One possible cause is a defect in the epithelium, or the lining of the bladder. If there is a leak in this protective lining, then the toxic substances that are found in urine could irritate the cells on the wall of the bladder.
Other factors that could contribute to Painful Bladder Syndrome include:. Even though the exact cause of interstitial cystitis is unknown, there are certain factors that can increase your risk of developing the syndrome. Interstitial cystitis , or Painful Bladder Syndrome, can in turn cause some complications. These include both physical and lifestyle complications. It can also lead to a lower quality of life. With more frequent trips to the bathroom and the pain that comes with the condition, it can interfere with daily activities, social interactions, and even work.
On top of that, interstitial cystitis can cause problems with sexual intimacy, which can put a strain on personal relationships and intimacy with a partner.
The syndrome can also lead to interrupted sleep, which can have an effect on both health and quality of life. The lower quality of life, interrupted sleep, and chronic pain can contribute to emotional stress and even depression. The symptoms of interstitial cystitis vary from person to person.
The symptoms may also vary over time as well as vary in severity. The most common symptoms of interstitial cystitis are:. Some people have periods with no symptoms at all, followed by periods of experiencing symptoms.
The severity will also differ from person to person. The pain can vary from a dull ache to a more piercing pain. It can also hurt to pee, which can vary in severity from stinging to a burning sensation. Some of the symptoms are similar to those in a urinary tract infection.
If someone who does have interstitial cystitis develops a urinary tract infection as well, the symptoms can increase in severity. There are some triggers that can actually make the symptoms of interstitial cystitis worse. These include:. What can trigger symptoms or make them worse can vary from person to person.
People with interstitial cystitis may want to consult a nutritionist or a dietitian in order to make an eating plan that avoids foods that trigger symptoms. First, however, you should keep track of what foods you ate right before experiencing painful symptoms. Diagnosis instead typically involves ruling out other conditions that have the same symptoms first.
Doctors want to rule out the following conditions:. Once your doctor has ruled out other possibilities that have similar symptoms, there may be a diagnosis of interstitial cystitis. Treatment for interstitial cystitis is mostly about managing the symptoms rather than treating the condition.
For many people, interstitial cystitis goes away on its own. Others make lifestyle changes to avoid triggers and to manage the symptoms. The first stage of treatment is typically avoiding foods that trigger symptoms, managing stress, trying to retrain your bladder to go for longer before urinating or some light exercise such as walking. It can take several weeks or even months for the symptoms to stop, however, if these changes work.
This stage includes physical therapy to relax the pelvic muscles and medication. Elmiron is the only prescription medication that is approved in the United States for treating interstitial cystitis. Over the decades since it was first approved, hundreds of thousands of patients have taken it to treat the symptoms of Painful Bladder Syndrome.
Even though for some patients with interstitial cystitis, the symptoms do ease after a few months, for many, the condition is chronic and they take Elmiron for years. Just like with any medication, taking Elmiron is not without its risks and side-effects. Some common side effects of taking the drug can include:. And many patients would have chosen not to take it.
Neither doctors nor the FDA, bear the blame for the lack of warnings. You may be able to file an Elmiron lawsuit against Janssen if you were prescribed the drug and have been diagnosed with maculopathy or vision damage. If you take Elmiron but have not yet received a maculopathy diagnosis, you may want to schedule an appointment with your eye doctor, who can perform retinal imaging tests.
Symptoms of Elmiron-related maculopathy include:. Our firm, and Paul, have a proven track record of successfully resolving major pharmaceutical lawsuits. All law firms are not the same. Our resources are greater, our verdicts are bigger, and our passion is unrivaled. Find out why we're trusted by millions during a free, confidential case review. Premature babies often require additional nutrition to support their development and offset their low birth weight.
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Back Locations. Back Alabama. Back Florida. Back Georgia. Back Indiana. Back Kentucky. Back Massachusetts. Back Pennsylvania. Back Tennessee. Can estrogen build up the urethral musculature and perivaginal tissues?
Yes, it can. Gynecologists use this to treat pelvic prolapse and mild stress incontinence. At times it helps in mild cases. I have not been impressed with estrogen therapy and IC. In one of my slides I mentioned that IC pain is modulated by hormone levels in women, so I suggest that if a woman is taking birth control pills and she is in pain, she may go off the pills to see if that helps.
