Interstitial Cystitis (Painful Bladder Syndrome)

Interstitial Cystitis 3Interstitial (in-tur-STISH-ul-sis-TIE-tis) Cystitis (IC) or Painful Bladder Syndrome

IC or painful bladder syndrome is a chronic medical condition in which a person experiences constant bladder pressure, and pain, sometimes the pain is in the pelvic area The pain levels can range from mild discomfort to severe pain.

The bladder is a hollow, muscular organ that stores urine. The bladder will expand to store more liquid until it is full and then it will send a signal to the brain that will communicate the need to urinate, through the pelvic nerves. This is the reason most people will have the urge to urinate. However, someone with interstitial cystitis, the signals can become jumbled – in which you will feel the need to urinate more often and with smaller volumes of urine than most people.

Interstitial cystitis most often affects women and can have a long-term impact on one’s quality of life. While there are no treatments that will reliably remove interstitial cystitis, there are medications and therapies that may offer relief.

Interstitial Cystitis 2Symptoms of Painful Bladder Syndrome

The signs of Painful Bladder Syndrome vary from person to person. If you have this condition, your symptoms may also change over time, occasionally flaring in response to common triggers, such as sitting for extended periods of time, exercise, sexual activity, stress or menstruation.

Interstitial cystitis signs and symptoms include:

  • Chronic pelvic pain
  • Pain during sexual intercourse
  • Pain or discomfort whilst the bladder fills, and relief at you urinate
  • Persistent and urgent need to urinate
  • Pain in the pelvis or between the vagina and anus ( in women) or between the scrotum and anus in men ( perineum)
  • Frequent urination, often small amounts, throughout the entire day and night. People with severe IC urinate as much as 60 times a day.

Interstitial CystitisThe severity of the symptoms caused by IC can vary based on the person, and others may experience periods where the symptoms disappear.

Although signs and symptoms of IC may look like a chronic urinary tract infection, urine cultures are usually free from bacteria. However, symptoms may worsen if a person with interstitial cystitis gets a urinary tract infection.

You should see a doctor if you are experiencing chronic bladder pain or urinary urgency and frequency that is higher than normal.

What Causes IC or Painful Bladder Syndrome
It is not known what precisely causes of IC, but it is likely many factors can contribute to it developing. For example people with IC may also have a deciding in the protective lining (epithelium) of the bladder. A puncture in the epithelium may allow toxic substances in urine to irritate the bladder wall.

Other suggestions have not be proven but include factors such as autoimmune reaction, infection, allergy or heredity.

Risk Factors

Some factors can lead to higher risk rates of IC

Gender – Women are diagnosed with interstitial cystitis more often than men. Men have nearly identical symptoms to those of interstitial cystitis. However, these symptoms are most often associated with prostate gland inflammation (prostatitis)
Age- Most individuals with interstitial cystitis are diagnosed during their30s or older.
Chronic Pain Disorder – IC may be related with having another pain disorder such as fibromyalgia or irritable bowel syndrome.

Interstitial Cystitis 5Complications

IC can result in several complications including:

Reducing Bladder capacity– IC can lead to a thickening of the bladder wall that reduced the bladder capacity, meaning it would hold less urine.
Lower quality of life – Frequent need to urinate and pain caused by IC will interfere with your social activities, daily routine and work.
Sexual intimacy – Frequent urination and pain can affect personal relationships and sexual intimacy.
Emotion issues- Chronic pain and interrupted sleep caused by IC can trigger emotional stress and depression.

Test and Diagnosis

To determine if you have IC or Painful Bladder Syndrome the doctor may run a few of the following test:
The doctor may request medical history or bladder dairy. Your doctor may ask you to describe your symptoms and may require that you keep a diary of the frequency in which you have to urinate, the volume of fluids you drink and volume of urine you pass.
Pelvic exam – During the pelvic exam your doctor will examine your external genitals, including the vagina and cervix and feel the abdomen evaluate any of the internal pelvic organs. The doctor may also examine the anus and rectum.
Urine test- A sample of urine will be analyzed to check for urinary track infection
Potassium sensitivity test – In this test, your doctor places two solutions – potassium chloride and water – into your bladder one at a time. You may be asked to rate on a scale of 0 to 5 the urgency and pain you feel after each solution is instilled. If you feel a noticeable difference in urgency and pain after the potassium solution than the water solution, the doctor may diagnose interstitial cystitis, Individuals with normal bladder can not tell the difference between the two solutions.

