Painful Bladder Syndrome

Causes

Although the symptoms are similar to those of a bladder infection , there is usually no clear cause. Bacteria, fungi, and/or viruses are rarely found in the urine of people with interstitial cystitis. Possible causes include:

• An autoimmune response that occurs following a bacterial infection of the bladder
• A leaky inner lining of the bladder that allows irritating substances in the urine to come into contact with the bladder wall

Risk Factors

Interstitial cystitis is more common in women.

Other factors that may increase the chances of interstitial cystitis:

• History of urinary tract infections
• Irritable bowel syndrome
• Associated pain disorders, such as fibromyalgia or chronic fatigue syndrome

Symptoms

The symptoms of interstitial cystitis vary from person to person. They can also occur in cycles. Symptoms may include:

• Urgent need to urinate.
• Frequent need to urinate several times a day.
• Discomfort, pain, or pressure in the bladder or pelvic area when the bladder is full, and relief when the bladder is emptied
• Pain during and after intercourse or during orgasms
• Blood in the urine
• Depression
• Pain in the vulva or vagina in women, or in the testicles, groin, or tip of penis in men

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done.

Tests may include:

• Urine test
• Urine culture

Treatment

There is no known treatment to cure interstitial cystitis. Treatment is aimed at managing symptoms. You may have to try several different treatments before you improve.

Treatment may include one or more of the following:

Bladder Distention

Some people experience relief after a bladder distention, which is done during a cystoscopy.

Bladder Instillation

During bladder instillation, a solution is put into the bladder through a tube in the urethra. It is held for anywhere from a few seconds to 15 minutes, and then voided. There are several different types of solutions used. Some solutions coat the bladder, some solutions are anesthetics, and some solutions are thought to decrease the inflammation.

Medications

Mediations may include:

• Over-the-counter pain relievers
• Prescription pain relievers
• Antidepressants
• Antihistamines
• Botulinum toxin A injections

Diet

There is no research linking diet to interstitial cystitis. However, many people find that changes in diet can help relieve pain. Different people have different foods that act as triggers. Foods commonly reported to aggravate interstitial cystitis include:

• Coffee
• Chocolate
• Artificial sweeteners
• Alcohol
• Acidic foods
• Carbonated beverages

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS uses an external device that sends mild electrical impulses into the body. It has helped relieve pain and decrease the frequency of urination in some people.

InterStim Therapy

InterStim therapy uses an approved device. It has been reported to possibly provide relief in some people with interstitial cystitis who do not respond to other treatments. The electronic device is implanted into the sacral nerve roots of the spinal cord. Electrical impulses are sent to these roots in regular intervals. The impulses are sent to adjust the neural output of the pelvic nerves supplying the bladder.

While some have reported some relief, they appear to be in the minority. Doctors do not know yet what makes the device helpful.

Bladder Training

Some people are able to train their bladder to have better control by setting a regular, timed schedule for emptying their bladder. The amount of time between voids is gradually increased. Bladder training should be attempted only after pain relief has been accomplished.

Surgery

Surgery is used after all other treatment methods have been exhausted and the pain remains severe. Surgical options include:

• Ulcer fulguration—instruments inserted through the urethra are used to burn ulcers with electricity or laser
• Ulcer removal—instruments inserted through the urethra are used to cut out ulcers
• Bladder augmentation—a segment of bowel is used to increase the capacity of the bladder
• Cystectomy —removal of the entire bladder

Surgery is rarely done for this condition. Many people continue to have pain even after surgery.

Prevention

There are no current guidelines for preventing interstitial cystitis because the cause is unknown.