PAINFUL BLADDER SYNDROME

Painful Bladder Syndrome, (Interstitial cystitis (IC)) is a condition that results in discomfort or pain in the bladder and the surrounding pelvic region. The symptoms of Painful Bladder Syndrome will vary from person to person and even in the same individual. Other symptoms of Painful Bladder Syndrome may include an urgent need to urinate, a frequent need to urinate, or a combination of both. Pain may change in intensity as the bladder fills with urine or as it empties. Women's symptoms of Painful Bladder Syndrome often get worse during menstruation.

Because Painful Bladder Syndrome varies so much in symptoms and severity, most researchers believe that it is not one, but several diseases. The term Painful Bladder Syndrome includes all cases of urinary pain that can't be attributed to other causes, such as infection or urinary stones.

In Painful Bladder Syndrome, the bladder wall may be irritated and become scarred or stiff Glomerulations (pinpoint bleeding caused by recurrent irritation) often appear on the bladder wall. Hunner's ulcers are present in 10 percent of patients with Painful Bladder Syndrome. Some people with Painful Bladder Syndrome find that their bladders cannot hold much urine, which increases the frequency of urination. Frequency, however, is not always specifically related to bladder size; many people with severe frequency have normal bladder capacity. People with severe cases of Painful Bladder Syndrome may urinate as many as 60 times a day, including frequent nighttime urination (nocturia).

Painful Bladder Syndrome is more common in women than in men.
Of the estimated one million Americans with Painful Bladder Syndrome, up to 90 percent are women.



What causes Painful Bladder Syndrome?
Some of the symptoms of Painful Bladder Syndrome resemble those of bacterial infection, but medical tests reveal no organisms in the urine of patients with Painful Bladder Syndrome. Furthermore, patients with Painful Bladder Syndrome do not respond to antibiotic therapy. Researchers are working to understand the causes of Painful Bladder Syndrome and to find effective treatments. In recent years, researchers have isolated a substance found almost exclusively in the urine of people with interstitial cystitis. They have named the substance antiproliferative factor, or APF, because it appears to block the normal growth of the cells that line the inside wall of the bladder. Researchers anticipate that learning more about APF will lead to a greater understanding of the causes of Painful Bladder Syndrome and to possible treatments. Researchers are beginning to explore the possibility that heredity may play a part in some forms of IC. In a few cases, IC has affected a mother and a daughter or two sisters, but it does not commonly run in families.

How is Painful Bladder Syndrome diagnosed?
Because symptoms are similar to those of other disorders of the urinary bladder and because there is no definitive test to identify Painful Bladder Syndrome, doctors must rule out other treatable conditions before considering a diagnosis of Painful Bladder Syndrome. The most common of these diseases in both genders are urinary tract infections and bladder cancer. Painful Bladder Syndrome is not associated with any increased risk in developing cancer. In men, common diseases include chronic prostatitis or chronic pelvic pain syndrome. The diagnosis of Painful Bladder Syndrome in the general population is based on presence of pain related to the bladder, usually accompanied by frequency and urgency absence of other diseases that could cause the symptoms Diagnostic tests that help in ruling out other diseases include urinalysis, urine culture, cystoscopy, biopsy of the bladder wall, distention of the bladder under anesthesia, urine cytology, and laboratory examination of prostate secretions.

Urinalysis and Urine Culture for Painful Bladder Syndrome:
Examining urine under a microscope and culturing the urine can detect and identify the primary organisms that are known to infect the urinary tract and that may cause symptoms similar to Painful Bladder Syndrome. A urine sample is obtained either by catheterization or by the "clean catch" method. For a clean catch, the patient washes the genital area before collecting urine "midstream" in a sterile container. White and red blood cells and bacteria in the urine may indicate an infection of the urinary tract, which can be treated with an antibiotic. If urine is sterile for weeks or months while symptoms persist, the doctor may consider a diagnosis of Painful Bladder Syndrome.

