Menopause. Cystitis & Trigonitis. Your Questions Answered by Internal Specialist, Dr. Mera

Cystitis means inflammation of the bladder in Latin. It describes a broad range of diseases with diverse etiology and pathologic mechanisms but with similar clinical presentations.
The most common symptoms are frequency, urgency, burning with urniantion and suprapubic pain. However, these symptoms are nonspecific and may also be associated with infection of the lower genitourinary tract (urethra, vagina) or with noninfectious conditions such as bladder cancer, urethral diverticulum, or kidney/bladder stones. 
Even vaginal infections or tissue changes with menopause can cause bladder symptoms. The incidence of different types of cystitis varies wildly by cause and the affected patient population.

TRIGONITIS AND CHRONIC CYSTITIS

The trigone is a triangular region of the bladder floor, where the three points of the triangle correspond to the locations at which the urethra and ureters connect. The trigone is the structure that allows the body to detect when the bladder is full. This flat, smooth region is highly sensitive, and as the bladder fills and expands, this area is stretched as well. When it gets big enough, the bladder signals to the brain that it needs to be emptied; the more the trigone expands, the stronger the signals become. 

Trigonitis is inflammation or “chronic cystitis” that is localized to the trigone region of the bladder. This inflamed patch of bladder wall acts like a bladder “ulcer” where chemicals and toxins in the urine are able to seep into the otherwise protected bladder muscle, causing irritability of the bladder muscle. These effects together then create the symptoms that mimic a UTI. Inflammation of this trigone region, whether it is from a bacterial infection or chronic cystitis, will produce hypersensitivity and bladder spasm causing increased frequency and urgency, burning with urination, painful intercourse, bladder pain, blood in the urine, and often pelvic and back pain.

CAUSES OF TRIGONITIS AND CHRONIC CYSTITIS:

There are multiple theories as to what causes this bladder wall inflammation and ulceration. Trigonitis occurs most often in women of childbearing age, but occasionally men develop it too. For this reason, the cause is thought by some researchers to be related to levels of the hormone estrogen. Some studies suggest there is a correlation between family or childhood history of bladder infections and the occurrence of chronic cystitis, however, so others believe that repeated infections might lead to chronic inflammation of the vesical trigone region. It’s exact cause is still unknown, and there is no standardized treatment plan. There are, however, several medications and treatments that can help control the symptoms.

SYMPTOMS:

Trigonitis and chronic cystitis can cause severe bladder pain and burning, pelvic pain and pressure, reduced bladder capacity, an increase in the frequency and urge to urinate, particularly at night, blood in the urine and urinary incontinence. For some, the problem can lead to increased pain when sitting in certain positions or discomfort during sex. In addition, some people experience sensitivity to certain foods, and eating them can trigger symptoms.

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