Pain in the bladder is observed with various types of cystitis, paracystitis, acute urinary retention, malacoplakia, cysts, benign and malignant tumors, traumatic injuries and foreign bodies of the bladder. It can be strong, weak, dull, sharp, cutting, aching, stabbing. Often combined with pain in the lower abdomen, urination disorders, changes in urine. The cause of the symptom is determined on the basis of complaints, examination data, laboratory and hardware techniques. Treatment is carried out using antibiotics, NSAIDs, analgesics, physiotherapy. According to indications, catheterization is performed, operations are performed.
Why does the bladder hurt
Cystitis
Cystitis is a large and diverse group of pathologies. More often it is infectious in nature, provoked by opportunistic bacteria. Less commonly, the disease is caused by fungi (candidiasis cystitis) and pathogens of STIs: chlamydia, trichomoniasis, mycoplasmosis, etc. Sometimes inflammation develops without the participation of microbes, it becomes the result of chemical, mechanical or radiation irritation of the mucosa. There are the following types of cystitis:
- Spicy. Pain in the bladder is given to the anus and perineum, combined with frequent imperative urges, the release of small portions of cloudy urine, pain at the end of urination. With the spread of inflammation to the neck of the organ, the pain becomes strong, constant, urinary retention or incontinence is possible.
- Postcoital. A variant of acute cystitis with short-term episodes potentiated by sexual contact. It is observed in girls who have just begun to live sexually, in women after complicated childbirth. Symptoms appear within the first days after intercourse. Soreness over the pubis, a feeling of fullness, false urges, discomfort, pain and burning during urination are noted.
- Chronic. With exacerbations, the same symptoms are found as with acute cystitis. The pain is constant or appears during urination (sometimes only at the end or at the beginning). Violations persist for several weeks, then disappear, and after a while appear again. The diagnosis is made with 2 exacerbations during six months or 3 during the year.
- Interstitial. Non-infectious variant of chronic progressive inflammation. There is no pain in the early stages. Subsequently, there is increasing pain in the projection of the detrusor with irradiation to the perineum, vagina, sacrum. When the bladder is full, the pain intensifies, after the discharge of urine it weakens or disappears. There are cramps, dysuria, nocturia, frequent urges.
- Trigonite. Metaplasia of the cells of the bottom of the bladder is often asymptomatic, with the addition of inflammation, periodic dull, aching, pulling pains, urgent urges, a feeling of incomplete emptying, burning, cramps during urination are determined.
The clinical manifestations of cystitis differ somewhat depending on the age and sex characteristics of patients, the presence of certain physiological conditions, accompanied by changes in the endocrine background. The following flow options are possible:
- Among women. Due to the short urethra and the proximity of the genitals, women of childbearing age are diagnosed with pathology more often than men. As a rule, it is provoked by hypothermia, exacerbations are noted mainly in the cold season.
- In children. Occurs against the background of insufficient hygiene, hypothermia, violations of the structure of the urinary tract. It is characterized by rapid development and rapid course with pain in the bladder radiating to the perineum, urination after 10-2 minutes, pain, false urges, terminal hematuria.
- In pregnant women. It is first detected or aggravated during the gestation period. Accompanied by pain of varying intensity when passing urine, pain above the pubis, aggravated by palpation, clouding of the urine. With postpartum cystitis, urinary retention is often observed.
- With a climax. It is formed against the background of hypoestrogenism, mucosal atrophy and deterioration of metabolic processes. It is manifested by constant aching pains in the lower abdomen, increased urges, pain and severe pain at the end of urination. Typically relapsing course.
- In men. Patients older than 4 years with infravesical obstruction are more likely to suffer. The pain extends to the groin, penis and scrotum. Along with other symptoms of cystitis, pain, burning and pain in the urethra at the beginning and end of urination are detected.
- Prostatocystitis. It is determined mainly in men of the older age group who underwent surgery on the prostate and urinary tract. It has a wide variety of symptoms. Patients are concerned about pain in the external genitalia, perineum, bladder. Dysuria, lethargy of the jet, and sometimes incontinence with urgent urges are noted.