Culture of Prostate Secretions for Painful Bladder Syndrome:
Although not commonly done, in men, the doctor might obtain prostatic fluid and examine it for signs of a prostate infection, which can then be treated with antibiotics.

Cystoscopy Under Anesthesia With Bladder Distention for Painful Bladder Syndrome:
The doctor may perform a cystoscopic examination in order to rule out bladder cancer. During cystoscopy, the doctor uses a cystoscope an instrument made of a hollow tube about the diameter of a drinking straw with several lenses and a light to see inside the bladder and urethra. The doctor might also distend or stretch the bladder to its capacity by filling it with a liquid or gas. Because bladder distention is painful in patients with IC / PBS, they must be given some form of anesthesia for the procedure. The doctor may also test the patient's maximum bladder capacity the maximum amount of liquid or gas the bladder can hold. This procedure must be done under anesthesia since the bladder capacity is limited by either pain or a severe urge to urinate.

Biopsy for Painful Bladder Syndrome:
A biopsy is a tissue sample that can be examined under a microscope. Samples of the bladder and urethra may be removed during a cystoscopy. A biopsy helps rule out bladder cancer.

What are the treatments for Painful Bladder Syndrome:
Scientists have not yet found a cure for Painful Bladder Syndrome, nor can they predict who will respond best to which treatment. Symptoms may disappear without explanation or coincide with an event such as a change in diet or treatment. Even when symptoms disappear, they may return after days, weeks, months, or years. Scientists do not know why. Because the causes of Painful Bladder Syndrome are unknown, current treatments are aimed at relieving symptoms. Many people are helped for variable periods by one or a combination of the treatments. As researchers learn more about IC / PBS, the list of potential treatments will change, so patients should discuss their options with a doctor.

Bladder Distention:
Many patients have noted an improvement in symptoms after a bladder distention has been done to diagnose Painful Bladder Syndrome. In many cases, the procedure is used as both a diagnostic test and initial therapy. Researchers are not sure why distention helps, but some believe that it may increase capacity and interfere with pain signals transmitted by nerves in the bladder. Symptoms may temporarily worsen 24 to 48 hours after distention, but should return to predistention levels or improve within 2 to 4 weeks.

Bladder Instillation:
During a bladder instillation, also called a bladder wash or bath, the bladder is filled with a solution that is held for varying periods of time, averaging 10 to 15 minutes, before being emptied. The only drug approved by the U.S. Food and Drug Administration (FDA) for bladder instillation is dimethyl sulfoxide (DMSO, RIMSO-50). DMSO treatment involves guiding a narrow tube called a catheter up the urethra into the bladder. A measured amount of DMSO is passed through the catheter into the bladder, where it is retained for about 15 minutes before being expelled. Treatments are given every week or two for 6 to 8 weeks and repeated as needed. Most people who respond to DMSO notice improvement 3 or 4 weeks after the first 6- to 8-week cycle of treatments. Highly motivated patients who are willing to catheterize themselves may, after consultation with their doctor, be able to have DMSO treatments at home. Self-administration is less expensive and more convenient than going to the doctor's office. Doctors think DMSO works in several ways. Because it passes into the bladder wall, it may reach tissue more effectively to reduce inflammation and block pain. It may also prevent muscle contractions that cause pain, frequency, and urgency. A bothersome but relatively insignificant side effect of DMSO treatments is a garlic-like taste and odor on the breath and skin that may last up to 72 hours after treatment. Long-term treatment has caused cataracts in animal studies, but this side effect has not appeared in humans. Blood tests, including a complete blood count and kidney and liver function tests, should be done about every 6 months.

