Interstitial Cystitis - Painful Bladder Syndrome

Interstitial cystitis, also known as chronic cystitis or painful bladder syndrome, is a condition that mainly affects women and is characterized by recurrent pain in the bladder, similar to those that arise in cases of urinary tract infection.

Interstitial cystitis
Interstitial cystitis

What is interstitial cystitis

The painful bladder syndrome is a still unknown disease with causes unclear. An acceptable definition for chronic cystitis is: the existence of discomfort (pain, burning, heaviness, pressure, discomfort...) in the bladder area lasting at least 6 weeks, associated with other symptoms of urinary tract infection, without, however, be of indeed signs of bladder infection.

In fact, painful bladder syndrome name is better than interstitial cystitis or chronic cystitis, as the term indicates cystitis bladder inflammation, which did not exist in most patients with this disease.

In only 10% of cases it is possible to find changes in the bladder to justify the pain. They are usually small ulcerated plaques that become visible when the bladder is very distended. In 90% of the remaining cases, however, even a biopsy of the bladder is able to find relevant changes in cells. It is believed that patients with painful bladder syndrome show changes in the functioning of the nerves in the bladder, making them more sensitive.

There is a current that is painful bladder syndrome as a variant of other pain syndromes, such as irritable bowel syndrome or fibromyalgia. In fact, it is common for the patient to have two or three of these diseases at the same time.

The painful bladder syndrome affects more women than men. About 9 per 1000 women have symptoms of chronic cystitis. In men, the rate is only 0.6 to 1000. Virtually all patients with interstitial cystitis are Caucasians (whites) and the symptoms usually appear after age 40, although also be cases in children.

Symptoms of chronic cystitis

The main symptom of painful bladder syndrome is a discomfort of the bladder, usually associated with the fact that it is full.

The characteristics of this nuisance vary between individuals and throughout the course of the disease. Some patients complain of pain, while others describe the sensation as a "pressure" or "discomfort". There are still some patients report bladder spasms. Symptoms may vary from one day to another, and the intensity of pain can be described as a mild pressure to a severe debilitating pain.

In many patients, chronic cystitis is a picture of chronic disabling pain, influencing the performance at work and in personal relationships. The pain, increased urinary frequency and fatigue can cause a deterioration in the quality of life. Some patients need to urinate 30 for 30 minutes.

Among the most common symptoms related to painful bladder syndrome are:
  • Urgency to urinate 57-98% of cases
  • constant urge to urinate 84-97%
  • Ache 66-94%
  • Need to wake up at night to urinate 44-90%
  • Dysuria (painful urination) 71-98%
  • Pain in the suprapubic region 39-71%
  • Pain in the perineum region 25-56%
  • Bladder spasms 50-74%
  • Feeling of pressure in the pubic area 60-71%
  • Vaginal pain during sex 46-80%
  • Depression 55-67%
  • Hematuria (blood in urine) 14-33%

The location of bladder discomfort is often described as being above the pubis or the urethral region, although sided abdominal pain or lower back pain associated with full bladder is also observed in some cases.

As to the appearance of symptoms, the majority of patients describe a gradual onset, with worsening of discomfort, urinary urgency and frequency over a period of months. A smaller group of patients describe the symptoms as sudden and severe since its inception. Some patients are even able to quote the exact date when the symptoms began.

Exacerbations of symptoms may occur following the ingestion of certain foods or beverages during stress, when it is too much time sitting, or after certain activities such as, for example, exercise or sex. The pain of chronic cystitis can also worsen during the second half of the menstrual cycle.

In most patients can not identify an event that serves as a trigger for the onset of symptoms. However, in some, chronic cystitis comes after an episode of urinary tract infection, a surgical procedure or trauma to the coccyx area.

An important feature of painful bladder syndrome is the fact of urinalysis no signs of urinary tract infection. Examination of simple urine (EAS or urinalysis) are always normal and urine culture is sterile repeatedly (negative). Eventually, the patient may present with hematuria (blood in urine) which makes it difficult diagnosis due to number of other urinary changes that must be discarded before thinking of chronic cystitis.

The presence of a positive urine culture from several negative does not invalidate the diagnosis of interstitial cystitis because nothing prevents the patient with painful bladder syndrome may have a urinary tract infection as anyone else. The problem is that even treating and eliminating the bacteria, if patient has even chronic cystitis, symptoms will persist.

The physical examination of patients with suspected chronic cystitis usually includes a complete gynecological examination in women and a digital rectal examination in men. Often, patients have tenderness in the abdomen, hips and buttocks. Women have sensitivity in the vagina and around the bladder, and the men in the scrotum and penis. For this reason, the medical examination can be uncomfortable.

Treatment of painful bladder syndrome

There is no simple treatment to eliminate the signs and symptoms of interstitial cystitis. Similarly, there is no treatment that works for everyone. What may work for one patient may not do any effect to another. Therefore, patients with painful bladder syndrome may need to try various combinations of treatments or treatments before finding an approach that alleviates their symptoms.

One of the goals of treatment is to teach the patient to avoid factors that may aggravate the situation. Identify food, activities and situations that trigger the symptoms is important to improve the quality of life. Cigarettes usually worsen symptoms, so stopping smoking is important.

The syndrome painful bladder is not a psychological disorder, but symptoms can be aggravated by stress, anxiety, depression or other psychological factors. In addition, the disease in some cases is so severe that it can cause difficulties in relationships, at work, in school and day-to-day overall. psychological support may be useful to deal with these problems.

Among the drugs that can be used to control symptoms are the analgesics, antiinflammatory and antidepressant drugs (typically amitriptyline).

There is a specifically designed drug for the treatment of interstitial cystitis, called pentosan polysulfate sodium, sold under the name Elmiron or Cistosan. This drug was developed to repair the lining of the bladder in people with painful bladder syndrome. Studies have shown that this medication is really effective in reducing the symptoms of some patients, although rarely make the symptoms disappear completely. Sodium Pentosan polysulfate must be taken for three to six months before any money can be identified.

Another drug commonly used in the treatment of chronic cystitis is dimethyl sulfoxide (DMSO), administered directly into the bladder through a catheter bladder. Administrations are usually weekly for six to eight weeks. DMSO is not effective in all patients and, in some cases, may cause temporary worsening of pain. This drug, however, has been used for many years, and is considered as very safe and side effect of long duration.

The transcutaneous electrical nerve stimulation (TENS) uses mild electrical pulses to relieve pelvic pain and, in some cases, reduce urinary frequency. Electrical wires are placed on the lower back or just above the pubic area. electrical pulses are administered by minutes or hours, two or more times a day depending on the patient response.

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