Painful bladder syndrome

Interstitial cystitis, also known as painful bladder syndrome, is a condition that results in recurring discomfort or pain in the bladder and surrounding pelvic region. Symptoms vary between person to person and vary from mild discomfort to intense pain. Interstitial cystitis affects more females than males.

What is the cause of interstitial cystitis?

There is no known cause of interstitial cystitis but there are several theories including:

  • An autoimmune response (the body’s own immune system may attack the bladder).
  • Leaking bladder lining (this is a defect in part of the lining of the bladder – glycosaminoglycans (GAG) layer. This could allow urine to irritate and inflame the bladder).
  • Histamines – the symptoms of interstitial cystitis may be caused by an allergic reaction leading to the release of histamine from cells. The histamines cause swelling and inflammation of the bladder lining.
  • Toxic urine – it may be an agent in the urine which irritates and inflames the bladder.
  • Post surgical condition – the condition is known to occur after a hysterectomy although it’s not clear why.
  • Anti-inflammatories – the use of non steroidal anti-inflammatory drugs have been linked to IC.
  • Infection – such as a viral infection

You may experience the following signs and symptoms

  • Pain during bladder filling, when the bladder is full or when voiding.
  • Pain during sexual intercourse.
  • Pain may also be felt in the pelvis, abdomen and vagina.
  • The need to frequently urinate during the day and overnight.
  • The need to urgently urinate (this means you are unable to delay urination) which may also be accompanied by frequency.

How is interstitial cystitis diagnosed?

  • Urine culture: this is to check for an infection
  • Cystoscopy: this is when a telescope is inserted into your bladder via the urethra to check the lining of the bladder. In some cases, a red patch known as Hunner’s ulcer is seen in the dome of the bladder which is diagnostic of interstitial cystitis.
  • Urodynamics: this will show you how much urine is in the bladder before you feel the need to urinate and how much you bladder can hold.
  • Hydro distension: this is when the bladder is distended using water or saline. This procedure can demonstrate tiny spots of bleeding from the bladder lining when the fluid is released called glomerulations.
  • Biopsy of the lining of the bladder: to exclude other diseases including malignancy.

How is interstitial cystitis treated/managed?

There is no cure for interstitial cystitis. Treatment and management is aimed at finding relief and achieving remission for each person.

  • Hydro distension (this is when the bladder is distended using water or saline): this procedure is performed under anaesthesia. Relief from symptoms occurs in approximately half of patients. If the procedure is successful, relief can be obtained for weeks or even months. If successful, the procedure can be repeated.
  • Instilled medications – these are medications inserted into the bladder. The solution is held in the bladder for 10-15mins. The medication installed is Dimythyl Sulfoxide (also called DMSO) and is administered once a week for approximately 6 weeks. DMSO is known to reduce inflammation in the bladder and block or reduce pain. Other medications include: Heparin (this may be mixed in with DMSO), Clorpactin (washout of the bladder under anaesthetic) or Bacillus Calmette-Guerin (BCG – this is also instilled in the bladder weekly for six weeks).

A new instillation called iAluril is now available. Ialuril works by helping to repair the damage layer (GAG layer) in the bladder thereby restoring the bladder’s protective coating and therefore relieving symptoms. This is administered directly into the bladder through a catheter. The catheter is then removed and you are instructed to leave the solution in your bladder for ½ hour before urinating normally. Treatment is initially weekly for 4 weeks then once every 2 weeks for the second month then monthly until symptoms settle.

  • Oral drugs – Elmiron 100mgs can be taken 3 times per day. Pain relief from this oral agent may take up to 4 months and a decrease in urinary frequency may take up to 6 months. Patients are encouraged to take this for 6 months and if no relief after that time then it may be stopped. This medication, although available in Australia, is very expensive. Other medications include: antidepressants (used to block the pain), antihistamines (used to reduce the inflammation in the bladder) and Gabapentin (used for pain relief).
  • Electrical nerve stimulation (transcutaneous electrical nerve stimulation – TENS). These are mild electrical impulses that enter the body for minutes to hours two or more times a day and works to relieve pain.
  • Bladder retraining: these are techniques used to help you reduce urinary frequency once pain relief is adequate.
  • Pelvic floor exercises: these exercises help to strengthen your pelvic floor muscles.
  • Surgery: Surgery is indicated when available treatment options have failed. Surgical options:
  1. Fulguration (burning the ulcer using laser) and removal of hunner’s ulcers.
  2. Augmentation Cystoplasty – (enlarging the bladder using part of the bowel)
  3. Cystectomy (removal of bladder) and formation of ileal conduit.
  • Diet modification – avoiding foods that may irritate the bladder including alcohol, caffeine, citrus beverages and foods high in acid such as tomatoes.
  • Smoking – avoid as smoking is a major cause for bladder cancer.
  • Physical activity – Exercise helps with general wellbeing both physically and mentally.

For more information and support

The Interstitial Cystitis Association

The International Painful Bladder Association

The Continence Foundation of Australia
(Fact sheets – Bladder training and Pelvic Floor exercises)
National Continence Helpline: 1800 33 00 66

The Interstitial Cystitis Network and Overactive Bladder

References:

  1. http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis
  2. www.ncbi.nlm.nih.gov