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Bladder Pain

Interstitial Cystitis (Painful Bladder Syndrome)

Interstitial cystitis, otherwise known as painful bladder syndrome, is a condition which makes your bladder inflamed or irritated. The condition can cause problems with urination and pelvic discomfort and is often more painful when your bladder is full. Because of this, it can also trigger incontinence symptoms.

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What are the symptoms of interstitial cystitis?

Painful bladder syndrome is tough to diagnose because it shares many symptoms with those of a bladder infection.

Common symptoms of interstitial cystitis include:

  • Sharp pain below your belly button
  • Sudden urges to urinate
  • Increased frequency of trips to the toilet
  • Waking in the night to use the toilet

Other symptoms include:

  • Urinary incontinence or leaking
  • Pain in your abdomen, urethra, vagina or perineum
  • Glomerulations (bladder haemorrhages)
  • Ulcers (Hunner's ulcers) and lesions in the bladder

Interstitial cystitis can be painful, particularly when the bladder is full. Often, there’ll be a brief period of relief after using the loo, which is why many sufferers use the toilet more often than usual. In extreme instances, painful bladder syndrome can lead to sleep deprivation too.

Symptoms may worsen during a women’s period or with sexual activity. Some foods and drinks can also provoke irritation. The condition can be unpredictable, as symptoms can go away but may return for no clear reason.

Causes of painful bladder syndrome

Interstitial cystitis is far more common in women, often affecting those in their 30s and 40s.

The exact causes are unknown. Some theories include:

  • Damage to the bladder lining
  • An allergic reaction
  • Problems with pelvic floor muscles
  • The immune system mistakenly attacking the bladder
  • Bacterial infection
  • Overextension of the bladder due to prolonged trips to the toilet
  • Injury to the nerves in, or surrounding, the bladder or spinal cord
  • A result of a surgical procedure or physical injury

How do you test for painful bladder syndrome?

It’s thought around 400,000 people in the UK have interstitial cystitis, 90% of whom are female. Diagnosing painful bladder syndrome is tough as, unlike other forms of cystitis, there is no obvious infection and symptoms don’t improve with antibiotics.

There is no single diagnostic test for interstitial cystitis and diagnosis can take time, as other possible causes must be excluded first.

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Your doctor will want to scrutinise your medical history and conduct a pelvic examination and series of urine tests. This is to ensure other treatable conditions are ruled out first, including urinary tract infections.

Tests used to rule out the causes of bladder pain include:

  • Urinalysis and urine culture: Urine is examined under a microscope. This method can identify the primary organisms known to infect the urinary tract.
  • Cystoscopy under anaesthesia: A cystoscope (a straw-sized tube containing several lenses and a light) is used to see inside the bladder and urethra. Your doctor may stretch the bladder to capacity by filling it with a liquid or gas. This can be painful for those with painful bladder syndrome, so is usually performed under anaesthesia.
  • Cystoscope biopsy: A biopsy is taken during a cystoscopy to help rule out bladder cancer.
  • Culture of prostrate secretions: This procedure is rare. It involves obtaining prostatic fluid and examining it for signs of a prostate infection, which can be treated with antibiotics.

A diagnosis of interstitial cystitis is generally attributed to pain related to the bladder, frequency and urgency of urination, along with an absence of other diseases that could cause these symptoms.

What treatments are available for interstitial cystitis?

Sadly, there is currently no permanent cure for interstitial cystitis. Even when symptoms disappear, they can return in the future.

There are, however, ways to relieve the symptoms of bladder pain. As causes are still unknown, current treatments aim to reduce symptoms and make the condition easier to manage.

If you have interstitial cystitis, you may benefit from lifestyle changes, including:

  • Improving your diet. To help avoid interstitial cystitis, reduce your intake of acidic and spicy foods.
  • Avoiding diuretics. This includes drinks high in caffeine, including tea, coffee and fizzy drinks; as well as alcohol, all of which are common bladder irritants.
  • Stopping smoking. Chemicals in cigarettes can irritate the bladder. Smoking is also known to trigger incontinence in some people.

Your doctor may also recommend medical treatment, such as:

  • Prescription medicine
  • Physical therapy
  • Bladder distension
  • Bladder installation (also called a bladder wash or bath)
  • Electrical nerve stimulation
  • Surgery (as a last resort and only if pain is debilitating)
  • Fulguration and resection of ulcers
  • Augmentation (bladder enlargement)
  • Cystectomy (bladder removal)

Tips to reducing symptoms

Ways to relieve pain of interstitial cystitis include:

  • Putting a hot water bottle on the perineum (the area between your anus and vagina, or anus and scrotum for men)
  • Relaxing in a squatting position with knees drawn towards your chest
  • Drinking plenty of water to ensure urine doesn’t become too concentrated and cause irritation
  • Wearing loose-fitting underwear, trousers or skirts to help you stay comfortable

If bladder pain becomes a persistent problem, it is possible you have interstitial cystitis. You should visit your doctor for proper diagnosis and advice for your needs.

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