Interstitial Cystitis – A Chronic Pain Syndrome

Interstitial cystitis (IC), or painful bladder syndrome (PBS), belongs to a family of disorders known as the chronic pelvic pain syndromes that include fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome. Previously IC/PBS has been termed as urethral syndrome, trigonitis and bladder pain syndrome. The International Continence Society described IC/PBS as "the complaint of supra-pubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and night time frequency, in the absence of a proven urinary infection and other obvious pathology."

IC/PBS is a long-lasting condition of unclear origin and has a 10 fold higher incidence in women than men.

In IC/PBS the glycosaminoglycan (GAG) layer amplifies permeability of the bladder urothelium such that urine components (urea, ammonia, and potassium) seep into the bladder tissue - leading to pelvic pain and annoying voiding urges. Plus, higher mast-cell activation results in bladder wall inflammation and fibrotic modifications.

Clinically IC/PBS patients vary as per the urgency, frequency, and/or pain. Typical IC/PBS symptoms include pelvic pain, painful sexual intercourse, repeated urinary tract infections, repeated vaginitis or prostatitis, waking up from sleep at night to urinate, and increased urinary occurrence and urges. During the premenstrual week women may undergo a flare up of symptoms.

Diagnosis is based on medical history and physical checkup including a pelvic test to exclude vaginitis, vulvar lesions, urethral diverticula, and pelvic-floor dysfunction. IC/PBS screening is based on The Pelvic Pain and Urgency/Frequency Patient Symptom Scale and the O'Leary-Sant Interstitial Cystitis Symptom Index and Problem Index questionnaires. Urinalysis, cystoscopy, potassium sensitivity test and a full bladder are used to detect hematuria, defects in the bladder lining, urothelium dysfunction and bladder pain respectively

As per the American Urological Association (AUA) guidelines, IC/PBS treatment depends on a patient's choice, seriousness of symptom and the doctor's assessment. All patients should be provided behavior modification strategies and receive drugs that control their pain and stress.

IC/PBS drug therapy includes intravesical drug instillation, also known as bladder bath or wash, with dimethylsulfoxide (DMSO) to decrease symptoms and pain. A troublesome garlicky flavor and scent is a frequent side-effect of DMSO.

Oral IC/PBS treatment includes cimetidine, amitriptyline, hydroxyzine and pentosan polysulfate sodium (PPS). PPS, FDA-approved for IC/PBS, dose regimen includes three-times-a-day, 100 mg tablet, 1 hour before or 2 hours after a meal.PPS acts slowly and reduces symptoms after 3-4 months of medication intake. Cimetidine relieves symptoms, amitriptyline regulates bladder pain and urgency, hydroxyzine suppresses mast-cell degranulation and inflammation.

Surgical procedures such as cystoplasty and urinary diversion are performed in IC/PBS patients that do not experience symptom relief with other therapies. A combination treatment strategy is the best approach to reduce symptoms. However, further treatment options are needed to better treat IC/PBS patients.

In conclusion, IC/PBS is a long-lasting condition which is frequently a challenge to diagnose and manage.

Reference : Interstitial Cystitis and Chronic Pain Syndrome; Amy Witte et al; US Pharm. 2012; 37(6):HS-2-HS-5.

Source: Medindia

Interstitial Cystitis / Painful Bladder Syndrome

DID you know that certain foods could worsen interstitial cystitis or the painful bladder syndrome?

Interstitial Cystitis

Interstitial cystistis is an umbrella term where a pathology cannot be defined but the patient suffers from recurring, pain in the pelvic region along with other symptoms including frequency or urgency in urination

Urinary Tract Infection - Pregnancy and bacteriuria

If left untreated, 25 to 30 percent of these women develop pyelonephritis. Pregnancies that are complicated by pyelonephritis have been associated with low-birth-weight infants and prematurity.

Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome (CRPS) is rare chronic pain disorder usually involving an arm or leg. It may follow injury, less commonly after surgery, stroke or heart attack. The cause is unknown

Cystitis

Cystitis is an inflammation of the urinary bladder. Cysitis is caused by bacteria and women are more likely get an infection after sexual intercourse.

Dysuria - Symptom Evaluation

Dysuria is a symptom of pain and burning while passing urine. It is more common in women and is often due to a bacterial infection.

How to Cope with Cancer Pain

Pain occurs in about 20-50% of patients with cancer. Proper therapeutic approach can help relieve and manage the condition.

Pelvic Pain in Women

Painful pelvic region is a common complaint in females. What is pelvic pain -its causes and treatment with diagnostic test required to diagnose the underlying pathology.

Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS) is a rare condition that occurs when blood vessels or nerves become compressed in the space between the collarbone and the first rib.