Bladder pain / interstitial cystitis

What is Painful Bladder or Interstitial Cystitis?

Interstitial Cystitis (IC) is a chronic inflammation of the bladder wall, which can also be diagnosed as Painful Bladder Syndrome (PBS) or Bladder Pain Syndrome (BPS).
It is a disorder with symptoms of mild to severe bladder pain and an urgent and/or frequent need to urinate.

How common is IC/PBS?
There is an estimated 400,000 people in UK with IC/PBS, of whom 90% are females and 10% are males.

What causes IC?
The cause of IC is not yet known. Research continues to find the cause. Indications suggest the condition could be due to a defective bladder lining, or an autoimmune disorder. IC may resemble a bacterial bladder infection, however short term antibiotics are not effective.

What are the main symptoms of IC?
People who have interstitial cystitis may have the following symptoms:
• An urgent need to urinate, (yet you may pass only very small amounts of urine each time) and increased frequency both in the daytime and during the night
• Pressure, pain and tenderness around the bladder, pelvis and perineum (the area between the anus and vagina). This pain and pressure may increase as the bladder fills and decrease as it empties in urination.
• A bladder that won't hold as much urine as it used to
• Pain during sexual intercourse

How is IC diagnosed?
IC is diagnosed by elimination. If the symptoms are suggestive of IC, diagnostic tests such as Urodynamics (bladder pressure studies) or Cystoscopy (looking inside the bladder with telescope) are performed to rule out other similar conditions like overactive bladder. Repeated midstream urine samples might be checked to rule out bacterial cystitis. It can take time to obtain a correct diagnosis as symptoms of IC/PBS can be similar to other conditions.

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How is IC treated ?

As yet there is no cure for IC, so treatment approaches are designed to control symptoms. Each patient has his or her own unique subset of bothersome symptoms. Many a times you need specialist team to design therapies to alleviate each of your symptoms. Most people feel better after trying one or more of the following treatments:
• Diet. Your doctor may tell you to change what you eat. You may need to avoid alcohol, acidic foods and tobacco.
• Bladder distension. Under anaesthesia, a doctor overfills your bladder with gas or fluid. This stretches the walls of the bladder.
• Bladder instillation for Interstitial Cystitis (also called a bladder wash or bath), a procedure in which the bladder is filled with a therapeutic solution (usually containing a combination of agents) that is retained in the bladder for varying periods of time, from a few seconds to 15 minutes, before it is released through urination. Doctors use treatments that are thought to either coat and protect the bladder or suppress inflammation.
• Medications for Interstitial Cystitis such as Elmiron (the first oral medication approved specifically for IC) ,an antihistamine called hydroxyzine, amitriptyline. It blocks pain and reduces bladder spasms. This medicine can make you sleepy, so it is usually taken at bedtime. Your doctor may also suggest that you take an over-the-counter pain medicine to ease pain. Doctors may also prescribe antihistamines to alleviate inflammation in the bladder, antidepressants for their anti-pain properties, and analgesics for pain relief.
• Transcutaneous posterior tibial nerve stimulation for Interstitial Cystitis in which doctors send mild electric pulses to a nerve in the foot through a small acupuncture needle. These pulses may work by increasing blood flow to the bladder, strengthening pelvic muscles that help control the bladder, and triggering the release of hormones that block pain.
• Bladder training for Interstitial Cystitis is a therapeutic technique in which patients void at designated times and use relaxation techniques and distractions to help keep to the schedule. Gradually, the patient tries to lengthen the time between the scheduled voids.
• Interstim for Interstitial Cystitis is a small pacemaker that sends impulses to the sacral nerve, which controls the bladder. Some patients with IC find that it helps relieve their frequency, but it is usually reserved for patients who have not responded to other treatments.
• Diet modification to treat Interstitial Cystitis may help alleviate symptoms because alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods can contribute to bladder inflammation, some physicians and patients believe. Although there is no scientific evidence linking diet to IC, eliminating these substances from the diet helps some people with IC.
• Smoking cessation to treat for Interstitial Cystitis is important because the chemicals in cigarette smoke can concentrate in the urine and irritate the bladder wall.
• Exercise to treat Interstitial Cystitis can help relieve IC symptoms in some people or even hasten remission.