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Cystitis is an inflammation of the inner layers of the bladder (mucous and submucosal). In childhood, this disease affects girls more often than boys, which is explained by the peculiarities of the structure of the female genitourinary system. Their urethra is wider and shorter, and in the immediate vicinity of it is the anus, which is a frequent source of infection. Cystitis can be either an isolated pathology or combined with inflammation of neighboring organs: for example, cystopyelonephritis or cystourethritis.
The disease manifests itself mainly at the age of 4 to 12 years, it can also be diagnosed in infants. At the same time, up to 35% of children experience cystitis before they reach 9 years of age.
Do children get cystitis?
Many parents believe that cystitis is a disease of adults, and it cannot occur in a child, but they are mistaken. Problems with the urinary system, including cystitis, are very common in children. Moreover, cystitis can develop even in infancy for various reasons.
The human urinary system is represented by a pair of kidneys, each of which departs through the ureter. They, in turn, flow into the bladder. This organ is designed to collect urine and bring it out through the urethra.
The bladder itself is lined from the inside with a mucous membrane, which is richly permeated with nerve endings and blood vessels. Therefore, its inflammation cannot go unnoticed by attentive parents.
Causes of cystitis in children
Among the reasons leading to the development of the disease in a child include:
Bacteria entering the bladder. Most often, strains of Escherichia coli are sown. Somewhat less often, pathogens such as Pseudomonas aeruginosa, Staphylococcus epidermidis, Mycoplasma, Ureoplasma, Klebsiella, Proteus become a stimulant of the disease. The main route of infection with bacterial cystitis is ascending, that is, infectious agents enter the organ through the urethra;
Inflammation of the bladder as a result of the penetration of viruses into the child’s body. Adenoviruses, herpes, parainfluenza can provoke the development of the disease. Urologists believe that the presence of a viral infection in the body leads to disruption of the microcirculation inside the bladder and contributes to the development of inflammation, which is often accompanied by a bacterial component;
Entering the bladder of fungi. More often than others, fungi of the genus Candida are found in its cavity. Such cystitis affects children with immunodeficiencies, with abnormalities in the structure of the genitourinary system and those who are often and for a long time treated with antibiotic therapy;
The cause of the development of the disease can be neurodysfunction – the so-called “neurogenic bladder in children.” At the same time, there is a disorder in the filling and emptying of the organ, which is associated with a failure in the nervous regulation of this process;
Vesicoureteral reflux, in which there is a return flow of urine into the kidney;
Urethral stricture. At the same time, the internal lumen of the channel through which urine passes narrows, this causes urination disorders, which, in turn, provokes inflammation;
In boys, cystitis can occur as a result of phimosis, when exposure of the glans penis is impossible or very difficult due to a pronounced narrowing of the foreskin;
Diverticula of the bladder, in which there is a depression in its wall that communicates with the main organ through the canal. This also leads to a violation of urination, a complication of which is cystitis;
Any violations of the protective properties of the bladder, which is often observed with dysmetabolic failures. A common cause of cystitis in this case is dysmetabolic nephropathy in children, when both the structural and functional capabilities of the kidneys are impaired;
Invasive urological examinations that the child has undergone, for example, cystoscopy, cystography, etc.;
Taking certain medications, for example, sulfonamides, cytostatics, etc .;
Gynecological diseases from which the girl suffers. Vulvitis or vulvovaginitis can provoke cystitis;
Any purulent-inflammatory processes in the body of a child can lead to the development of cystitis. These factors include tonsillitis, staphyloderma and streptoderma, pneumonia, omphalitis;
Helminthiases, which are widespread in childhood. In this case, parasites (mainly at night) crawl out of the anus, often penetrate into the bladder and bring the infection there;
Multiple intestinal infections;
Appendicitis can cause the development of cystitis, but this happens if the appendix is located in the pelvic floor;
Dysbacteriosis of the intestine or vagina;
The presence of a tumor either in the bladder or in the urethra;
Disorders in the work of the endocrine glands, in particular, diabetes mellitus;
Failure to comply with the rules of personal hygiene;
Hypovitaminosis;
Changes in the acid-base balance of urine.
In addition to the above reasons that lead to the direct development of cystitis in children, there are some provocative factors. Under the condition of their influence, the disease will occur with a greater probability.
These factors include:
Overwork;
Exhaustion;
hypothermia;
Chronic constipation;
Low physical activity, especially prolonged immobilization;
Decreased immunity against the background of previous diseases;
Secondary immunodeficiency;
The presence of infection in parents;
Access to swimming pools and saunas.
