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Bladder Pain? - Diagnosing and Treating Interstitial Cystitis

April 07, 2019


Do you go to the bathroom too much? Are you experiencing “frequent urinary tract infections (UTIs)? Does your bladder hurt, or are you feeling discomfort in the low abdomen/pelvis (lower belly) or the perineum (bicycle seat area)?

You may be suffering from Interstitial Cystitis (IC). This benign but annoying inflammatory condition affects the bladders of both men and women. The symptoms are often written off to “recurrent prostatitis” in men, and to “frequent UTIs” in women. If you have had these problems, and haven’t discussed the possibility of IC with your doctor, then it is time for another visit.

IC is diagnosed with a procedure called “cystoscopy and hydrodilation of the bladder.” A urine culture should be negative for infection. During this procedure, your doctor will look into your bladder with a small telescope, and fill the bladder with sterile water or saline to its fullest capacity at a certain physiological pressure. You will feel that your bladder is very full, and it might be very uncomfortable for a few moments. Although most patients undergo this procedure in the office setting, it can also be done under an anesthetic. When the bladder pressure is released, and the fluid is evacuated, the doctor will look at the lining of the bladder for abnormalities. If they see small bruises, called “glomerulations,” or small tears in the bladder mucosa, called “Hunner’s Ulcers,” then IC is the primary diagnosis. It is also important to notice any other bladder abnormalities if they exist, and to check a urine cytology, which should be devoid of malignant cells. Some doctors like to biopsy the bladder during this procedure, looking for inflammatory cells (mast cells) which may invade the muscular wall of the bladder. But this is not necessary, and if it is not found, does not rule out the diagnosis of IC.

Treatment for IC begins with the hydrodilation of the bladder. By the next day, most patients are experiencing significant relief from their irritative bladder symptoms. Two types of medications can restore bladder health. The first, called Elmiron, provides a healthy coating to the inside of the bladder. It mimics natural glycosaminoglycans make the lining of the bladder slippery inside, to help repel bacteria. The second, hydroxyzine, is an anti-histamine. Hydroxyzine can limit the release of histamine from mast cells invading the muscular wall of the bladder, reducing chronic inflammation. Because it can make you drowsy, it is taken at bedtime. Both Elmiron and hydroxyzine are taken by mouth. I recommend taking these medications for 1 year. After that, a trial of going off the medications is possible.

You can further improve your recovery from IC by looking for the things in your diet that cause bladder discomfort. The likely triggers to IC symptoms are caffeine, alcohol, and acidic foods (for example: orange juice, tomatoes, and cranberries). I ask patients to notice if something is an irritant, and to delete that from their diet when possible, one at a time. For more information on adopting a simple, healthier lifestyle, please read my post on the Paleo Diet.

If you are experiencing irritative bladder problems or chronic pelvic discomfort, ask your doctor or medical provider about Interstitial Cystitis. Proper diagnosis and treatment can put you on the path to better overall health. Contact us here today for a consultation or for any of your questions and concerns.

Wishing you the best in health,
Clifford Gluck M.D. FACS