As the name says itself it is chronic pain occuring in bladder also called as Painful bladder syndrome and Interstitial Cystitis(IC). It is a chronic condition causing bladder pain and pressure problem in which the bladder holds pee after your kidneys have filtered it but before you pee it out. Due to this it causes pain and pressure below your belly button. If there is urinary bladder pain that lasts for more than 6 weeks and is not caused by other conditions like infection or kidney stones, then there is Intersitial cystitis.

Bladder is a hollow, muscular organ that stores urine. The bladder expands until it’s full and then signals your brain that it’s time to urinate, communicating through the pelvic nerves. This creates the urge to urinate for most people. With IC, these signals get mixed up you feel the need to urinate more often and with smaller volumes of urine than most people.

In severe cases one has to pee as many as 40-60 times a day which can even keep you up at night. This disease affect your social life, exercise, sleep and your ability to work. As many as 90% of people with IC are women that means women are affected about five times as often as men and to a lesser extent, affect men and children. Onset is typically in middle age.

Guide for Bladder Pain Syndrome

Signs and symptoms

It has wide range of symptoms which range from mild to server. They vary from person to person with IC. Symptoms can come and go or they may be constant.

• Bladder pressure and pain that gets worse as the bladder fills up range from a dull ache to piercing pain
• Pain in the lower tummy, lower back or urethra
• Chronic pelvic pain
• Pain or discomfort while the bladder fills and relief after urinating
• For women-pain in the vulva, vagina, anus or the area behind the vagina
• For men-pain in the penis, scrotum, testicles pr the area behind the scrotum
• Urgent and persistent urination need to pee often that is more than the normal 7-8 times daily occuring all day and throughout the night interrupting sleep cycle
• Frequent urination of small amounts throughout the day and night upto 60 times a day
• Even after pee, the feeling to go again right now
• For both men and women pain during or after sexual intercourse
• Urinary incontinence or leaking
• Scarred or stiff bladder
• Ulcers and lesions in the bladder

Sometimes symptoms are made worse by certain foods and drinks. For some they get worse if under stress. For women, the symptoms fluctuate with their mentural cycle.

Causes

The cause for IC is unknown but abnormalities in the leakiness pr structure of the lining of the bladder are believed to play a role in the development of IC. Because the symptoms of IC are varied most doctors believe that it represents a spectrum of disorders rather than one single disease and is a real physical problem not a result of sign or symptom. There are several theories about the  possible cause of the condition including-

• Defect or damage in the lining of the urinary bladder that cause irritation
• Bladder trauma
• Bladder overextension due to long periods without going to the bathroom
• Pelvic floor muscle dysfunction used to control urination
• Autoimmune disorders
• Primary neurogenic inflammation causes the body to release chemicals that cause symptoms
• Hypersensitivity or inflammation of pelvic nerve problem makes the bladder feel pain from things that usually don’t hurt
• Immune system attacks the bladder
• Bacterial infection
• Spinal cord trauma
• Allergic reaction
• Genetic defects and heredity
• Chronic pain disorders like fibromyalgia or irritable bowel syndrome

Risk factors

There are no definite risk factors for developing the condition. However, women are more likely than men to develop IC. Generally it is seen in 20-60 years of age. Women with IC are more likely to have frequent urinary tract infections and to have previous gynecologic surgery than women without IC.  Also having fair skin and red hair has been associated with a greater risk of IC.

Certain chronic illness have been described as occuring more frequently in people with IC like inflammatory bowel disease, systemic lupus erythematosus, irritable bowel syndrome, chronic discomfort in the vulvar area, allergies, endometriosis and fibromyalgia.

Complications

IC can cause several complications-

• Reduced bladder capacity due to stiffening of the bladder wall
• Lower quality of life as a result of frequent urination and pain
• Sexual intimacy
• Sleep disturbances
• Anxiety and depression

Urologists are physicians that specialize in diagnosis and treatment of interstitial cystitis.

Diagnosis

Unfortunately, diagnosing bladder pain often takes a long time and is tough.

Medical history and bladder diary should be taken.

Physical and neurological examination– IC may reveal tenderness of the bladder either when pushing on the abdomen over the bladder or during the pelvic examination in women.

Laboratory tests-

• Urinalysis and urine culture
• Potassium sensitivity test
• Lidocaine instillation
• Urodynamics
• Cystoscopy under anesthesia with bladder distension
• Urine cytology
• Bladder and urethra biopsy
• Prostate fluid culture

Treatment

There is no cure though treatment can make life better with medications and other therapies may offer relief. No single treatment works for everyone.

Lifestyle changes- self care may help to improve the symptoms

• Avoiding certain foods and drinks such as tomatoes and alcohol
• Redcuing stress
• Smoking cessation
• Control on how much you drink
• Exercise

Oral medications- tablets and capsules include-

• Aspirin and ibuprofen are used as a first line of defense against mild discomfort
• Antidepressants of the tricyclic group such as amitryptiline help to reduce the hyperactivation of nerves within the bladder wall
• Antiseizure medication gabapenti also has been used to treat the pain
• Oral antihistamines such as loratadine and cetrizine help to reduce allergic symptoms
• Pentosan polysulfate sodium (Elmiron)
• Tolterodine, solifenacin or mirabegron help to relax the bladder muscles

Some medications can also be passed directly into bladder using a thin tube called as catheter. These are known as intravesical medications or bladder instillations. Examples include lignocaine a local anaesthetic and hyaluronic acid or chondroitin sulphate that may help restore the bladder lining.

Therapies- following therapies are helpful

• Physiotherapy
• Bladder retraining
• Bladder distention
• Bladder instillation containing dimethyl sulfoxide
• Psychological therapy
• Transcutaneous electrical nerve stimulation(TENS)

Surgery can be done when there are lesions in bladder when other treatments don’t work.In very rare cases cystectomy to remove the bladder completely may be necessary.

Conclusion

People with IC have fairly minor symptoms  but others experience drastic symptoms that directly impact quality of life. Over time, the persistent urge to use the bathroom can cause some people to shy away from social activities, opting instead for the comfort of home. Sexual and emotional relationships may suffer.

According to the U.S. Department of Health and Human Services, life with a chronic condition like IC may increase your likelihood of developing depression.

 If you have ongoing urinary urgency or pelvic pain, make an appointment to see your doctor. There is no single test to diagnose IC.Medications and lifestyle changes can help to ease symptoms and make it easier to manage life with IC.

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