribing therapeutic measures for cystitis with blood, the doctor must conduct a diagnosis in order to obtain the most complete information about the condition of the bladder, to assess the need for specific and long-term treatment.

Mandatory drug therapy is prescribed:

• antibiotics (according to the results of bacteriological examination of the urinary fluid);
• amitriptyline (one of the basic representatives of tricyclic antidepressants, capable of normalizing mast cells, increasing the working capacity of the bladder, reducing the severity of symptoms, calming);
• antihistamines (stabilize mast cells, reduce swelling and the severity of the inflammatory process).

Among other drugs that may be included in the treatment regimen for cystitis with blood, one can name the following:

• Uristat (Phenazopyridine);
• preparations of the nitrofuran series;
• non-steroidal anti-inflammatory drugs;
• opioids;
• drugs to improve microcirculation and metabolic processes.

Prevention

For preventive purposes, the following rules and principles are recommended:

• strict observance of the rules of personal and intimate hygiene;
• timely correction of anatomical defects of the urinary tract, if there are indications for this;
• timely treatment of gynecological problems, genital infections (treatment is carried out simultaneously for both partners), urological diseases;
• compliance with sexual hygiene;
• quality control of the microflora, both in the intestines and in the vagina, especially with prolonged use of antibiotics or when using spermicidal agents;
• timely emptying of the bladder, drinking enough fluids (prevention of dehydration);
• obligatory act of urination immediately after sexual intercourse (postcoital prophylaxis for persons with constant exacerbations after sexual intercourse).

Forecast

For preventive purposes, the following rules and principles are recommended:

• strict observance of the rules of personal and intimate hygiene;
• timely correction of anatomical defects of the urinary tract, if there are indications for this;
• timely treatment of gynecological problems, genital infections (treatment is carried out simultaneously for both partners), urological diseases;
• compliance with sexual hygiene;
• quality control of the microflora, both in the intestines and in the vagina, especially with prolonged use of antibiotics or when using spermicidal agents;
• timely emptying of the bladder, drinking enough fluids (prevention of dehydration);
• obligatory act of urination immediately after sexual intercourse (postcoital prophylaxis for persons with constant exacerbations after sexual intercourse).