Can Overactive Bladder Be Controlled
Overactive bladder therapy can be challenging to manage. However, many people are very satisfied with the treatment they receive and they often see a dramatic improvement in their quality of life. Your doctor will guide you to the best steps to begin with and give you options for any additional treatments you may need over time.
Some people may also find the following therapies and supportive treatments helpful:
- physiotherapy a specialist pelvic floor physiotherapist can help you relax your muscles to ease pain.
- acupuncture may help with pain relief
- talking therapies and counselling to help you cope with your symptoms and their impact on your life
- transcutaneous electrical nerve stimulation where a small battery-operated device is used to relieve pain by sending electrical impulses into your body
- pain management ask the GP to refer you to a pain specialist
Is It Overactive Bladder Or Interstitial Cystitis
No one wants to be told that they have Interstitial Cystitis . I know I sure didnt. Even when you dont know what IC is yet , you still hear the part of the diagnosis that says no known cause and no known cure. Im guessing that some doctors must hesitate to diagnose it or at least wish that they didnt have to tell someone that they have it. Im guessing this because I dont want to tell you that you have it either. However, if it were me back when I was experiencing what they are now calling Overactive Bladder, I would have wanted to know. I would have wanted to know why my bladder was overactive and I would have wanted to know how to prevent it from getting worse. No doubt I would have also wanted a magic pill to fix me where I didnt have to go to the bathroom all the time. In fact, Im sure this is the way I would have gone had I seen those gotta go commercials years ago. However, I still believe that I would have wanted to know the truth even if I were one of the lucky ones that the pill actually helped, I believe it because if I had known then what I know now, I could have prevented a whole series of mistakes that led to a full-blown IC nightmare. So okay, Im just going to say it. Im afraid if youve been told that you have Overactive Bladder that most likely what you really have is a mild case of Interstitial Cystitis.
What Happens When You See A Gp
BPS can have similar symptoms to long-term or frequent UTIs, so the GP may give you a urine test to check for a UTI.
Standard urine tests used in GP surgeries and hospitals may not pick up all infections of the bladder. You may be prescribed antibiotics to see if they help.
A GP may also suggest simple treatments such as:
- keeping a food diary and avoiding foods and drinks that make your symptoms worse
- stopping smoking chemicals in tobacco can irritate your bladder
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Cortical Regulation: Stress Anxiety And Depression
The sensory signals from bladder afferent converge in the PAG where they are modulated by input from the limbic system , insula, and prefrontal cortex , which can in turn modulate or be modulated by the hypothalamic pituitary adrenal axis. As such, changes to cortical networks or modulation of the emotional affective state can have profound effects on bladder sensation and may be an underlying mechanism in the development and persistence of OAB and IC/PBS symptoms.
The link between stress and bladder disorders is supported by pre-clinical studies in rodents that consistently induce bladder overactivity or mechanical hyperalgesia following stress-treatments . In addition, this hypersensitivity has been found to be dependent on , or correlate with, significant changes in brain regions associated with emotional processing and bladder control . Neonatal maternal separation in female mice, as a model of ELS, enhances visceromotor responses to urinary bladder distension accompanied by altered hippocampal input onto the HPA axis . If sensitisation of peripheral afferent endings occurs in these models as a consequence of stress, or if sensitisation is arbitrated solely within the CNS has yet to be fully determined.
How Is It Diagnosed
ThereÃ¢s no test for interstitial cystitis. If you go to your doctor complaining about bladder pain along with frequency and the urgency to pee, the next step is to rule out what else it could be.
Both men and women would first need to rule out urinary tract infections, bladder cancer, sexually transmitted diseases, and kidney stones.
These tests can rule out other conditions:
- Urinalysis and urine culture. YouÃ¢ll be asked to pee in a cup. ItÃ¢ll be sent to a lab to check for infection.
- Postvoid residual urine volume. Using an ultrasound, this test measures the amount of pee that remains in your bladder after you go to the bathroom.
- Cystoscopy. A thin tube with a camera is used to see the inside of the bladder and urethra. This is usually done only if there is blood in your pee or if treatment doesnÃ¢t help.
- Bladder and urethra biopsy. A small piece of tissue is taken and tested. This is usually done during cystoscopy.
- Bladder stretching. Your bladder is filled with liquid or gas to stretch it out. YouÃ¢ll be asleep under anesthesia. Sometimes this is also used as a treatment. This is done with a cystoscopy.
- Prostate fluid culture . Your doctor will need to press on your prostate and milk a sample to test. This is not commonly done.
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Diagnosis Of Interstitial Cystitis
In diagnosing interstitial cystitis, interviews are used to confirm symptoms and cystoscopy to see if other similar diseases can be ruled out.
The reddish mucous membrane is common in interstitial cystitis. Patients with interstitial cystitis have difficulty retaining enough urine and keep their bladder from expanding. Therefore, if you fill the bladder with water, dilate it, and drain it, you will see punctate bleeding from the bladder mucosa.