Ways of penetration of infection into the bladder are also varied. The most common route of infection is ascending, when microorganisms rise from the anogenital zone or from the urethra through the urethra to the bladder. A descending route of infection is also isolated, when infectious agents enter the organ from the kidneys through the ureter. The hematogenous path (from other sources of inflammation in the blood), lymphogenous (through the lymphatic pathways) and traumatic (through the damaged wall of the organ) are also not excluded.
Is the risk of developing cystitis the same for all children?
If we consider children of the first year of life, then the risk of developing this disease is approximately equal in girls and boys. In preschool and adolescence, cystitis predominantly affects female children. At the same time, the incidence of the disease increases by 6 times compared with boys of the same age.
These data are quite understandable and are determined by the structural features of the female urinary system. In addition to the fact that the channel through which urine passes is shorter, both the anus and the vagina are located very close. This greatly facilitates the entry of infection into the cavity of the bladder in an ascending way.
It is noticed that the disease appears more often in those children who have a predisposition to it. Among the risk factors, various diseases and pathological conditions are noted that contribute to a more successful consolidation and development of infection in the organ.
The most dangerous in this regard are:
Urolithiasis disease;
Avitaminosis;
Colitis, dysbacteriosis, pancreatitis, enteritis in a chronic form;
Infectious diseases that reduce immunity, as well as diabetes in childhood;
All congenital malformations of the genitourinary system.
There are also additional risk factors that affect the incidence of cystitis in children. For example, girls who violate the rules of personal hygiene, use too much soap and gels for washing, suffer more often. The risk group includes children who have undergone surgery, had trauma to the genitourinary system, as well as those who take significant amounts of certain drugs (urotropin, drugs that depress the immune system, etc.). The presence of foreign bodies in the bladder also has an effect, for example, it can be stones.
Symptoms of cystitis in children
It is necessary to differentiate the symptoms of the disease in children up to a year and after, since at a younger age they express their anxiety in a different way.
Among the symptoms that should alert the parents of a child up to a year are the following:
The child cries for no apparent reason;
The kid is excessively irritable and shows anxiety even in a dream;
Urination is either too frequent or, on the contrary, too rare;
There may be an increase in body temperature, although this does not always happen;
Urine turns an unnatural dark yellow color.
Symptoms of the disease in children after a year are somewhat different. Cystitis, as a rule, develops rapidly and rapidly.
Among the main clinical manifestations:
Urinary syndrome, which manifests itself in frequent desires to empty the bladder. The child either involuntarily urinates in his pants, or goes to the toilet every 20, and sometimes 10 minutes. Such a disorder is due to the fact that the mucous membrane of the bladder, as well as all the nerve endings connected to it, are irritated and inflamed;
The child experiences pain in the pubic area and above it, can report this to parents. Often, pain is given to the perineum and becomes more intense with palpation of the inflamed area. Also, the pain tends to increase when the bladder fills even slightly;
Despite the frequent urge to urinate, emptying the bladder is quite problematic. This is due to the fact that urine does not have time to accumulate in the proper volume, and the irritated mucous membrane of the organ requires emptying again and again. Each release of even a small portion of urine is accompanied by cuts and pains;
Urinary incontinence may occur;
terminal hematuria. This symptom is characterized by the fact that at the end of the act of urination, a few drops of blood are released from the urinary canal;
Urine itself acquires a dark color, becomes cloudy. Flakes and sediment may be found in it. This is clearly seen if the liquid is collected in a transparent glass vessel. If the child suffers from hemorrhagic cystitis, then the urine acquires a color similar to the color of meat slops;
Urine with cystitis acquires a sharp, unpleasant odor;
In some cases, there may be an increase in body temperature.
Acute and chronic cystitis in children
Just like an adult, a child can suffer from acute and chronic cystitis. Their leading difference is that chronic cystitis occurs with a certain frequency and it is much more difficult to get rid of this form of the disease.
Acute cystitis in children
Manifests the disease with the fact that the child begins to behave restlessly. Then there is a full range of dysuric symptoms: pollakiuria, urine output in small portions, pain when emptying the bladder. There are pains in the suprapubic region, both night and daytime urinary incontinence may appear.
To recognize acute cystitis in a very young child, it is important for parents to notice how he passes the process of urination. As a rule, the child screams a lot, and after that the diaper becomes wet. It can be seen that the color of the urine changes, it becomes more cloudy, and some mucus may also be found in it. Gross hematuria is a sign of hemorrhagic cystitis.
It is worth knowing that acute cystitis in children can proceed in different ways. Sometimes a child suffers a mild illness, after 3 days everything goes away on its own. In some cases, cystitis is extremely difficult. Signs of general intoxication of the body join, fever is observed. Most often, this course of the disease is characteristic of the spread of the pathological process to the kidneys with the development of pyelonephritis. If, against the background of adequate therapy, there is no noticeable improvement in the condition after 5 days, then it is extremely necessary to visit a urologist and conduct more serious studies: cystography, cystoscopy, intravenous urography, etc.
