Painful Bladder Syndrome/Interstitial Cystitis

By OBOS Common Medical Conditions Contributors | January 28, 2011

Painful bladder syndrome/interstitial cystitis (PBS/IC) was for many years thought to be an inflammatory condition of the bladder wall, but recently it has been recognized as poorly understood chronic pain syndromes that develop for multiple reasons.

A clinical diagnosis is based primarily on symptoms of urgency/frequency of urinating and pain in the bladder and/or pelvis. Standard treatments of many decades are no longer routinely considered effective. One large urological study from 2000 concluded that no current treatments have a significant impact on symptoms with time.

PBS/IC is at least five times more common in women than men, affecting close to 500,000 females in the United States, with an average age of onset of about 40 years; 25 percent of those affected are under age 30.

PBS/IC has symptoms similar to those of the common urinary tract infection known as cystitis. However, with PBS/IC, routine urine cultures are negative, and there is usually no response to antibiotics. You may feel pelvic pain and pressure and an urgent need to urinate, sometimes as often as 60 to 80 times a day. You may also have vaginal and rectal pain. Pain during sexual intercourse is common. The symptoms can vary from mild to severe.

Diagnosis

PBS/IC may be incorrectly diagnosed as urethral syndrome or trigonitis, or you may be told there’s nothing wrong and that you have a sensitive bladder. A complete battery of urologic tests typically produces negative results. Conditions that have similar symptoms include bladder infections, kidney problems, vaginal infections, endometriosis, and sexually transmitted infections (STIs).

Medical Treatment for PBS/IC

There is no consistently effective treatment or cure for PBS/IC. However, the most commonly recommended approaches are:

  • Medication, including nonsteroidal anti-inflammatory drugs, antispasmodics, and antihistamines. Pentosan polysulfate sodium (Elmiron), an oral medication, may protect the bladder from irritants in the urine
  • Low-dose antidepressants, which appear to have antipain properties
  • Diet changes, eliminating caffeinated beverages, alcohol, artificial sweeteners, spicy foods, citrus fruits, and tomatoes
  • Transcutaneous electrical nerve stimulation (TENS) to block pain, using a small portable unit worn on the body

The following approaches all involve surgery, the benefits of which are sometimes unproved, and all of which pose significant risks:

  • Bladder distention (hydrodistention) stretches the bladder by filling it with water while you are under regional or general anesthesia.
  • Dimethyl sulfoxide (DMSO, Rimso-50), an anti-inflammatory medication, is placed directly into the bladder.
  • Oxychlorosene sodium (Clorpactin) is placed directly into the bladder; regional or general anesthesia may be necessary for this.
  • Major surgery (partial or complete removal of the bladder, or of certain nerves leading to the bladder) is often followed by severe complications and should be done only as a last resort.

Developing effective IC therapies is a major challenge facing all researchers in this field. The American Urological Association is planning to publish the first guidelines regarding methodology for diagnosis and treatment during 2011. In 2010, a large multicenter NIH-funded study reported on findings that myofascial physical therapy (specialized stretching of the thin tissue that covers all the organs of the body) was shown to be effective when compared with conventional massage techniques.