Bladder pain syndrome (formerly known as interstitial cystitis) refers to an unpleasant sensation perceived to be related to the bladder and associated with bothersome urinary symptoms lasting for more than six weeks without another specific identifiable cause.
Prevalence estimates range from about 0.5 – 5 %, with women affected more commonly than men. The hallmarks of the syndrome are pelvic pain, excessive urinary frequency (over 10 times per day), minimal urine leakage, temporary relief of pain following urination, and a small bladder capacity (less than 350 cc).
Causes and Risk Factors
The underlying cause of the disorder is not clear but it may be triggered by some initial insult and seems to occur more commonly in patients with other chronic pain syndromes.
When to Speak with a Urologist about Bladder Pain Syndrome
You should talk to a Urologist about bladder pain syndrome if you have persistent pelvic discomfort and frequent urination without evidence of a urinary tract infection.
What to Expect when Seeking Treatment
In addition to history and physical examination, initial assessment include urine testing to rule out infection and evaluating your diet to see if you are consuming foods or drinks that may be contributing.
No single treatment has been shown to be effective for bladder pain syndrome. It will likely be necessary to try multiple different therapies with multiple modifications in an attempt to personalize your treatment plan and control your symptoms. Complete resolution of pain, unfortunately, is often not achievable. Therapeutic options are employed stepwise starting with the most conservative and progressing to more invasive options.
Behavioral modifications may improve symptoms by avoiding various trigger foods and beverages such as citrus, spicy foods, artificial sweeteners, caffeine and alcohol. Stress and anxiety reduction has been shown to improve symptoms.
Pelvic floor physical therapy can help release pelvic muscle tension. Almost 60% of patients reported moderate symptom improvement after 12 weeks of weekly myofascial release pelvic physical therapy.
In terms of possible medications, long-term antibiotics or steroids are not recommended for treatment of bladder pain syndrome. The use of narcotic pain medications should also be avoided. Prescription oral medications, such as amitriptyline and pentosan polysulfate, have shown moderate benefit with about 60% of patients reporting improvement though side effects can include sedation and nausea.
Other medication may be instilled temporarily into the bladder weekly for several weeks including DMSO or mixtures of heparin, lidocaine and cortisone that may improve symptoms.
If conservative options are not successful, cystoscopy under anesthesia with hydrodistension, or stretching of the bladder, may improve symptoms. About 50% of patients report relief, but the benefit rarely lasts longer than 6 months and so repeat procedures are often necessary.
Other options include the injection of Botox into the bladder muscle under cystoscopy or the implantation of the Interstim nerve stimulator into the lower back in an attempt to modify the pain nerve impulses. Botox appears to improve symptoms in about 70% of patients though the effect dissipates by 6-9 months and there is a small risk of needing to self-catheterize temporarily. Interstim appears to have long-term success rates in about two-thirds of patients.
Final options include using a powerful immunosuppressant called cyclosporine or major surgery involving the removal of the bladder altogether.