Bladder Pain Syndrome and Interstitial Cystitis

Many women come into my office with complaints of “a bladder infection that won’t go away”.  Other times a description of burning, aching, stinging with urination, or even at times just intractable urinary frequency may cause them to seek consultation.  It is not unusual to see someone with a bladder pain syndrome who has been on antibiotics, bladder relaxants, pain medications, and had multiple different procedures relating to pain or frequency to no avail.  These women are usually quite frustrated, afraid, and often angry or suspicious because they have already either been told to see a psychiatrist or that there is nothing more to be done.  Many women with these symptoms will give a history of an autoimmune disorder, endometriosis, irritable bowel syndrome, fibromyalgia, migraine headaches, or vulvodynia/vulvar vestibulitis.  Although there are no definite answers regarding the cause for Interstitial Cystitis, the effects are better understood.  The normal protective coating on the bladder surface is compromised so that irritants are able to get to the underlying bladder cells more easily, setting up inflammation and resulting in pain.  Severe cases can result in reduced bladder capacity and scarring in the bladder, with ulcerations and irritation visible on the surface of the bladder when it is seen on cystoscopy.  Some of the time, chronic infections may result which are difficult to clear.  The first and most important part of this problem to address is making a diagnosis.  Often, the history of the problem will strongly suggest IC.  Cystoscopy with hydrodistension (looking into the bladder with a small camera and filling the bladder to maximum physical capacity) is one of the procedures that can be performed to evaluate the bladder more closely, confirm the diagnosis, and initiate treatment in many cases.  This is typically done under anesthesia, as the overfilling of the bladder is very uncomfortable for someone with a very sensitive bladder.  Biopsies may be taken at this time, as well as cauterization of ulcers, if present, which may improve symptoms as well.  Instillation of a cocktail of medications found to be helpful in the treatment of IC may be performed at the end of the procedure.  In the USA, RIMSO-50 (DMSO) is approved as a bladder instillation in the treatment of IC.  It will often be mixed with additional medications such as heparin, lidocaine, or sometimes a particular antibiotic in order to have the desired effect.  Sometimes, the effects of these treatments can be dramatic.  Other times, the results are more disappointing, but often there is some improvement after initiating therapy, particularly if the patient follows the dietary restrictions recommended for controlling IC.  An oral medication approved for the treatment of Interstitial Cystitis is Elmiron.  This medication may need to be taken for a few months before the effects become evident.  Side effects may occur with any of the treatments, so taking other health conditions and medications into account is important when starting therapy.  There are also “over-the-counter” treatments used for IC.  D-Mannose, Prelief, and phenazopyridine are sometimes used to obtain relief.  Other bladder analgesics can be useful in some cases as well.  It is important to tailor the treatment to the individual, as triggers and symptom relieving regimens may differ from person to person.  I also encourage patients to undertake an overall wellness program, consider acupuncture as well as restorative, stress-relieving techniques such as yoga to help deal with the problem.  I refer my patients to the Interstitial Cystitis Network (www.ic-network.com) to find dietary suggestions and a community of support.  If you suspect you have such a condition and wish to make an appointment for a consultation, you may contact my office at 561-701-2841.
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Author
Linda Kiley, MD Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.

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