Transcutaneous Electrical Nerve Stimulation for Painful Bladder Syndrome:
With transcutaneous electrical nerve stimulation (TENS), mild electric pulses enter the body for minutes to hours two or more times a day either through wires placed on the lower back or just above the pubic area, between the navel and the pubic hair, or through special devices inserted into the vagina in women or into the rectum in men. Although scientists do not know exactly how TENS relieves pelvic pain, it has been suggested that the electrical pulses may increase blood flow to the bladder, strengthen pelvic muscles that help control the bladder, or trigger the release of substances that block pain. TENS is relatively inexpensive and allows the patient to take an active part in treatment. Within some guidelines, the patient decides when, how long, and at what intensity TENS will be used. It has been most helpful in relieving pain and decreasing frequency in patients with Hunner's ulcers. Smokers do not respond as well as nonsmokers. If TENS is going to help, improvement is usually apparent in 3 to 4 months.

Smoking in relation to Painful Bladder Syndrome:
Many patients feel that smoking makes their symptoms worse. How the by-products of tobacco that are excreted in the urine affect Painful Bladder Syndrome is unknown. Smoking, however, is the major known cause of bladder cancer. Therefore, one of the best things smokers can do for their bladder and their overall health is to quit.

Exercise for Painful Bladder Syndrome:
Many patients feel that gentle stretching exercises help relieve Painful Bladder Syndrome symptoms.

Bladder Training for Painful Bladder Syndrome:
People who have found adequate relief from pain may be able to reduce frequency by using bladder training techniques. Methods vary, but basically patients decide to void (empty their bladder) at designated times and use relaxation techniques and distractions to keep to the schedule. Gradually, patients try to lengthen the time between scheduled voids. A diary in which to record voiding times is usually helpful in keeping track of progress.

Diet for Painful Bladder Syndrome:
There is no scientific evidence linking diet to Painful Bladder Syndrome. But the experience of many people and that of many doctors is that certain foods, drinks, etc may contribute to Painful Bladder Syndrome. Some patients also note that their symptoms of Painful Bladder Syndrome worsen after eating or drinking products containing artificial sweeteners. Patients may try eliminating various items from their diet and reintroducing them one at a time to determine which, if any, affect their symptoms. It is important to always have a well balanced diet in dealing with Painful Bladder Syndrome.

Very High Oxalate Foods:
Chocolate
Strawberries
Cocoa

High Oxalate Foods:
Blackberries
Blueberries
Grapes, Concord
Currants, red
Dewberries
Figs
Gooseberries
Kiwi
Lemon peel
Lime peel
Orange peel
Raspberries
Rhubarb
Tangerine
Some Beers
Beetss
Celery
Collards
Dandelion greens
Eggplant
Escarole
Green beansr
Kale
Leeks
Parsley
Parsnips
Peppers
Pokeweed
Popcorn
Potatoes
Pumpkin
Rhubarb
Rutabagas
Sorrel
Spinach
Squash
Swiss chard
Tomato sauce
Turnip greens
Watercress
Yams
Juices containing berries high in oxalates
Tea, black, Indian, herbal
Cinnamon
Pepper
Ginger
Soy sauce
Beans, green, waxed, dried
Baked beans in tomato sauce
Nuts
Peanuts
Pecans
Peanut butter
Sesame seeds
Soybean curd
Sunflower seeds
Soy products
Fig Newtons
Fruitcake
Marmalade

Medium Oxalate Foods:
Apples
Apricots
Berries
Blackberries
Blueberries
Dewberries
Red raspberries
Currants
Cherries
Cranberries
Grapefruit
Grapes
Oranges
Peaches
Pears
Pineapple
Plums
Prunes
Tangerines)
Some Beers)
Coffee
Some Fruit juices
Basil
Dill (1 tbsp)
Ginger
Malt
Mustard)
Nutmeg
Soy sauce
Asparagus
Artichokes
Brussel sprouts
Broccoli
Carrots
Corn
Cucumber
Garlic
Green beans
Kohlrabi
Lettuce
Butter
Mushrooms
Mustard greens
Onions
Potatoes
Radishes
Snow peas
Watercress
Barley
Cornbread
Cornmeal)
Cornstarch
English muffin
Macaroni
Oatmeal
Spaghetti
Spaghetti in tomato sauce
Wheat or plain flour
Cashews
Lima beans
Split peas
Sunflower seeds
Walnuts
Liver
Sardines
Marmalade.

