Treatment For Ic Bladder Pain

What Are The Symptoms Of Ic / Pbs

The key symptoms of IC/ PBS are pain, frequency of urination and urgency .

Pain in IC / PBS:

• Is felt classically as the bladder fills with urine. Urination usually relieves the pain.
• May be experienced as a discomfort, tenderness, feeling of pressure on the bladder, burning sensation in the bladder or burning vaginal discomfort.
• May be felt in the lower abdominal area and can sometimes extend to the lower part of the back and/ or to the groin or thighs.
• May be constant or intermittent.
• May occur with sexual intercourse in both women and men.

Urgency is experienced as a constant and often intense need to pass urine.

Frequent urination usually occurs both day and night and in some patients may be very severe. It is not always related to a small bladder size and may be due to marked bladder hypersensitivity.

Particularly in the early stages of IC / PBS, some patients may have urgency and frequency without a true sensation of pain. What they may experience instead is a feeling of heaviness or pressure above the pubic bone.

Symptoms can begin gradually or suddenly and with no apparent reason.

In mild forms of IC / PBS or in the early stages of IC / PBS, symptoms may occur as transient attacks known as flares which may be mistaken for urinary tract infections. It is therefore important to have a urine culture to help distinguish these symptoms from a bacterial urine infection.

The symptoms of IC / PBS vary greatly from person to person and even in the same individual over time.

Should I Limit The Amount Of Fluids I Drink

No. Many people with bladder pain syndrome think they should drink less to relieve pain and reduce the number of times they go to the bathroom. But you need fluids, especially water, for good health. Getting enough fluids helps keep your kidneys and bladder healthy, prevent urinary tract infections, and prevent constipation, which may make your symptoms worse.9

What Is Interstitial Cystitis

Interstitial cystitis is a chronic, inflammatory, painful pelvic and bladder condition that can sometimes be difficult to treat. According to the Interstitial Cystitis Association, IC is also referred to by several other names, including painful bladder syndrome , bladder pain syndrome and chronic pelvic pain.

Is interstitial cystitis considered a disability? In some ways, yes. IC is sometimes said to be debilitating and can be associated with severe pain and limitations, negatively impacting peoples quality of life. Unfortunately, its considered a life long condition that must be managed on an ongoing basis, much like autoimmune disorders or digestive issues such as IBS.

Many people mistake IC for other health conditions, especially urinary tract infections . This is because these two conditions share similar symptoms, like bladder and pelvic pain. However, with IC there is no infection present, unlike with UTIs. IC can also be confused with chronic prostatitis in men, which experts believe has led to an under-diagnosis of IC among adult men.

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What To Expect From Your Provider

Be prepared to answer questions from your provider, such as:

• How often do you feel the urge to urinate with little or no warning?
• Do you feel the urge to urinate immediately after you’ve urinated?
• Do you ever urinate less than two hours after you finished urinating?
• Do you wake up at night to urinate?
• Do you have pain or burning in your bladder?
• Do you feel pain in your abdomen or pelvis?
• Are you currently sexually active?
• How much do your symptoms bother you?

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How Is The Diagnosis Made

The doctor must make sure that other diseases are not causing the symptoms. Similar symptoms may be caused by:

• a bladder infection or urinary tract infection
• radiation therapy to the pelvic area
• systemic diseases such as diabetes
• drugs and chemicals that may affect the bladder.

To make the diagnosis, your doctor usually begins with a general examination, including a pelvic exam and urinalysis. The urine is usually normal, with no signs of bacterial infection. For a definite diagnosis of IC, a cystoscopic examination is usually necessary. In this procedure, the patient is put under general anesthesia, the bladder is distended with water and the doctor uses a telescopic device to look inside the bladder. The doctor may also take a biopsy from your bladder to help exclude other conditions.

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What Causes Interstitial Cystitis

The exact cause of BPS is not clear. However, there are several ideas about what might cause it.

These include:

• damage to the bladder lining, which may mean pee can irritate the bladder and surrounding nerves
• a problem with the pelvic floor muscles used to control peeing
• your immune system causing an inflammatory reaction

Some people who have been diagnosed with BPS , may have a long-term urinary infection in the bladder, which has not been picked up by current urine tests.

BPS may also be associated with chronic conditions such as fibromyalgia, myalgic encephalomyelitis or chronic fatigue syndrome and irritable bowel syndrome .