A special type of inflammation is radiation cystitis, which develops against the background of radiation therapy for malignant tumors of the small pelvis. The acute variant occurs immediately or within a few weeks after treatment. Shows typical symptoms. The chronic form of the pathology is characterized by intense pain in the area of the bladder, constant dysuria, urge after 10-15 minutes, cramps, persistent incontinence, recurrent gross hematuria.
Paracystitis
Inflammation of the perivesical tissue develops against the background of iatrogenic injuries, operations, diseases of the pelvic organs. Patients with paracystitis complain of unbearable, extremely sharp pain over the womb. General hyperthermia, intoxication syndrome, painful urination are noted. Sometimes there is swelling above the pubis. When the abscess breaks into the bladder, urine with pus leaves, the condition improves.
Pain in the bladder
Urolithiasis disease
Pain in cystolithiasis is caused by trauma to the walls of the detrusor with calculi. Painful sensations increase sharply, become acute, extremely intense when urinating, changing posture, movements. Possible irradiation to the thighs, vulva, perineum. During the migration of stones, pain and pain are supplemented by a delay or interruption of the urine stream. If the calculus gets stuck in the cervix, incontinence is possible.
Acute urinary retention
Occurs against the background of urolithiasis, urethral strictures, diseases of the prostate gland. Pressing pain and swelling in the bladder, strong urges with impossibility of urination are observed. There is a sharp increase in pain with pressure in the suprapubic region. Patients with AUR are restless, are in a characteristic half-bent position.
Cysts and tumors
Discomfort, dull aching pains in the lower abdomen and the navel area appear with large urachus cysts, accompanied by a feeling of incomplete emptying and frequent urination. When the cyst breaks into the bladder, signs of acute cystitis are found. Benign detrusor tumors are asymptomatic for a long time or are accompanied by dysuria and hematuria. When inflammation is attached, the clinical picture is supplemented by pain in the perineum and above the womb, which intensifies at the final stage of urination.
With leukoplakia, constant aching pain is combined with pain, difficulty urinating, imperative urge, incontinence. With the involvement of the neck, a total lesion, the pain becomes pronounced, intense. In 10-20% of cases, cancer is detected in patients with leukoplakia. With carcinoma of the bladder, the onset of pain is preceded by hematuria. At first, the pains bother only when the detrusor is filled, then they become constant, sharp, unbearable, they radiate to the sacrum and groin.
Trauma and foreign bodies
With intraperitoneal ruptures, acute intense pains in the suprapubic zone are determined, which then spread to the entire abdominal cavity, supplemented by muscle tension, stool and gas retention, nausea and vomiting. With retroperitoneal injuries, a painful swelling over the bosom is revealed in combination with false urges. Victims with bladder injuries often develop traumatic shock.
Foreign bodies of the detrusor are asymptomatic or accompanied by pain and pain in the lower abdomen. The pain is aggravated by movement. There is hematuria, ischuria, or frequent painful urination. When infected, pyuria is possible.
Other reasons
In some cases, pain in the bladder is noted with the following urological and gynecological pathologies:
- cystocele;
- malacoplakia;
- shriveled bladder.
Sometimes pains in combination with painful sensations are found in mental disorders: hysteria, neurasthenia, psychotic states.
Diagnostics
Diagnostic measures are carried out by a urologist. The specialist interviews the patient to establish the circumstances and the moment of occurrence of pain and pain, the presence and nature of other symptoms, changes in the clinical picture over time. In case of emergency pathologies (AUR, paracystitis, injuries), an external examination of patients with an assessment of the general condition and identification of characteristic symptoms is of great importance.
In other cases, useful data can be obtained by examination and palpation of the abdomen, but they are usually nonspecific. To determine the etiology of pain, the following diagnostic procedures are prescribed:
- Gynecological examination. It is produced to exclude pathologies of the female genital organs, accompanied by similar symptoms. During the examination, the condition of the external opening of the urethra is assessed, attention is paid to the presence of pathological secretions, signs of inflammation of the vulva and vagina.