Low Oxalate Foods:
Apples, peeled
Avocado
Cherries
Cranberries
Grapes
Lemons
Lemon juice
Lime juice
Mangoes
Melons
Cantaloupe
Honeydew
Watermelon
Nectarines
Raisins
Butter
Buttermilk
Cheese
Milk
Yogurt
Butter
Margarine
Vegetable oils
Barley water
Cider
Fruit juices
Gingerale
Orange soda
Pineapple juice
Root beer
Some Wines
Alfalfa sprouts
Cabbage
Cauliflower
Cucumbers
Lettuce
Zucchini squash
Basil
Chives
Dill
Mustard
Nutmeg
Oregano
Vanilla extract
Vinegar
Egg noodles
Rice
Rye bread
Beef
Chicken
Corned beef
Eggs
Fish
Ham
Lamb
Pork
Turkey
Honey
Jellies)
Maple syrup
Sugar.

Pelvic floor treatments in Painful Bladder Syndrome
Pelvic floor dysfunction may also be a contributing factor thus most major in Painful Bladder Syndrome clinics now evaluate the pelvic floor and/or refer patients directly to a physical therapist for a prompt treatment of pelvic floor muscle tension or weakness. Pain in the bladder and/or pelvis can trigger long term, chronic pelvic floor tension which is often described by women as a burning sensation, particularly in the vagina. Men with pelvic floor tension experience referred pain, particularly at the tip of their penis. In 9 out 10 Painful Bladder Syndrome patients struggling with painful sexual relations, muscle tension is the primary cause of that pain and discomfort. Tender trigger points, small tight bundles of muscle, may also be found in the pelvic floor. Pelvic floor dysfunction is a fairly new area of specialty for physical therapists world wide. The goal of therapy is to relax and lengthen the pelvic floor muscles, rather than to tighten and/or strengthen them as is the goal of therapy for patients with incontinence. Thus, traditional exercises such as Kegels, can be helpful as they strengthen the muscles, however they can provoke pain and additional muscle tension. A specially trained physical therapist can provide direct, hands on, evaluation of the muscles, both externally and internally. While weekly therapy is certainly valuable, most providers also suggest an aggressive self-care regimen at home to help combat muscle tension, such as daily muscle relaxation audiotapes, stress reduction and anxiety management on a daily basis. Anxiety is often found in patients with painful conditions and can subconsciously trigger muscle tension.

Other Conditions in Painful Bladder Syndrome
It is important to note that some people with Painful Bladder Syndrome suffer from Anxiety disorder, and other conditions that may have the same etiology as Painful Bladder Syndrome. These include: irritable bowel syndrome (IBS), Fibromyalgia, Chronic fatigue syndrome, Endometriosis, Vulvodynia, and chemical sensitivities. Men with Painful Bladder Syndrome are frequently diagnosed as having chronic nonbacterial prostatitis, and there is an extensive overlap of symptoms and treatment between the two conditions, leading some researchers to posit that the conditions share the same etiology and pathology.

Medication in Painful Bladder Syndrome
As recently as a decade ago, treatments available were limited to the use of astringent instillations, such as clorpactin or silver nitrate, designed to kill infection and/or strip off the bladder lining. In 2005, our understanding of Painful Bladder Syndrome has improved dramatically and these therapies are now no longer done. Rather, Painful Bladder Syndrome therapy is typically multi-modal, including the use of a bladder coating, an antihistamine to help control mast cell activity and a low dose antidepressant to fight neuroinflammation. The two US FDA approved therapies for Painful Bladder Syndrome have had recent setbacks in various research studies.



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