What You Need To Know
- Interstitial cystitis is a chronic pain condition. Diagnosis and treatment can be difficult, as the exact cause is unknown.
- No specific test exists to diagnose interstitial cystitis it is often diagnosed after other conditions have been ruled out.
- Genetic and immune disorders, recurrent bacterial infections, and pelvic floor dysfunction are possible factors that can lead to this condition.
- Excessive frequency of urination, urinary urgency, and urethra, bladder or pelvic pain are common symptoms.
- Treatment is divided into five phases, ranging from lifestyle changes to injections to surgery.
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How Common Is Ic/bps
BPS /IC is a chronic condition with unknown aetiology As the definition of IC/BPS has evolved it is seen now as a diagnosis of exclusion with no definitive diagnostic test hence it is difficult to estimate prevalence, which can be dependant on whether symptoms are clinician assigned or patient reported. We know from NHS Digital that in 204/15 that there were over 330,000 Patient Episodes of Urinary related problems including IC.
Having the right information about your condition is vital.
Overactive Bladder Vs Interstitial Cystitis: Overlapping Conditions
Posted by John Thomas Stoffel, MD | May 2022
John Thomas Stoffel, MD, presented Overactive Bladder vs. Interstitial Cystitis: Overlapping Conditions? during the 41stAnnual Ralph E. Hopkins Urology Seminar on February 3, 2022, in Jackson Hole, Wyoming.
How to cite: Stoffel, John Thomas. Overactive Bladder vs. Interstitial Cystitis: Overlapping Conditions? February 3, 2022. Accessed Aug 2022. https://grandroundsinurology.com/overactive-bladder-vs-interstitial-cystitis-overlapping-conditions/
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What Causes Interstitial Cystitis
The exact cause of interstitial cystitis isnt clear. Unlike other types of cystitis, theres no obvious infection in the bladder and antibiotics dont help.
There are several theories about the possible cause of the condition, including:
- damage to the bladder lining, which may mean urine can irritate the bladder and surrounding muscles and nerves
- a problem with the pelvic floor muscles
- your immune system mistakenly attacking your bladder
- an allergic reaction
Who Gets Interstitial Cystitis
As many as 90% of people with IC are women. Somewhere between about 3% to 6% of adult women have some form of IC. Thatâs about 3 million to 8 million American women. About 1.3% of American men also have it.
On average, people first start having problems in their 40s. The risk of getting it goes up as you get older.
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Influence Of Childhood Traumatic History Anxiety And Depression On Perceived Stress Levels
Stress levels may be influenced by psychosocial factors such as childhood traumatic events, anxiety and depression. These factors were assessed using the childhood traumatic event scale and the hospital anxiety and depression scale , respectively . OAB patients with a childhood history of sexual trauma or physical trauma reported higher stress levels on the PSS compared to OAB patients without such a history . OAB patients with higher anxiety scores had higher stress levels than those with lower anxiety scores , PSS of 23.1Â±1.3 versus 11.9Â±1.1, p< 0.0001. OAB patients with higher depression scores had higher stress levels than those with lower depression scores , PSS of 22.9Â±1.2 versus 15.1Â±1.4, p=0.014.
Current Treatments For Interstitial Cystitis Painful Bladder Syndrome Overactive Bladder Or Urethral Syndrome
At the moment the outlook for people diagnosed with IC/PBS/OAB or US is grim. Popular advice includes making lifestyle changes and learning to cope.
Sufferers are offered surgery or prescribed painkillers, including opiates, bladder relaxants and bladder instillations to alleviate symptoms. Bladder instillations had no more effect than a placebo, a recent large-scale study found.
As no treatment does very well in trials, there is no universally agreed care pathway. Standard treatments are known to be ineffective and often risky. They aim only to help with symptoms rather than trying to cure.
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Difference Between An Overactive Bladder Vs Ic
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First Things First: Do You Have A Bladder Infection Or Not
The reason female voiding dysfunction is difficult is that all the symptoms that are irritative in nature occur with a bladder infection as well. The first response by doctors to the above symptoms is to prescribe an antibiotic. If the symptoms are not from a bladder infection but from IC or overactive bladder , then the symptoms will not improve. What often happens is that the patient then gets a vaginal infection from the antibiotics which complicates the diagnostic and therapeutic picture.
- A bladder infection will have white cells in the urine
- A bladder infection will have a positive urine culture
- A yeast infection will burn to void and when not voiding
- A bladder infection burns only when you urinate
- Sometimes you have to treat a bladder and vaginal infection
- If no vaginal infection, anti-yeast medicines wont help
- If no bladder infection, antibiotics wont help
- Overactive bladder and IC symptoms are not because of infection
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Oxalates And Interstitial Cystitis
Oxalates are the salt form of oxalic acid, an acid that is found in many plant foods and can also be produced in the body.
Oxalic acid can form oxalate crystals when binding to minerals such as calcium. When deposited in the body, these can cause a lot of pain, similar to tiny glass shards.
This is probably most well-known with regards to kidney stones, which can often be oxalate/calcium stones.
