Interstitial Cystitis: Guest Feature by Dr. Martha B. Boone

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Interstitial Cystitis
By Dr. Martha Boone

Interstitial Cystitis is a chronic inflammatory condition of the bladder. Its cause is unknown. The most common type of cystitis in women is caused by a bacterial infection and can usually be treated with antibiotics.

Interstitial Cystitis is NOT caused by bacteria and does not respond to conventional antibiotics therapy, in most cases. Interstitial Cystitis can present with a variety of complaints.

Interstitial Cystitis is also known as the painful bladder syndrome. It can be a chronic condition in which bladder pressure, bladder pain, pelvic pain, frequency, and urgency can appear in any combination of symptoms. The most common symptom seen in clinical practice is discomfort when the bladder is full and a feeling of relief when the bladder is empty.

Interstitial Cystitis (IC) is different from urinary tract infection. A urinary tract infection is actually caused by a bacteria that is found in a urine culture. Interstitial Cystitis (IC), to the best of our current knowledge, is not an infectious disease. IC is felt to be most likely an inflammatory disease of the bladder. The cause of IC remains unknown despite many years of research.

Signs and symptoms of IC:

Pain in your pelvis between the vagina and anus. For men, pain in the scrotum and anal area, and pain above the pubic bone.

Chronic pelvic pain.

Urgent need to urinate.

Frequent urination of small amounts throughout the day and night.

Pain or discomfort when the bladder fills and relief after urinating.

Painful intercourse.

Even though the cause of IC is not known, there are several theories. Some believe that the bladder’s protective lining has been damaged in some manner. Others believe that IC may be a type of autoimmune reaction. Some researchers have felt that heredity plays a part. Prior bacterial infections can predispose a person to IC and some researchers believe that it may be at least partially an allergic reaction.

IC may improve on its own or the patient may have cyclical episodes of IC “flares”. Risk factors include being female:

Sex
Women have a 90% greater incidence of IC than men.
Age
Most people with IC are diagnosed during their 30’s or older. There are however, cases of younger people with IC.
Any chronic pain disorder.
People who have irritable bowel syndrome, fibromyalgia, migraine headaches, and any other chronic pain disorder, appear to be more prone to IC.

IC can result in a number of complications:

Reduced bladder capacity: IC can lead to the deposition of collagen in the bladder wall which can make the bladder wall stiff. This can lead to a reduced bladder capacity which means your bladder holds less urine.

Decreased quality of life: Frequent urination and pain can interfere with activities, work, and daily enjoyment of life.

Sexual problems: Frequent urination and pain with intercourse can strain personal relationships and make intimacy difficult.

Emotional problems: Chronic pain and interrupted sleep association with IC can lead to emotional stress and the lack of sleep can actually lead to depression.

Diagnosis:

Medical History and Bladder Diary. Your doctor will ask you to describe your symptoms so we request that you keep a bladder diary to include the volume of fluid that you drink and the volume of urine that you make.

Pelvic Examination. During a thorough pelvic examination, your doctor will check for any gynecological causes of your pelvic pain.

A urine test. Your doctor will perform a urinalysis and urine culture to be certain you are not suffering from a bacterial infection.

Many Facilities perform a Potassium sensitivity test. It is my feeling that this test is not necessary and can lead to an inordinate amount of pain, urgency and discomfort that is not necessary to make the diagnosis.

Cystoscopy. With Cystoscopy your doctor will insert a small scope with a tiny camera into your urethra to evaluation the lining of your bladder. This can be performed in the operating room along with distention of your bladder and possible irrigation of your bladder with anti-inflammatory drugs. Cystoscopy is performed mostly to rule out bladder cancer.

Bladder Biopsy. Bladder biopsy is not absolutely necessary to the diagnosis to IC. Biopsy is done to determine the degree of inflammation and to rule out bladder cancer.

To have the diagnosis of IC, all that is necessary is for you to have symptoms of a urinary tract infection (frequency or urgency or burning with urination or pelvic pain, or a feeling of discomfort with bladder filling) and to have had 3 negative urine cultures.

TREATMENTS FOR IC:

There are many treatments for IC and each of them has approximately a 75% success rate:

Physical therapy: Decreasing the muscle tenderness and restrictive connective tissue can greatly aid in decreasing symptoms of IC.

