Almost a third of all children (25-30%) who have reached the age of majority suffer acute cystitis at an early, preschool or school age, and the majority of patients are female. This is connected both with the anatomical features of the urinary system in girls and boys, and with the level of immunity, with the presence of a whole complex of factors contributing to the disease.
But these characteristics of the disease are found out later, when his clinical picture has already appeared, and the little patient began to be examined. At the very beginning, the symptoms of cystitis in children with both forms of the disease are the same, and the term “acute” means a bright and violent manifestation of pathology. Differences in the manifestations of acute infectious cystitis can be caused only by the age of a small patient, the characteristics of his body and the ability to express his complaints. It is necessary to take this into account, as the ability of parents to recognize cystitis by its characteristic symptoms as early as possible will ensure the timely start of its treatment.
Symptoms of cystitis in young children
In this age period, it is necessary to distinguish very young patients, up to one year old, and older ones, when they still cannot tell, but are already able to localize the pain. In infants, acute cystitis is rarely diagnosed, but it is still possible. It is quite difficult to suspect cystitis in a baby, since a child can only express his painful condition by changing behavior. The appearance of discomfort or pain in the abdomen, the child expresses with capriciousness, crying, anxiety. Violation of urination, given the constant use of diapers in babies, is also difficult to fix. In addition, the peculiarities of the mucous membrane of the urinary tract in children under one year of age are such that inflammatory events quickly spread throughout all departments, and acute cystitis can be supplemented with pyelonephritis or urethritis.
In order to avoid the development of complications, the parents of the infant should necessarily call the pediatrician to the house if the expected signs of cystitis appear in the child:
- he became moody and irritable, restless, and too whiny;
- urine changed, it became more or less, and the color became dark yellow;
- appetite deteriorated, lethargy appeared, the temperature increased to approximately 38 degrees (these signs of intoxication are possible, but not necessary).
Changing the properties of urine is more likely to notice if the baby is already sitting confidently (after 6 months) and the parents have begun to teach him to the pot. At this age, the child will not yet say that he has a tummy ache, but by crying while urinating in the pot, it is already possible to understand what is the matter. Studying the amount and color of urine will also help suggest acute cystitis or urethritis in a baby.
The symptoms of cystitis in children over one year of age are the same, but the child can already help in the diagnosis. He is already able to localize the pain and, unable to express in words, can show the pen on the lower region of the tummy. Some children almost always keep their hands on their stomachs, showing the localization of pain and discomfort. The anxiety and irritability of the baby remains, and the tearfulness can come to crying during urination.
At this age, parents can already clearly record the change in the frequency of acts of removing urine. Their increase or decrease are signs of trouble in the urinary system. Irritability, capriciousness, tearfulness of a child can simultaneously become manifestations of intoxication syndrome. Fever is added to them, as well as decreased appetite and refusal to eat.
How is acute cystitis manifested in older children?
Diagnosis of the disease in children who are already able to clearly localize the pain syndrome, describe its characteristics and present a complex of complaints to the doctor, is not as difficult as in young patients. In older children, the influence of external adverse factors and the possibility of the emergence of comorbidities increase, so the incidence of acute cystitis increases, mostly in girls.
Clinical manifestations develop suddenly, often against the background of complete health, and in most cases after hypothermia of the child. Symptom complex of acute cystitis at this age includes the following signs by which pathology can be determined quite quickly:
- the occurrence of frequent urination, up to 2-4 times in 1 hour, or every 10-20 minutes;
- urges become painful and are caused by cramps in the bladder muscle wall;
- the appearance of pain over the pubis, which increases with the filling of the bladder;
- pain may radiate (spread) to the upper abdominal regions and mimic other pathologies, as well as to the perineal area, which sometimes requires a differential diagnosis with acute paraproctitis;
- the appearance of a symptom of stranguria, or sharp pain at the base of the bladder in the last seconds of urination;
- urinary incontinence develops in some children;
- urine becomes turbid, darker, in rare cases due to the development of the hemorrhagic form of acute cystitis, blood appears in it, up to the pink-red color of urine;
- the possibility of intoxication syndrome, in contrast to babies, is more likely, and the temperature can rise from febrile numbers to more febrile numbers (more than 38 degrees);
- in some patients, the appearance of a reflex urinary retention is observed, which is explained by a violation of the nervous regulation of the bladder and urethra, as well as spasm of the urethral sphincter.
