Cystalgia is not a disease, but rather a symptom complex, manifested by frequent painful urination or pain in the abdomen below the act of urination, in the absence of objective signs of a bladder. It occurs in 10 – 15% of the cases of the total number of patients referring to the urogynecologist. It is observed, as a rule, in women aged 20 to 50 years. More precisely, this suffering will be called a symptom of chronic pelvic pain in women.
The cause of the pain symptom and the violation of urination is a violation of blood and lymph circulation in the pelvic area. (triangle Lieto), inflammatory processes in the pelvic organs and retroperitoneal tissue, diseases of the genital organs, hormonal disorders (estrogen deficiency), pregnancy, abortion, surgical interventions, allergic factors, neurovegetative dysregulation of the bladder, especially its neck. As a result of microcirculation disorders in the pelvic organs (uterus, bladder), edema of the deep layers of the bladder wall arises and the result is a pain syndrome.
The disease is often observed in young women with hypo- genitalism and severe menstrual irregularities. They have a disease or worsens during menstruation, during pregnancy.
Endometriosis. especially outside. in the area of the ligamentous apparatus of the uterus or the transitional fold is also the cause of the pain symptom of the strongest shortly before menstruation and directly into menstruation.
A certain connection of “cystalgia” with diseases of the genital organs causing hemodynamic disorders is established. These include inflammatory and tumor processes of internal genital organs. Hyperemia, slowed blood flow or shortage of blood supply causes pain and dysuric phenomena. First of all, this varicose enlargement of the ovarian veins, as a local manifestation of varicose veins.
Often, the onset of the disease is associated with sexual disorders. First of all, this is the case for women who use interrupted sexual intercourse as a contraceptive in a sexual life, women with masochistic tendencies, perceive sexual activity as violence against themselves, or among aggressive women who experience sexual anger from their submission to a man, in frigid women. Sexual dissatisfaction in such patients leads to stagnant phenomena in the small pelvis, and in addition, causes a state of mental exhaustion; in connection with this, the term “psychosomatic cystitis” was introduced. Therefore, cystalgia should be considered as a disease based on neuroendocrine diseases. hemodynamic disorders and functional disorders of the neuromuscular apparatus of the bladder, especially its neck.
Clinical manifestations: frustration of urination, pain in the bladder and in the perineum, discomfort in the urethra. Pains in the perineum and in the suprapubic region are usually clearly localized, irradiate into the iliac or lumbosacral region (sometimes their localization is not clearly defined). As a rule, pain blunt, persistent, appear during and outside the act of urination, with or after sexual intercourse; can occur without any cause and disappear after bladder emptying.
In addition to pain, there are rarely disorders of urination, expressed in pollakiuria, imperative and painful urination (especially at the end of the act), in the feeling of incomplete emptying of the bladder. The disease is characterized by the duration of the course, the alternation of periods of remission and exacerbations. Provoking factors can be cooling the body, constipation, drinking alcohol, spicy foods.
It is necessary to distinguish between neurogenic dysfunctions of the bladder, in which urination disorders prevail, and chronic pelvic pain syndrome in women.
The diagnosis is based on anamnesis and a thorough clinical examination. In the case where there is a violation of urination of one kind or another without pain, it is necessary to establish a diagnosis of neurogenic dysfunction of the bladder. If there is a pain syndrome, then in the end of the diagnostic search, an accurate diagnosis of the disease should be established, and not the name of the symptom.
When making a diagnosis, special attention is paid to obstetric history and gynecological operations; on the nature of sexual relations (the presence or absence of orgasm, painful intercourse), the use of contraceptives; collect data on menstrual function, transferred diseases. You should pay attention to the signs of inflammation of the genital organs, to find out the issues related to the reproductive function.
The examination of genitals is mandatory. Examination of the external aperture of the urethra, so the caruncles and prolapse of the urethra often complicate the course of the disease. Conduct a laboratory study of urine (urine in patients with “cystalgia” does not have pathological changes). Laboratory and X-ray and radiological methods determine the function of the kidneys, upper and lower urinary tract. Exclude organic diseases of the bladder, for this purpose, cystoscopy is used and, with appropriate indications, other diagnostic methods (cystoscopy, ultrasound, etc.)
Particular attention should be paid to ultrasound of the pelvic organs with Doppler study of the vessels of the uterus. Characteristic is the expansion of the uterine vessels, the expansion of the ovarian veins, the retrograde flow of blood at the Valsalva test.
Urodinamichesky research (KUDI) is obligatory at inspection of such patients.
With cystoscopy, either no changes are seen from the mucosal side, or there is a lack of a clear mucosal pattern in the region of the bladder triangle and the lower segment of the cervix.
One of the most important diagnostic methods is laparoscopy, which allows detecting foci of endometriosis with a chronic pain symptom.
Patients with severe emotional and neurotic disorders are counseled by a neurologist to avoid neurogenic bladder dysfunction, in particular, to strengthen the processes of contraction and relaxation of detrusor and sphincters due to a violation of their innervation. In some cases, the hormonal function of the ovaries is assessed using a karyopicnotic index.
Treatment of patients with a symptom of chronic pelvic pain should be complex. First of all, it is necessary to eliminate the causes and etiological factors of the disease development.
If the cause of pain is endometriosis, then it is necessary to prescribe a specific hormonal therapy.
If the doctor diagnoses a serious violation of venous outflow, then surgical treatment is necessary – laparoscopic ligation or endovascular intervention on the pelvic veins.
With the established diagnosis of neurogenic bladder dysfunction, a set of therapeutic effects including pharmaceuticals normalizing the normal contractility of the detrusor of the bladder is used.
If the patient has a violation of the hormonal function or age-related involute changes in the genital organs (kraurosis, atrophic colpitis, omission of the vaginal walls, prolapse of the uterus), then HRT and operative correction of genital prolapse is necessary.
In other words, so often “diagnosed” cystalgia does not have the right to exist, since it does not indicate the cause of the disease and makes attempts to treat this symptom complex ineffective.