Your health: Interstitial cystitis

IT’S almost like reflex — the moment you start having the urge to urinate frequently, especially if accompanied by pain or discomfort in the bladder, you immediately cast the blame on a bladder infection. But obstetrician-gynaecologist Dr Anna-Kay Taylor Christmas said the actual culprit could actually be interstitial cystitis.

“Interstitial cystitis is the medical term for painful bladder syndrome which causes bladder pain and a constant need to empty the bladder, even if it is not full. It is ten times more common in women than men, and is often associated with other pain syndromes such as fibromyalgia,” Dr Taylor-Christmas said.

She said the underlying cause of the condition, like many other pain syndromes, is still unclear. However, patients commonly complain of the urge to urinate frequently, pain which is worsened by a filling bladder and relieved by emptying the bladder, pain extending to the rest of the pelvis (urethra, vagina, rectum, vulva), pain during sex, and for men, pain in the scrotum, testicles, penis, or the area behind the scrotum.

Dr Taylor-Christmas notes that since interstitial cystitis has a wide variety of symptoms, many of which mimic other bladder problems, the condition can be quite tricky to diagnose.

“Essentially, other conditions will have to be ruled out, such as bladder infection, cancer, over-active bladder syndrome or complications of radiation. A bladder diary is often very helpful, and patients are asked to track their pain and urination habits for several days in a row to see if it fits into a particular pattern. Sometimes cystoscopy (small camera to look into the bladder for visible abnormalities) or urodynamics (special testing for overactive bladder or incontinence) is needed to help aid the diagnosis,” Dr Taylor-Christmas shared.

She said that once the condition has been diagnosed, then the doctor will determine the course of treatment, usually starting with more conservative measures. These include:

•Changing diet to avoid foods that trigger symptoms.

•Changing fluid intake to adjust the volume and concentration of urine.

•Applying warm or cold compresses over the bladder and other sensitive areas.

•Pelvic floor exercises to strengthen the muscles supporting the bladder.

•Bladder retraining to help suppress the urge to void by behavioural modification.

•Physical therapy to allow trigger point release (done and taught by the pelvic physiotherapist).

She says that these measures may not always be successful, and as such the doctor will then determine the appropriate medication as well as more invasive therapies (including surgery) to address the problem.

“Medications include oral treatments such as antidepressants and usually are required for a period of several months to have the desired effect. Note must be taken of potential interactions with other medication. A pain specialist may also be required to coordinate and monitor the therapy, and medications may also be instilled directly into the bladder using a catheter,” Dr Taylor-Christmas outlined.

On the surgical front, Dr Taylor-Christmas said that there are a variety of treatment options spanning from implanting a device onto the nerve that supplies the bladder to modulate pain, injection of muscle relaxants into the bladder wall, or in severe cases diverting urine from the bladder into an external bag to prevent the bladder from filling. She said that these more invasive treatments must be weighed carefully to balance the risk of complications with the potential benefit they can provide.

She warns that pain may not completely resolve even with more invasive methods, but may significantly improve to the point of allowing normal daily functioning again.

Dr Christmas advised that while the treatment for this condition is often complex, requiring multiple disciplines over a prolonged period, patience and good social support are also a requirement for a good outcome. She notes that while it can sometimes be discouraging because the symptoms usually recur, you should find comfort in the fact that while there is no cure, there are treatments available that can improve your quality of life.