How to determine cystitis in the external examination of the child
All these violations by the urinary system, the doctor determines, after hearing the complaints of the child and his parents. He then proceeds with a general examination of the patient, during which the presence of intoxication syndrome (measurement of body temperature), possible edema or pastosity (looseness and wateriness of the skin), skin color and visible mucous membranes are clarified.
Palpation (palpation) of groups of lymph nodes specifies their condition; special attention is paid to the study of the groin area. If the lymph nodes of this zone are somewhat enlarged and painful, then this symptom indicates the presence of a pathological process in the pelvis and indirectly about acute cystitis.
On abdominal palpation, the doctor determines the location of the pain. If the child responds accordingly to the palpation of the suprapubic zone, especially if the bladder is filled, the presence of acute cystitis is confirmed. The doctor examines other internal organs of the abdominal cavity, especially the retroperitoneal space (lumbar region), where the kidneys are located. After all, the development of acute cystitis in children can be accompanied by renal pathology.
Laboratory and instrumental diagnosis of cystitis in children
Before prescribing appropriate therapy, the attending physician must make a final diagnosis. Updating acute cystitis necessarily requires laboratory tests and, in some cases, instrumental examination. Only after all the diagnostic measures have been taken can the exact shape of the inflammatory process in the bladder, its severity, possible complications and concomitant diseases be established. Medical tactics directly depend on this.
Laboratory tests include clinical testing of blood and urine. In acute cystitis in the blood of a small patient does not find the specific signs of this particular disease. But evidence of circumstantial evidence is always determined, namely signs of an inflammatory process in the body. These include an increase in the number of leukocytes (leukocytosis), the emergence of young forms of these cells (to replace dead leukocytes during inflammation), a sharp increase in ESR.
More informative and useful for the diagnosis of cystitis urine analysis. In order for the data obtained to be accurate, it is necessary to properly collect the urine. In children’s practice, especially for very young children, this can be difficult to do. Parents should try not to collect all the urine, but only the middle portion, the study of which will provide the most correct information.
In the study of urine, the portion volume is measured, the color and transparency, the presence of mucus, suspensions and impurities, and acidity are evaluated. Next, the technician performs a microscopic examination, during which the cellular composition of the sample is determined. The method of counting the number of cells in the visual fields is used. In the absence of cystitis in each field of view there are 1-2 leukocytes, 1-2 epithelial cells, and there are no bacteria and erythrocytes. In the presence of inflammation in the bladder, the number of leukocytes literally “rolls over”: from 20-30 pieces to completely covering the field of view. Also there is a high content of epithelium and bacteria, red blood cells are possible. The degree of bacteriuria is higher in chronic form of cystitis than in acute.
It is possible to determine the type of bacterial pathogens either by microscopic examination or by microbiological method, that is, sowing on nutrient media. Also, the use of test strips is gradually being introduced into practice, with the help of which you can quickly determine the presence of protein in the urine, blood, and leukocytes. A screening method for determining nitrites in urine is also used, which directly indicates a high content of bacteria. These methods are necessary not only for the rapid diagnosis of cystitis in children, but also for the dynamic monitoring of the effectiveness of treatment.
Of the instrumental diagnostic methods in childhood, ultrasound of the bladder is most preferable. Its absolute safety for the health of the baby, painlessness and non-invasiveness allow the use of ultrasound not only for diagnosis, but also in the process of treatment of cystitis.
In each individual case, one of the ways is chosen:
- transabdominal ultrasound (through the front wall of the abdomen, the most common);
- transrectal (through the rectum);
- transurethral (through the urethra).
Scanning is carried out with a filled bladder in order to determine its shape and wall thickness as accurately as possible. Ultrasound signs of cystitis in children are considered uneven thickening of the walls of the bladder, changing their contours and reducing the normal echogenicity of tissues.
Other diagnostic methods, namely roentgenoscopy, X-ray and endoscopy (cystoscopy), are very rare in children, according to strict indications. They are necessary if the differential diagnosis of cystitis with the pathology of other parts of the urinary tract (pyelonephritis, congenital anomalies), with appendicitis, paraproctitis, bladder neoplasm is carried out.
For the timely diagnosis of children’s cystitis, all methods are important. Still, knowledge of the main symptoms of the disease and the ability to recognize them are in the first place.