What Is Trigonitis?
As the name suggests, trigonitis is a condition that affects the trigone of the bladder. The urinary bladder is a balloon-like structure present in the urinary tract. It is connected to the kidneys by tube-like structures known as ureters. A tube-like structure known as the urethra connects the bladder to the outside and allows urine drainage. The bladder and the urethra junction is known as the bladder neck or trigone. It has been named trigone because it is a triangular piece of tissue attached to the lower end of the bladder. When this area (trigone) becomes damaged, the condition is known as trigonitis. It is commonly seen in women and people who use catheters frequently to drain their urine. The condition needs to be treated at the earliest to avoid complications.
What Are the Causes of Trigonitis?
Trigonitis is not always the result of inflammation. Instead, the cells in the trigone undergo certain abnormal changes known as non-keratinizing squamous metaplasia. These changes result in a condition known as pseudomembranous trigonitis. The cellular changes occur due to a disturbance in the female hormones, mainly estrogen and progesterone. The other causes of trigonitis are listed below:
-
Recurrent Urinary Tract Infection - Urinary tract infection is a term used to describe the infection that can occur in any urinary tract organ. If the patient ignores the symptoms of urinary tract infections, the risk of trigonitis or bladder inflammation increases.
-
Catheter - A catheter is a tube inserted into the urinary bladder through the urethra to drain urine. People suffering from chronic kidney disease and unable to pass urine require a catheter. Also, those who underwent surgery in the past might need a catheter to pass urine. Usually, the patient does not require a catheter for a few weeks after the surgery. However, patients might sometimes need to use the catheter for a long time. This increases the risk of irritation and inflammation because the bacteria can enter the bladder easily.
-
Hormonal Imbalances - Hormones play an important role in the cellular changes in the bladder lining. During pregnancy and menopause, the levels of estrogen and progesterone change drastically. As a result, the cells in the bladder lining change abnormally, giving rise to pseudomembranous trigonitis. Males might develop trigonitis after prostate cancer.
What Are the Symptoms of Trigonitis?
The signs and symptoms of trigonitis are similar to those of urinary tract infections. The symptoms of trigonitis are listed below:
-
Urinary urgency (urinating more than eight times per day).
-
Bladder pressure.
-
Dysuria (painful urination).
-
Difficulty in passing urine.
-
Hematuria (blood in the urine).
What Tests Are Done to Diagnose Trigonitis?
Trigonitis is diagnosed based on medical history, physical examination, and imaging tests. The laboratory tests like urinalysis and blood tests might be recommended, but they are not very useful. The diagnostic methods have been described below:
1. Medical History - A medical history is a verbal communication between the doctor and the patient to know about the symptoms of the condition, the family history, the drug history, and the past treatments. For example, a patient using a catheter for a prolonged period is more likely to develop trigonitis.
2. Physical Examination - The doctor examines the patient to check the physical signs of trigonitis. Usually, the patient will be in distress due to the pain and inflammation.
3. Laboratory Tests - The following laboratory tests are usually advised-
-
Blood Tests: A blood test helps to know the levels of white blood cells and electrolytes in the body. It also helps to check the infection present in the body.
-
Urine Test: Urinalysis is done to check the problems related to the urinary tract. The urine sample is examined in the laboratory under a microscope. It does not indicate anything about trigonitis but helps to check the blood, bacteria, and white blood cells.
How Is Trigonitis Managed?
The treatment of trigonitis depends on the symptoms. Asymptomatic patients do not require any treatment, but a urologist must be consulted if the patient is symptomatic. The following treatment options help to ease the symptoms -
1. Antibiotics: If the patient suffers from trigonitis due to a urinary tract infection, antibiotics greatly help. The following antibiotics are usually recommended:
-
Cefixime.
-
Cefprozil.
-
Cephalexin.
-
Amoxicillin and Clavulanic acid.
-
Trimethoprim.
2. Antidepressants - Low-dose antidepressant-like Imipramine might be prescribed to control bladder pain.
3. Medications to Relax Bladder Muscles - Prazosin and Phenoxybenzamine are mainly used to treat bladder-neck dysfunction and trigonitis. They are alpha-blockers that work to relax the muscles of the urinary bladder. As the bladder muscles are relaxed, the urine flows out of the bladder smoothly.
3. Non-steroidal Anti-Inflammatory Drugs - Ibuprofen and Naproxen Sodium help prevent bladder pain and inflammation.
4. Surgery - Surgical intervention is required when the medications fail to resolve the condition. The surgery is performed under general anesthesia. First, an incision is made in the neck of the bladder. Next, a tube known as a resectoscope is inserted into the urinary bladder. It contains a camera that helps to view the neck of the bladder. It also contains a tool that uses an electric current to remove the tissue blocking the bladder neck. This method is also known as bladder fulguration.
What Is the Difference Between Trigonitis and Interstitial Cystitis?
Interstitial cystitis is a part of the spectrum of diseases known as painful bladder syndrome. The patient experiences intense pain and inflammation in the bladder and the surrounding area. The exact cause of interstitial cystitis is still under research. However, scientists believe that a defect in the mucus lining of the bladder is responsible for bladder irritation or interstitial cystitis. Sometimes, trigonitis is confused with interstitial cystitis because of similar symptoms. However, there is a vast difference between the two conditions. Both trigonitis and interstitial cystitis are characterized by bladder inflammation. However, in trigonitis, the inflammation is confined to the trigone area of the bladder.
On the contrary, interstitial cystitis is characterized by inflammation in the bladder and the surrounding organs. Patients suffering from trigonitis usually complain of pain in the pelvis that radiates to the urethra. In interstitial cystitis, the patient presents with pain in the abdominal region.
Conclusion:
Trigonitis, or the inflammation of the bladder neck, is commonly seen in females. Post-menopausal and pregnant females are at the highest risk of trigonitis. It is because their hormone levels change rapidly. In addition, patients using a catheter for a long time to drain urine are more likely to develop trigonitis. Trigone is an area present between the bladder and the urethra. Sometimes, the bacteria might travel from the urethra and irritate this area, resulting in trigonitis. Patients might not present with symptoms in the initial stages but face difficulties urinating when the inflammation spreads around the bladder. Both surgical and non-surgical options are available to treat trigonitis, but the exact treatment plan to be followed depends upon the severity of the condition. Consult a urologist to learn more about trigonitis and other bladder problems.