Chronic cystitis in children
As for the chronic form of the disease, it mainly develops against the background of inadequate therapy for acute cystitis. Congenital or acquired diseases of the urinary system, for example, circulatory disorders in the pelvic organs, crystalluria, etc., can contribute to the chronicity of the pathology. Immunodeficiencies, infectious and somatic diseases aggravate the situation.
If we consider the clinical manifestations of the chronic form of the disease, then they can be both latent and acute recurrent. Most often, chronic cystitis is a secondary disease, in which the symptoms of the acute form prevail.
Usually, the disease recurs after hypothermia of the body or due to the occurrence of an intercurrent infection, that is, one that joins by chance. In most cases, children complain of one or two clinical symptoms during an exacerbation of the disease – pollakiuria or urinary incontinence.
Doctors note that most children suffering from chronic cystitis have vesicoureteral reflux. About 92% of children in addition to this suffer from pyelonephritis.
Diagnosis of cystitis in children
If the parents have even the slightest suspicion that the child develops cystitis, it is urgent to see a doctor. Self-diagnosis and treatment are unacceptable, only a specialist should deal with this problem.
As diagnostic methods to determine cystitis in a child, the following are used:
Urine culture and antibiogram;
Urine sampling for general analysis;
Blood sampling for general analysis;
Urine sampling for biochemical analysis;
Carrying out ultrasound examination of the kidneys and bladder;
Differentiation of acute cystitis from appendicitis, vulvovaginitis, phimosis, balanitis and paraproctitis.
As it becomes clear, the main biological material that is donated to detect the disease is urine. Therefore, it must be able to collect it correctly.
How to collect urine from a child for analysis?
The accuracy of the diagnosis, and hence further treatment, depends on how correctly the parents collect urine from the child.
For this, the following rules must be observed:
The collection container must be sterile. You can buy special cups at the pharmacy. If this is not possible, then any glass container is suitable, which is pre-washed with warm water and soda, and then sterilized by boiling for 10 minutes;
For analysis, it is best to take an average portion of urine. That is, the child begins to urinate, and only after a few seconds you can bring a jar, and then remove it without waiting for the end of the act of urination. But since in infants it can be quite problematic to collect the average portion, then you need to take what you managed to collect for analysis. The average portion is optimal, so less bacteria from the external genitalia and leukocytes from the same get into it;
Equally important is the hygiene of the child’s genitals before starting to collect urine for analysis. To do this, the girl must first be washed with soap. The direction of movement should be from the perineum to the anus. As for boys, they need to thoroughly rinse the cavity of the foreskin that surrounds the head of the penis;
When urine is collected, it is advisable to deliver it to the clinic within an hour. If this is not possible, then the collected analyzes should be refrigerated. The maximum storage period is one day.
Treatment of cystitis in children
Treatment of a disease in an acute form does not always require hospitalization. In an uncomplicated form of the disease, the child is observed by a doctor on an outpatient basis, and receives the main therapy at home. It is important during the treatment period to prevent hypothermia of the body, it is recommended to warm up. Dry heat is applied to the area of the bladder. However, for warming up, it is forbidden to put the child in a hot bath. This is due to the fact that excessively high temperatures will increase the blood supply to the diseased organ and aggravate the disease. If the doctor recommends warming the child in the bath, it is important that the temperature in it does not exceed 37,5 ° C. The child should be in the bath in a sitting position. As for dry heat, salt is heated in a frying pan for this purpose, then it is wrapped in a dense cloth and applied to the suprapubic region. It is important to prevent burns of the skin, so several layers of tissue are applied to the treatment area.
Equally important to speed up the healing process is diet. It is imperative to exclude all spicy dishes, as well as hot spices. It is recommended to fill the diet with fruits and vegetables; from drinks, fruit drinks based on cranberries and lingonberries contribute to the disinfection of the bladder. Dairy drinks and products are no less useful.
For therapeutic purposes, the child is prescribed the use of mineral waters. In this case, the dosage for a child weighing 20 kg will be 100 ml at a time (calculation: 5 ml per 1 kg of body weight). Multiplicity of mineral water intake – 3 times a day. It is better if the child will drink a portion of water about an hour before meals. It is important that the mineral water used for treatment does not contain gases.
When a child is prescribed antibiotic therapy, heavy drinking should be avoided. This is due to the fact that the concentration of drugs in the urine will decrease. This situation, in turn, adversely affects the effectiveness of the treatment. However, it is worth making sure that the child visits the toilet and empties the bladder at least once every three hours. This is a prerequisite for treatment.