- Ultrasonography. Ultrasound of the bladder is informative for cystitis, paracystitis, cystolithiasis, tumors and urachus cysts. Allows you to detect residual urine or determine the cause of AUR. For men with cystitis and prostatocystitis, an ultrasound of the prostate is recommended to assess the condition of the prostate gland, to detect possible infravesical obstruction.
- Cystoscopy. It is indicated for establishing the form of chronic cystitis (performed without exacerbation), diagnosing paracystitis, clarifying the location, size and prevalence of neoplasms. With KSD and AUR, it has a therapeutic and diagnostic nature, makes it possible to detect stones and eliminate mechanical obstacles to the flow of urine. During the procedure, if necessary, a biopsy is taken.
- X-ray methods. In the process of cystography with paracystitis, compression and deformation of the bladder are visualized, with cystolithiasis, X-ray positive stones are seen, with tumors, a filling defect is detected, with cysts, the presence of a message between the formation and the detrusor is determined. In patients with complicated urachus cysts, it is possible to perform fistulography to study the fistulous canal.
- tomographic techniques. CT and MRI of the bladder are used to assess the extent and depth of malignant neoplasia, to detect small neoplasms that are not visible on ultrasound. In the course of the layer-by-layer study of the organ, it is possible to clarify the severity of injuries and the volume of urohematomas in injuries.
- Laboratory tests. Urinalysis is of primary diagnostic value. In the KLA, hematuria, leukocyturia, bacteriuria, pyuria, proteinuria can be detected. By microbiological examination, the causative agent of infection is established, antibiotic sensitivity is determined. Histological or cytological analysis of the biopsy allows to differentiate different types of tumors, to establish the form of cystitis.
Urologist appointment
Treatment
Conservative therapy
Many patients require a special diet. Patients with cystitis are advised to give up spicy and fatty foods, increase the amount of fluid they drink. With ICD, the diet is determined taking into account the composition of the stones. The treatment regimen includes the following methods:
- Inflammatory diseases. The basis of therapy are antibacterial agents. With candidal cystitis, medications with an antifungal effect are prescribed. With paracystitis, sulfonamides are additionally used. Uroseptics, NSAIDs, combined phytopreparations, intravesical instillations, exercise therapy, inductothermy, UHF, iontophoresis, laser therapy are recommended.
- OZM. Carry out catheterization. With psychosomatic and neurogenic ischuria, the genitals are irrigated with warm water, m-cholinomimetics are injected subcutaneously. With urinary retention while taking hypnotics and antidepressants, drug withdrawal or dose reduction is required.
- Traumatic injuries. With tears and contusions, catheterization is performed. With the development of shock, anti-shock measures are taken. Preoperative preparation for complete ruptures includes antibiotics, hemostatics, analgesics, anti-inflammatory drugs, drugs to stabilize hemodynamics.
- Malignant tumors. Operative techniques are supplemented with intravesical immunotherapy, contact or remote radiation therapy.
Surgery
Patients with AUR, if catheterization is not possible, undergo epicystostomy. Depending on the nature of the pathology, such surgical interventions are performed as:
- Paracystitis: opening, drainage of phlegmon and abscesses of the perivesical tissue, intestinal plasty or augmentation cystoplasty in case of detrusor wrinkling against the background of chronic purulent inflammation.
- Cystolithiasis: endoscopic lithoextraction, percutaneous suprapubic litholapaxy, transurethral cystolithotripsy, open suprapubic cystolithotomy.
- Cysts: percutaneous puncture of a cystic formation, one-stage or two-stage excision of a cyst.
- Tumors: laser resection, electrocoagulation, electroresection, TUR of the bladder, partial or radical cystectomy followed by ureterocutaneostomy or intestinal plasty.
- Foreign bodies, injuries: revision of the abdominal cavity with suturing of the bladder, endoscopic removal of foreign objects, open cystotomy.