Many cases of acute cystitis, if carefully treated in this way, will recover completely without the use of local treatment. If, however, the disease does not yield to these measures, local treatment becomes necessary.
In many instances the woman first comes under treatment when the disease has reached a chronic stage; or it may be that the disease has begun subacutely, and has gradually progressed without having presented any symptoms of acute onset. Local combined with general treatment is then often advisable from the beginning.
Local treatment consists of general applications made to the whole of the interior of the bladder through the catheter; direct application, limited to the diseased portions of the mucous membrane, through the endoscope; and operation, or the formation of a vesico-vaginal fistula.
Fig. 191.—Apparatus for washing the bladder.
Washing out the bladder with sterile warm water, either pure or medicated, is often very useful. Gentleness in manipulation and asepsis should be carefully observed in this procedure, or much more harm than good may result from it. The operation, if properly performed, should never give pain to the woman.
A very simple apparatus is required, consisting of a soft-rubber catheter, of moderate size, attached to a small glass funnel by means of a rubber tube and a piece of glass tubing. The whole is about 2 feet long ([Fig. 191]).
The catheter, slightly lubricated at the point, should be gently introduced into the bladder, and the urine should be slowly withdrawn. As the urine flows into the funnel its character may be observed. The rapidity of the flow of the urine may be regulated by raising or lowering the funnel. As the last portion of the urine is withdrawn the flow should be very slow, in order to prevent injury to the vesical mucous membrane from dragging it into the eye of the catheter.
When the bladder is emptied, sterile hot water may be introduced through the funnel and the process of withdrawal repeated. The mucus, pus, or blood which had remained in the bladder after evacuating the urine may be examined as the water flows into the funnel. This process may be repeated several times if necessary to wash out the bladder. The water should be about the temperature of the body (100° F.). It is less irritating to the mucous membrane if there is dissolved in it boracic acid or common table salt, about 1 dram to the pint, though these ingredients should not be added if they act chemically on the substances subsequently used in the medicated solution.
The quantity of water introduced into the bladder may be regulated by the feelings of the patient. The distention of the bladder should never be great enough to cause pain. Usually an ounce of fluid is all that can at first be tolerated without producing pain. As improvement takes place more fluid may be introduced in the subsequent treatments.