Drug treatment is reduced to taking the following drugs:
Protected penicillins, such as Augmentin, Amoxiclav;
Can be selected drugs from the group of cephalosporins – Ceclor, Tazicef, Cedex, Zinnat;
Combined sulfonamides – Co-trimoxazole;
Derivatives of phosphonic acid, for example, Monural;
In adolescence, fluoroquinolones may be prescribed;
Uroseptics are used for uncomplicated forms of the disease;
To eliminate a pronounced pain syndrome, antispasmodics, such as No-shpa or Papaverine, are indicated. However, it is first necessary to exclude acute surgical pathology.
Treatment with antibacterial agents should last at least a week. But the effect should be assessed after two days. If there is no improvement, advanced diagnostics are needed. For this, a control ultrasound is performed, as well as cystoscopy.
If the disease has dragged on and turned into a chronic form, then a consultation with a urologist is mandatory. He will prescribe a three-component treatment. Firstly, inflammation in the organ is neutralized by creating the maximum concentration of a suitable antibacterial agent in the bladder. Secondly, violations of the functional ability of the organ are eliminated. Thirdly, conditions are created to improve all bioenergetic processes in the bladder wall. Treatment in this case is based on the general principles of chronic cystitis therapy, but is selected individually for each child.
It is impossible to carry out antibiotic therapy of chronic cystitis in children without obtaining the results of a bacteriological study. It determines to which drug the pathogenic microflora that caused the disease is sensitive. However, antibiotics should not be used unless there is a reason. It is important to use the funds appropriately when the chronic form of the disease worsens. At the same time, it should be accompanied by dysuric symptom complexes and an increase in body temperature. If the state of health remains normal, but at the same time there are frequent urge to urinate, pain in the pubic area, then treatment is possible only with the use of uroseptics. The course of antibiotic therapy in the chronic form of the disease can be extended up to 10 days. As a rule, children who have a history of diabetes mellitus or a recent urinary infection take antibiotics for two weeks. Therapy can be stopped when the urine culture is sterile and the clinical manifestations of the disease disappear.
Schoolchildren who suffer from chronic granular cystitis are shown installations of a diseased organ using potent local antiseptics. Among them is Miramistin solution, 2% protargol solution. However, installations are used when long-term therapy using multiple drugs does not give the desired effect.
As for school absences, the child will be able to attend classes 3 weeks after the onset of the acute stage of the disease. At the same time, physical education is limited to at least a month. As an important recommendation – the refusal to swim in open water for the entire coming year. If possible, the child should undergo sanatorium treatment without leaving their climatic zone. Visiting other countries is recommended no earlier than one year later. During attacks of exacerbation of cystitis, the child is prescribed herbal medicine, for this he is given infusions of medicinal herbs. However, a doctor should recommend them. The most popular are chamomile, St. John’s wort and horsetail.
As for physiotherapeutic procedures, they are possible after the symptoms of an acute inflammatory process subside.
The most effective in this regard gives:
Magnetotherapy on the suprapubic area. This contributes to the activation of blood flow in the damaged organ, starts the work of inactive vessels, helps to reduce the transmission of nerve impulses from the diseased bladder, which, in turn, reduces pain;
Electrophoresis using antibacterial and antiseptic drugs, which reduces inflammation;
Treatment with microwave electric fields that improve blood flow and accelerate metabolism.
Uncomplicated cystitis is treated by a pediatrician. In other cases, it may be necessary to consult more specialized specialists, such as a pediatric urologist or nephrologist, a pediatric surgeon, and a gynecologist.
As for the prognosis for recovery, with adequate therapy, in most cases it is favorable. To completely get rid of the disease, as a rule, a weekly course is enough. The chronic form of cystitis most often occurs when ignoring the symptoms of the disease, refusing to visit a doctor, self-medicating, and also if the child has anatomical and functional disorders of the genitourinary system.
Since the disease can lead to serious complications (perforation of the bladder wall, peritonitis, pyelonephritis, paracystitis, etc.), not only timely diagnosis and treatment of the disease is important, but also prevention. In childhood, these activities are reduced, first of all, to the timely elimination of constipation, as they disrupt the blood supply to the bladder. In addition, parents should be attentive to the hygiene of the baby. It is important to wash children up to a year after each act of defecation, to wipe it only with a personal towel. Older girls and boys need to be taught how to take care of themselves. In addition, you should carefully monitor your body temperature and avoid hypothermia. Compliance with these simple rules will prevent the development of such a serious disease in a child as cystitis.