Key Points About Interstitial Cystitis

• Interstitial cystitis is an inflamed or irritated bladder wall.

• The cause of IC is unknown and it does not get better with antibiotics.

• There is no best way to diagnose IC. A variety of tests may be needed. Urine tests will be done and imaging tests may be used to look at the different parts of the urinary tract and make sure everything is normal. Tissue samples may be removed from the bladder and examined under a microscope to see if cancer or other abnormal cells are present.

• Treatments are aimed at easing symptoms. A variety of procedures, medicines, and lifestyle changes may be advised.

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Home Or Lifestyle Treatments

For about half the cases, interstitial cystitis goes away by itself. Among those who need treatment, most find relief and get their lives back to normal.

Treatment is mainly about symptom control. It takes trial and error to find the right combination of treatments. And it usually takes weeks or months to calm the symptoms.

The first stage of treatment is to try to avoid triggers and try lifestyle changes that may help ease symptoms.

• Retrain your bladder to hold more urine. For example, if you feel the need to pee every 30 minutes, try to stretch it out to 45 minutes.
• Cut down on stress. It can be a trigger. Taking 5 minutes a day to do something for yourself can be a start. Stretch, read a book. Relaxation techniques, talking to a friend, or meditation may help.
• Wear loose clothing. Tight clothes can put pressure on your bladder.
• Do low-impact exercise. For example, walk or stretch.
• Change what you eat and drink to avoid triggers. See below for examples of possible trigger foods and drinks.
• If you smoke, quit.

A lot of people find that certain foods or drinks irritate their bladders. You donât have to cut these all out at once. Notice when your symptoms are bad and think back on if you ate or drank any of these. It may be a good idea to keep a food and symptom journal. Take note of what you have each day and how you feel. You can look back to see if there are connections. Not all of these will bother every person.

Common triggers:

How Is It Diagnosed

Thereâs 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.

In women, endometriosis is another possibility. For men, IC can be mistaken for an inflamed prostate or chronic pelvic pain syndrome.

These tests can rule out other conditions:

• Urinalysis and urine culture. Youâll be asked to pee in a cup. Itâll 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 doesnât 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. Youâll 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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New Approaches In Managing Interstitial Cystitis/bladder Pain Syndrome

Amber Jerauld, PharmD, BCACPAmbulatory Care Clinical Pharmacy SpecialistUHS Hospitals

Ambulatory Care Clinical Pharmacy SpecialistPGY-1 Pharmacy Resident Program DesigneeUHS Hospitals

Brent Carlson, PharmD, BCPS, BCCCPCritical Care Clinical Pharmacy SpecialistPGY-1 Pharmacy Residency Program DirectorUHS HospitalsJohnson City, New York

US Pharm

ABSTRACT:Interstitial cystitis/bladder pain syndrome is a chronic condition of the bladder, which causes pain or discomfort in the absence of infection or other identifiable causes. The exact etiology of IC/BPS is unknown, leading to controversy regarding treatment. The American Urological Association guideline recommends a stepwise approach in the selection of treatment options, based on patient characteristics and the severity of symptoms. Due to the difficulty in fully understanding this condition, the goal of therapy is to provide symptom relief and improve quality of life.

Can Eating Certain Foods Or Drinks Make My Bladder Pain Symptoms Worse

Maybe. Some people report that their symptoms start or get worse after eating certain foods or drinks, such as:16

• Citrus fruits, such as oranges
• Drinks with caffeine, such as coffee or soda

Keep a food diary to track your symptoms after eating certain foods or drinks. You can also stop eating foods or drinks one at a time for at least one week to see if your symptoms go away. If not, stop eating other trigger foods or drinks one at a time for one week to see which ones may be causing some of your symptoms.

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Presentation Of Male Ic Patients

Historically, IC/BPS in men has been considered relatively unusual with a female to male ratio of 10:1.3, 59 However, uncontrolled clinical series over the past two decades have suggested the incidence of male IC/BPS may be higher than previously observed.5, 60 IC/BPS in men is diagnosed by identifying the same symptom complex that makes the diagnosis in women. That is, if the man fulfills the criteria established by the definition of IC/BPS , he can be assumed to have the disorder. In the MAPP Study which enrolled men and women with IC/BPS and/or CP/CPPS, about 3 out of 4 men had symptoms of painful bladder filling and/or painful urgency, consistent with IC/BPS. The data suggested that the overlap between IC/BPS and CP/CPPS in men is under-appreciated and that many men with CP/CPPS-like symptoms may in fact have IC/BPS if the bladder pain/storage symptoms are inquired. Men with IC/BPS is less likely to report perineal pain as their most bothersome symptom. Instead, men with IC/BPS are more likely to have suprapubic tenderness.58 Early clinical symptoms may begin with mild dysuria or urinary urgency. Mild symptoms may progress to severe voiding frequency, nocturia, and suprapubic pain.