There is also some evidence that excess oxalates could play a role in painful bladder conditions, such as interstitial cystitis. However, this evidence is more anecdotal than based on scientific studies . Today I would like to look at some potential connections between oxalates and interstitial cystitis.
I dont believe that there is one single cause to so-called interstitial cystitis, which is why I try to look at the different possibilities. I had heard about the potential of high-oxalate foods before, but oxalates recently peaked my interest when some of my own test results showed high oxalic acid levels. Not much later, I also spoke to a client whose urinary symptoms seemed to get worse when high-oxalate foods were consumed.
Oxalates And The Urinary Tract
Oxalates can form in the kidneys, as well as the bladder and ureter. If they grow big enough, they become kidney stones and can cause a lot of pain.
But even small crystals have the potential of causing pain. Some of these crystals can have very sharp ends.
The shape of oxalate crystals somewhat depends on which mineral they bind to. Calcium stones for example can look like little stars or even corals. Zinc crystals can look like little discs with very sharp edges.
Oxalate stones seem to be more common in the kidneys and therefore, there seems to be a chance of high oxalates affecting the urinary tract.
Now what would happen if smaller crystals were present in high amounts in the urinary tract, without being full-blown kidney stones? Well they might just have the potential to cause some pain and potentially damage.
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Patients With Refractory Overactive Bladder May Have Interstitial Cystitis
Investigators have suggested that some patients diagnosed with OAB, particularly those refractory to treatment with anticholinergics, may have IC.7,23 One recent retrospective study examined the prevalence of IC in 47 symptomatic women diagnosed with idiopathic detrusor overactivity.7 Following a trial of oxybutynin and/or tolterodine or imipramine, 22 women had a satisfactory response to treatment .7 Of the 25 remaining women who were considered to have refractory detrusor overactivity, 24 had a positive potassium sensitivity test , which supports the diagnosis of IC .5,7 In a separate study of 28 women with refractory detrusor overactivity who had failed to respond to anticholinergics, 8 were found to have increased mast cell counts in the detrusor muscle, consistent with the histological features of IC. Five of the women with increased detrusor mast cell counts who also had clinical and cystoscopic features of IC, including petechial hemorrhages and decreased bladder capacity, were given treatment for IC, and in all cases the symptoms were relieved.24 These findings provide support for considering IC in patients with detrusor overactivity refractory to anticholinergic treatment.7
About The 41st Annual Ralph E Hopkins Urology Seminar:
The Ralph E. Hopkins Urology Seminar is a multi-day meeting focused on training urologists in the latest in assessing, diagnosing, and treating urologic conditions in the clinical setting. Updates are provided on urologic cancers, stone disease, urologic reconstruction, female urology, infertility, emerging surgical techniques, and general urology. Dr. Stoffel presented this lecture during the 41st iteration of the meeting on February 3rd, 2022 in Jackson Hole, Wyoming.
For further educational activities from this conference, visit our collection page.
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Oab Or Ic Symptoms In The Presence Of Blood In The Urine
- If a female has these symptoms and there is blood in the urine there is the possibility of a small ureteral stone near the bladder exists
- The blood must be proved to be benign with CT Scan and cystoscopy
Now to the issues of your bladder unrelated to an infection and requires treatment modalities that dont utilize antibiotics and require the expertise of someone in tune with what you are experiencing. You know who you are. We at the Northeast Georgia Urological Associates understand the frustration of bladder disorders and want to help. Christie Woodruff, our nurse practitioner, has a particular interest in these disorders in females. She, along with the over thirty years of experience of the NGUA physicians treating these type of conditions, is anxiously awaiting beginning the process of making things better.
Christie on the Radio Discussing Interstitial Cystitis-A Podcast.
Correlation Between Perceived Stress Levels And Urinary Symptoms Among Oab Patients
Among OAB patients, high perceived stress levels on the PSS was positively correlated to total scores on ICIQ-UI , UDI-6 , IIQ-7 , and quality of life subscale on the OAB-q , see Table . No significant correlation between perceived stress levels and the following instruments was observed: ICIQ-OAB, symptom bother subscale on the OAB-q, USS, and the numeric ratings of their urgency or frequency .
Table 2 Correlation of perceived stress levels and urinary symptoms among OAB patients
When the specific items of the ICIQ-UI questionnaire was examined separately in an exploratory analysis, two of the items was also positively correlated to perceived stress levels on the PSS .
When the four items of the ICIQ-OAB questionnaire was examined separately in an exploratory analysis , response on the urinary incontinence question was positively correlated to perceived stress levels on the PSS . On the other hand, responses on the frequency question , nocturia question and urgency question did not show any significant correlation to the PSS .
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Things You Can Do To Help Bps
Things that may help improve your symptoms include:
- reducing stress try exercise, warm baths and mindfulness-based meditation techniques
- making sure you are hydrated regularly throughout the day
- keeping a food diary if you notice certain foods or drinks make symptoms worse, avoid them, but ask for medical advice first
- stopping smoking the chemicals in cigarettes can irritate your bladder