|
|
|
Home | About Us | Latest News | Speakers and Events | Educational Resources | Patient Stories | Contact Us |
|
Definition
Cystitis is a very nonspecific
term meaning inflammation of the bladder.
Interstitial cystitis (IC) is a condition
that results in recurring discomfort or pain in the bladder and the
surrounding pelvic region.
Symptoms vary, but most commonly include an
urgent need to urinate (urgency), a frequent need to urinate (urgency),
and/or pelvic pain usually worsened with bladder filling and lessened
with bladder emptying.
The symptoms may worsen with certain foods
or stress.
It occurs far more frequently in women than
men and it is estimated that of the 1 million Americans with IC, up to
90% are women.
Women’s symptoms often worsen during menses
and many women experience pain with intercourse.
In men, the pain may be at the tip of the
penis, groin, or testicles.
Diagnosis
Because symptoms are similar to
those of other disorders of the urinary bladder and because there is no
definitive test to identify IC, it is considered almost a diagnosis of
exclusion.
A doctor must rule out urinary tract
infections and bladder cancer, and in men chronic prostatitis.
An examination of urine will be done to
look for red blood cells (possibly cancer or a stone) or an infection.
A questionnaire may give a score which
correlates with IC and fluids instilled into the bladder can either
worsen the symptoms of patients with IC (potassium chloride sensitivity
test) or lessen the symptoms (lidocaine, heparin, DMSO).
A cystoscopy (looking into the bladder with
a telescope) may be done under anesthesia and can rule out bladder
cancer and may actually help with the symptoms afterwards.
To date there is no one test that
definitively diagnoses IC.
Treatments
Bladder Distention Stretching the bladder under
anesthesia during cystoscopy can be both diagnostic and therapeutic.
Symptoms
may temporarily worsen for 1 to 2 days, but then will return to baseline
or actually improve.
It is felt that the stretching may
interfere with pain signals transmitted by nerves in the bladder. Bladder Instillation The only drug approved by the
FDA for bladder instillation is dimethyl sulfoxide (DMSO, RIMSO-50).
The drug is instilled into the bladder
through a small tube (catheter) and is held in the bladder for 15
minutes before being expelled.
Treatments are given every week for 6 to 8
weeks and then repeated as needed.
Some patients learn how to do the
catheterizations and instillations at home.
It is felt that DMSO passes into the
bladder and reduces inflammation, blocks pain and may prevent muscle
contractions.
The DMSO may be combined with other agents
including heparin, kenalog (steroid),sodium bicarbonate (acid reducer),
and lidocaine or marcaine (anesthetic), carrying these agents with it.
One
bothersome side effect of DMSO is a garlic-like taste and odor on the
breath and skin that can last up to 3 days.
Lidocaine and marcaine are short and long acting
anesthetics that can be instilled into the bladder for immediate relief
and can last hours to several days, and can be done at home. Oral Medications Pentosan polysulfate sodium (Elmiron) This is the first oral drug
approved by the FDA for IC in 1996.
It is taken on an empty stomach three times
a day, and can take up to 6 months to have a reduction in urinary
frequency and IC pain. It is felt that Elmiron may work
by repairing defects in the bladder lining.
Side effects include minor gastrointestinal
discomfort and 4% risk of hair loss which is reversible when the drug is
stopped.
Amitryptyline (Elavil) This is a tricyclic
antidepressant which can help with sleeping and is used at lower doses
than that for treatment of depression.
It can cause weight gain, constipation, and
reduced libido. Histamine Blockers (Atarax, Vistaril, Clarinex,
Zyrtec) These drugs prevent the release
of histamine from mast cells in the bladder, which is felt to be one of
the causes of IC.
The newer agents are taken once daily and
do not cause fatigue. Gabapentin (Neurontin),
Pregabalin (Lyrica)
These are antiseizure
medications which have been used to treat chronic pain, and can have
benefit in IC.
They have variable dosing and their main
side effects are dizziness and fatigue. Anticholinergic Medications
(Detrol LA, Ditropan XL, Enablex, Levbid, Oxybutynin,
Oxytrol, Sanctura, Vesicare)
These medications are used to
treat an “overactive bladder”, and may work by relaxing the bladder
muscle causing less urgency and frequency, or by reducing the sensation
of feeling the need to urinate.
Their main side effects are dry mouth,
blurred vision, and constipation. Prelief This is an over the counter medication which is a
tasteless additive sprinkled on food to deacidify foods that would
otherwise cause a flare. L-arginine This is an amino acid which is involved in the
production of nitric oxide and is obtained from a health food store. Narcotics These can be used to effectively
improve the patients mood, job status, and family life, but abuse can
occur when the narcotics are used to escape from life’s problems, not
just treat the pain.
They come in long-acting and short-acting
forms, and many times are best managed by a pain doctor.
They also can cause side effects including
constipation, sedation, confusion, respiratory depression and even
death.
Tramadol (Ultram) is an atypical narcotic, and can
help with mild and moderated pain with IC. Urinary anesthetics (Pyridium, Urelle, Utira-C, Prosed
DS, Pyridium Plus) These agents turn the urine either orange or blue and
may be combination drugs working as an anesthetic, antiseptic (kills
bacteria), and anticholinergic. Long-term Oral Antibiotics There is some thought that IC
may be caused by low levels of bacteria and antibiotic therapy for 6
months may be beneficial.
Vaginitis may need to be treated. Diet There is no scientific evidence linking diet to IC,
but many patients find that alcohol, tomatoes, spices, chocolate,
caffeinated and citrus drinks, and high-acid foods may contribute to
bladder irritation and inflammation. Physical Therapy This includes electrical
stimulation, biofeedback and bladder training to help with pain relief
and frequency reduction.
Many times it is covered by insurance.
(Botox) Intravesical Botox has been used with success
to treat IC, and can help with both the pain and the frequency. It is
an off label use of Botox, but occasionally insurance companies will pay
for the procedure which can be done in the operating room under
anesthesia, or in the office under local anesthesia. It lasts for 3 to
6 months before the symptoms return and it needs to be repeated.
Stimulation of the sacral nerves affects the muscles of the bladder and
the pelvic floor and can aid with frequency, urgency, and sometimes even
the pain. A test stimulation can be done in the office under local, but
the permanent implant must be done in the operating room. It is
approved by Medicare, and thus, many of the private carriers cover it.
A thin wire is placed in the lower back and mild stimulation is
delivered through an external device similar to a TENS unit, and if
successful, the permanent device is placed in the operating room with
the small stimulator placed under the skin in the lower back.
(Urological and Sexual Health Care Specialists)
6560 Fannin,
Website:
www.hmutx.com
|
|
Disclaimer Statement: |
