PL 19. Painful bladder syndrome/interstitial cystitis
Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate, a frequent need to urinate, or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women's symptoms often get worse during menstruation. They may sometimes experience pain during vaginal intercourse.
Because IC varies so much in symptoms and severity, most researchers believe it is not one, but several diseases. In recent years, scientists have started to use the terms bladder pain syndrome (BPS) or painful bladder syndrome (PBS) to describe cases with painful urinary symptoms that may not meet the strictest definition of IC. The term IC/PBS includes all cases of urinary pain that can't be attributed to other causes, such as infection or urinary stones. The term interstitial cystitis, or IC, is used alone when describing cases that meet all of the IC criteria established by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Because symptoms are similar to those of other disorders of the bladder and there is no definitive test to identify IC/ PBS, doctors must rule out other treatable conditions before considering a diagnosis of IC/PBS. The most common of these diseases in both sexes are urinary tract infections and bladder cancer. In men, common diseases include chronic prostatitis or chronic pelvic pain syndrome. In women, endometriosis is a common cause of pelvic pain. IC/PBS is not associated with any increased risk of developing cancer.
The diagnosis of IC/PBS in the general population is based on the presence of pain related to the bladder, usually accompanied by frequency and urgency of urination absence of other diseases that could cause the symptoms.
Diagnostic tests that help rule out other diseases include urinalysis, urine culture, cystoscopy, biopsy of the bladder wall and urethra, and distention of the bladder under anesthesia.
Because the causes of IC/PBS are unknown, current treatments are aimed at relieving symptoms. Many people are helped for variable periods by one or a combination of treatments. As researchers learn more about IC/PBS, the list of potential treatments will change, so patients should discuss their options with a doctor.
In our clinical practice, bladder hydro-distention under anesthesia with random biopsy of bladder mucosa would be done for diagnosis of IC and also for quick relieving of symptoms for most patients as soon as possible. After that, amitriptyline or combination with intravesical therapy of sodium hyaluronate would be the option for our patients. Only for patients failed the two medications, we would suggest Sacral nerve nuromodulation (InterStem), it does work for some of patients. For those aging patients failed all available conservative treatment available in China, we would suggest total cystectomy with urinary diversion. So far, 11 patients had received total cystectomy with urinary diversion, the pain did disappear but life style changed forever.