Oral medications: Advil, Motrin, Naproxen, and Tramadol.

Amitriptyline is world-wide the most prescribed drug for IC and felt by many to be the most effective.

Antihistamines (Claritin, Atarax)

Pentosan (Elmiron) is the only FDA approved drug for IC. It is believed to have anti-inflammatory effects and to restore the innersurface of the bladder lining.

Other techniques include:

Transcutaneous Electrical Nerve Stimulation Unit. This mild electrical pulse can relieve the pelvic pain and in some cases, reduces the urinary frequency. (TENS)

Sacral Nerve Stimulation. Your sacral nerves are your primary link between the spinal cord and the nerves in your bladder. Stimulating these nerves may reduce urinary urgency association with IC. With sacral nerve stimulation, a thin wire is place at the sacral nerve and it delivers light electrical impulses to your bladder. The advantage to this therapy, is that it can be tested prior to permanent implantation. This is one of Dr. Boone’s favorite treatments for the urgency and frequency of IC. When the number of trips to the bathroom are decreased, particularly at night, the patient can frequently manage the pain syndrome more effectively.

Bladder Hydrodistention. Dr. Boone is one of the most experienced doctors in Georgia, with this technique. Many patients will notice an improvement in symptoms after undergoing Cystoscopy with Hydrodistention in the operating room. This procedure may be repeated. It is usually combined with bladder irrigation of anti- inflammatory agents. Dr. Boone uses the “Rescue Bladder Cocktail”.

Medications can be instilled into the bladder in the office. Dr. Boone uses the “Rescue Cocktail” and has patients come once a week for 6-12 weeks for the bladder installation.

Surgery. Most practitioners caring for IC patients use surgery infrequently. There are lesions in the bladders of some IC patients called Hunner’s ulcers. If these are resected, patients can see great improvement. These lesions are however, somewhat rare. In the past, surgeons have removed the bladder, augmented the bladder with other organs such as bowel and cauterized the lining of the bladder. None of these surgeries are recommended, except as a very last resort, as the success rates are extremely low.

Fortunately IC, responds well to lifestyle and home remedies. Dietary changes may decrease bladder irritants. Common irritants are carbonated beverages, caffeine, chocolate, citrus products, Vitamin C, tomatoes, pickled foods, alcohol, spices, and artificial sweeteners.

The Interstitial Cystitis Association can provide a full list of the foods. Dr. Boone does not recommend that you take all of these items out of your diet at once. It is best to do an elimination diet whereby, you take them out one at a time. For example: if you think that tomatoes are irritating your bladder, have no tomatoes for an entire week. Then, re-introduce them in “a big way” by eating an entire tomato or drinking an entire glass of tomato juice. Within 2-4 hours of ingesting the irritant, your bladder should experience symptoms. Over the course of several months, the patient can determine which foods are problematic. Interestingly enough, about 50% of IC patients will have no sensitivity to food.

Some doctors are enamored with Bladder Training and Bladder Drills. This is simply trying to wait before you go to urinate. By gradually waiting longer between bathroom visits, it is believe that some patients can increase their functional bladder capacity. Dr. Boone has had minimal success with Bladder Training and Bladder Drills. But, with patients with minor symptoms, it certainly would be worth trying.

Other self care practices include wearing loose clothing to avoid any pressure on your abdomen or perineum. Reducing stress by using visualization, biofeedback, meditation, mild yoga, and mindfulness can be very effective. Do not smoke as smoking can worsen the painful condition and contributes greatly to the development of bladder cancer. Mild exercise, and mild stretching exercises can reduce IC symptoms. Heavy exercise may actually worsen the symptom by worsening pelvic spasms.

Many patients have received improvement in pain management by using acupuncture techniques. Dr. Boone uses Metro Acupuncture in Atlanta, GA. Make certain that your acupuncturist is familiar with treating pelvic pain.

Since IC is a chronic disease that occurs in young people, support is often necessary. If you find yourself with depression or anxiety related to your IC, please seek psychiatric assistance early for stress management.

A great resource for all patients with IC is the Interstitial Cystitis Association. They can be found on the internet and offer many forms of assistance.

(c) Martha B. Boone MD LLC. All rights reserved. Reposted with permission.

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