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Neuromodulation Sacral And Pudendal

Sacral neuromodulation has been studied for the treatment of symptoms in BPS. The two-stage procedure involves a test phase followed by implantation of the permanent stimulator. The implanted electrode and conducting lead stimulate the afferent sacral nerves as they exit the sacral foramina. Several small studies have investigated the use of SNM in patients with severe BPS, with conflicting results.

The long-term efficacy of SNM was evaluated in patients from a single centre.70 Between 1994 and 2008, 46 out of 78 patients had a positive 1st stage percutaneous stimulation response and subsequently had permanent implantation. All patients had cystoscopic evidence of Hunner lesions or glomerulations. After 5 years, more than 50% improvement in GRA scale was observed in 70% of patients and the average improvement on the GRA scale in these patients was 80%. Of the 28% of patients who had the electrode and leads removed, the chief reason cited was poor outcome. Fifty per cent of all patients underwent device revision at some point during the 5-year follow-up.

These positive outcomes have been confirmed in a recent meta-analysis, including 12 studies and 583 patients.71 SNM was associated with significant reductions in pelvic pain, frequency, nocturia, urgency, and Interstitial Cystitis Problem Score. Overall pooled treatment success rates were 84% .

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What Is The Latest Research On Bladder Pain Syndrome Treatment

Researchers continue to search for new ways to treat bladder pain. Some current studies focus on:

• New medicines to treat bladder pain
• Meditation as a way to control bladder pain
• The role of genetics in bladder pain
• Acupuncture treatment

To learn more about current bladder pain treatment studies, visit ClinicalTrials.gov.

Natural Treatments For Interstitial Cystitis /bladder Pain Syndrome : Getting To The Root Causes

Interstitial cystitis , also called bladder pain syndrome or painful bladder syndrome, is a chronic condition affecting both women and men with symptoms that can range from mild irritation to severe pain.

The condition can be difficult to treat and many patients are left suffering with very little hope for improvement.

Im happy to say that I have helped many patients suffering from the debilitating pain of IC who turn to naturopathic medicine as a last hope.

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Changes To Your Lifestyle

It is likely that you will be recommended to make some changes to your lifestyle, especially your diet. Certain foods and drinks can irritate the lining of your bladder and make your symptoms worse. These may include alcohol, tomatoes, spices, chocolate, caffeinated and citrus drinks and acidic foods. It may be worthwhile making a food diary to try to assess which foods aggravate and worsen your symptoms.

The simplest way to find out whether any foods bother your bladder is to try an elimination diet for one to two weeks. On an elimination diet, you stop eating all foods that could irritate your bladder. If your bladder symptoms improve while you are on the elimination diet, this means that at least one of the foods was irritating your bladder. The next step is to find out exactly which foods cause bladder problems for you. You should then try eating one food from the list of foods you stopped eating. If this food does not bother your bladder within 24 hours, this food is likely safe and can be added back into your regular diet. The next day, try eating a second food from the list, and so on. In this way, you will add the foods back into your diet one at a time and your bladder symptoms will tell you if any food causes problems for you.

Some people look at ways to reduce their stress levels, as this can actually improve their symptoms.

Optimizing Psychosocial Treatment Of Interstitial Cystitis/bladder Pain Syndrome

Interstitial cystitis/bladder pain syndrome is a debilitating, incurable, and costly pain condition affecting approximately 3-8 million individuals in the United States and is extremely challenging to treat. Evidence suggests psychosocial factors accompany and intensify the illness.

Information from the National Library of Medicine

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How Is Interstitial Cystitis /bladder Pain Syndrome Diagnosed

Interstitial cystitis /bladder pain syndrome tends to be a diagnosis of exclusion.

Its critical to differentiate chronic UTI from interstitial cystitis /bladder pain syndrome .

Your doctor should take a comprehensive patient history and order testing to rule out infections, neurological disorders, kidney stones, cancer, endometriosis, pelvic masses, prostate enlargement and other structural abnormalities.