Cystoscopy – The doctor will a insert a thin tube with a miniature camera (cystoscope) via the urethra, allowing the doctor to see the lining of the bladder. You doctor may also inject liquid into the bladder to measure your bladder capacity called a hydrodistention. Your doctor may perform a cystoscopy procedure with an anesthetic medication so that you are more comfortable.
Biopsy – During a cystoscopy and you are under anesthesia, you doctor may take a sample of the bladder tissue (biopsy) and the urethra for examination under a microscope. A biopsy would also check for other conditions.

Treatments and Medications

There is no simple treatment option that can eliminate the signs and symptoms of IC and one treat It may be needed to try various types of treatment or combinations before your doctors find an approach that relieves your symptoms.

Physical therapy, working with a physical therapist can address pelvic pain cause by with muscle tenderness, restrictive connective tissue or muscle abnormalities in the pelvic floor.

Oral Medications

Oral drugs that may improve the signs and symptoms of IC include the following:

Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB,) or Aleve or Naproxen, to relive pain.
Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), This can assist in relaxing the bladder and block pain.
Antihistamines, similar to loratadine (Claritin, others0 which may reduce urinary urgency and frequency and relieve other symptoms.
Pentosan (Elmiron), was approved by the Food and Drug Administration to treat interstitial cystitis. The method that works is not known, but it may restore the inner lining of the bladder as well as protect the bladder wall from a substance in urine that could cause irritation. It can take two to four months before you can start to feel relief in pain and up to six months to have a decrease in urinary frequency.

Stimulating Nerves

Transcutaneous electrical nerve stimulation (Tens). With TENS, mild electrical vibrations relieve pelvic pain and, in some situations, reduce urinary frequency. TENS can help to increase blood flow to the bladder, and strengthen muscles to help control the bladder or triggering the raise of substances that block pain. Electrical wires positioned on the lower back above the pubic area deliver these electrical pulses, and the frequency and length of time depend on the best therapy that works for you.
Sacral nerve stimulation- Your sacral nerves are a primary link between the spinal cord and nerves in your bladder. Inciting these nerves may reduce urinary urgency associated with interstitial cystitis. Sacral nerve stimulation uses thin wire placed near the sacral nerves delivering electrical impulses to your bladder, which are similar to the functionality of a pacemaker for the heart. If procedure decreases the symptoms, it may make sense to have a device surgically implanted for permanent use.

Bladder distention
Some people notice a momentary improvement in symptoms after undergoing cystoscopy
with bladder distention. Bladder distention is the stretching of the bladder with water or gas. The system may be repeated as a treatment if the response lasts a long time.

Medications instilled into bladder
In bladder instillation, your doctor places the prescription medication dimethyl sulfoxide into your bladder through a thin, flexible (rinmos-50) into your bladder through a thin, flexible tube (catheter) inserted through the urethra. The solution seldom is mixed with other medications such as a local anesthetic, and remain to sin your bladder for 15 minutes; You urinate to expel the solution.

You might receive dimethyl sulfide – also called DMSO- treatment weekly for six to eight weeks and then have maintenance treatment as needed – such as every couple of weeks, for up one year.

A newer method to bladder instillation uses a solution containing the medications lidocaine, sodium bicarbonate, and either pentosan or heparin.

Surgery

Doctors will seldom use surgery to treat IC due to removing part of, or all of the bladders do not relieve pain and can lead to additional complications. People with severe pain or those whose bladders can hold only minuscule volume of urine are possible candidates for surgery, but usually only after other treatment options have not been affective, Surgical options include the following:
Fulguration – This is minimally invasive methods involve in insertion of instruments through the urethra to burn off ulcers that may be causing IC
Resection – is a minimally invasive surgery that involves insertion of instruments through the urethra to out of around any ulcers.
Bladder augmentation is this procedure, surgeons remove the infected portion of the bladder and replace it with a piece of the colon, but the pain remains, and some people need to empty their bladders with a catheter many ties a day.


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