Clinical Conditions

Definition

Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) is a chronic condition that consists of urinary urgency, frequency, nocturia (being awakened by the urge to urinate more than once per night) and/or bladder pain, which tends to increase as the bladder fills. The intensity of these symptoms may range from mild to debilitating. The presence of this syndrome suggests that there is no underlying cause for the symptoms such as a urinary tract infection or bladder tumor. However, medical evaluation is needed to confirm the absence of infection, tumor or another condition with similar symptoms. The National Institutes of Health estimates that 700,000 people in the US suffer from PBS/IC, and 90% are women.

Symptoms

The symptoms of PBS/IC often occur in episodes of increased intensity, known as “flares,” followed by a period of remission. In severe cases, urinary frequency can occur more than 60 times a day during flares. Some foods and beverages, as well as tobacco use tend to make the symptoms worse. Women suffering from PBS/IC may also suffer from additional pelvic pain from the spasm of the pelvic floor muscle, irritable bowel syndrome, fibromyalgia, migraines, asthma, environmental allergies, lupus, rheumatoid arthritis, endometriosis, vulvodynia and anxiety disorders.

Cause

The exact cause of PBS/IC is not known, but multiple factors are believe to be involved, such as a disruption of the bladder lining causing an over activity of pain nerves in the bladder. Risk factors include young age, being female and a family history of PBS/IC.

Diagnosis

There is no test for the diagnosis of PBS/IC. Testing is done to rule out other possible causes of the symptoms of PBS/IC such as bladder cancer, urinary stones, sexually transmitted diseases or other gynecological problems.

Treatment Options

While there is no cure for Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC), there are several surgical and non-surgical treatment options available. A combination of these options is usually required for symptom control. Finding the combination of options that will provide relief often requires diligence and patience.

Non-Surgical Treatments

Bladder diet

Following a bladder diet means avoiding food and beverages that irritate the bladder and intensify urinary symptoms. A “bladder elimination diet” is a way to determine which particular foods and beverages make your symptoms worse.

Pelvic floor therapy

Pelvic floor therapy consists of a series of visits to a physical therapist with specialized training in the treatment of pelvic floor problems. The physical therapist uses a combination of the techniques listed below depending on the type of urogynecological condition present.

  • Behavioral modification: education on diet, fluid intake and other lifestyle changes to manage various bothersome symptoms
  • Bladder training: learning to use the pelvic floor muscles to suppress overactive bladder symptoms (urinary urgency, frequency, noturia and urge urinary incontinence)
  • Biofeedback: an intravaginal device is used to train the pelvic floor muscles to contract or relax correctly
  • Functional electrical stimulation: a device that can be used intravaginally or externally that delivers a gentle electrical current to activate or relax the nerves and muscles in the pelvis
  • Manual therapy: pressure applied to and released from muscles in spasm to relax them and increase blood flow to the area for healing
  • Joint and tissue mobilization: gentle manipulation to help calm the muscles and nerves of the pelvis
Various medications

There are several types of oral medications on the market that Dr. Tyagi uses to treat PBS/IC.

  • Anticholinergic medications (i.e., Ditropan [oxybutynin], Sanctura [trospium chloride], Vesicare [solifenicin], Detrol [tolterodine])
  • Elmiron
  • Valium
  • Elavil (amitriptyline)
Bladder instillations

Bladder instillations are repeated instillations of lidocaine, heparin and other substances into the bladder to decrease bladder pain. The mixture is instilled through a small catheter inserted into the bladder through the urethra two times per week until the desired results are achieved.

Referral to a mental health professional

If appropriate, a referral will be made to a mental health professional.

Surgical Treatments

InterStim™ Therapy

InterStim™ Therapy is an FDA-approved treatment for urinary urgency, frequency, urge incontinence and retention. The InterStimTM is a small device that is implanted under the skin of one of the upper buttocks. It works by gently stimulating the sacral nerves to help the bladder function more normally.

Spinal nerve blocks

Specialists in pain management can assist in the care of patients not responsive to other treatment modalities. They use injections to nerves in the spine or pelvis to block pain and other symptoms.