If she is not on birth control pills, I suggest that she try that to see if it helps. Sometimes that makes a difference. Our next speaker is Dr. He has particular expertise in pelvic floor dysfunction, which he will be speaking to us about today as well as the etiology of IC. Good afternoon everybody! I woke up this morning in Orlando, lectured to a group of urologists about IC, and then flew to NY to come speak with you this afternoon!
I'm very happy to be here and I thank Dr. Ratner and the ICA for inviting me. It is always wonderful to be speaking with my esteemed colleagues, Dr. Moldwin and Dr. We will talk today about the etiology of interstitial cystitis.
We know that the disease process begins in the bladder with epithelial damage. Although there are numerous theories about what causes IC, we all agree that there is probably more than just one thing going on. I would like to explain how we came up with the idea of a GAG layer problem. Urea the final product of the decomposition and utilization of proteins in the body. It is eliminated through the urine can be measured very easily in the bloodstream.
If we put urea into an IC patient's bladder, it is absorbed into the bloodstream. In a normal bladder, very little urea would come through, because there is a normal GAG layer, which prevents the urea from being absorbed by the bloodstream. When we treat a normal control bladder with protamine a chemical detergent that destroys the GAG layer , we are basically creating an experimental IC bladder. Lowell Parsons performed a study in that suggested that IC had something to do with damage to the lining of the bladder.
There were nonbelievers in the urologic community, then and even now. There was recently an article that tried to disprove the GAG layer theory. In fact, they did the opposite, they proved it all over again. They took another substance, a sugar called rhamnose, which can be measured in the bloodstream. This is a sugar that doesn't occur in the normal foods that we eat. Rhamnose was put in IC bladders and then measured in the bloodstream.
The rhamnose was measured in high quantities in the bloodstream of IC patients, but is not found in bladders of normal control patients. In , we started to become interested in potassium. Potassium is an important participant In the inflammatory cascade caused by IC.
When you put protamine into the normal bladder, the GAG layer is destroyed and high levels of potassium are measured in the blood stream. When you treat the patient with heparin instilled into the bladder, the potassium absorption goes down. You may be thinking, "This is all about blood tests and potassium levels, but my life is all about pain, frequency and urgency. In another potassium stimulation test, instead of measuring the potassium, we asked the patients what they were feeling when the potassium was put into the bladder.
Before the potassium was instilled into normal bladders, they had very little urgency and pain. When the protamine was put into the bladder, they developed IC symptoms.
We then treated those patients with heparin and the pain and urgency scale went down. These are all sophisticated studies that we used to convince our colleagues that there is science to this whole idea of GAG layer damage in IC.
It is not only your bladder that behaves this way. There are other conditions in the bladder that are also KCl potassium positive. There is a condition similar to IC in people who have had too much radiation therapy to their bladder which also shows a positive response to the KCl test. In men with prostate enlargement, who suffer no pain or urgency related to bladder disease, the KCl test is negative.
The proposed pathophysiology of interstitial cystitis includes: a urothelial permeability dysfunction, GAG layer deficit, potassium gets into the cells and irritates nerve endings, causes activation of mast cells, secretion of inflammatory mediators such as histamine, resulting in an ongoing inflammatory cascade.
If you have GAG layer damage as seen in IC, potassium from foods you have eaten can go through the interstitium of the bladder and cause these responses. It stimulates the potassium to depolarize nerve endings. The secretions from those nerve endings, which are in the bladder wall, secrete neuropeptides and neurotransmitters, like substance P.
We can measure these to show that they occur in higher proportions than in normal patients. These act on other cells in the bladder wall, like mast cells, which contain histamine.
This causes the mast cells to secrete histamine, which further stimulates the nerve endings, and this becomes a vicious cycle. This is what causes at least the bladder symptoms associated with IC. This is a bladder biopsy of an IC patient. This is an electron microscopic view, which is not done routinely. Here is a mast cell, with black histamine granules.
Very often when we do biopsies, we ask the pathologist to stain for mast cells. The mast cells often degranulate from the trauma of the cystoscopy and biopsy, which can cause the mast cells to dump histamine. Thus, the pathologist may not be able to find mast cells. See these empty white vacuoles? That is where the histamine was. There are other things being secreted besides histamine.
Leukotrienes are being absorbed by the blood vessels. Heparin-like substances are secreted that stimulate sensory nerves. Substance P is also secreted. This is how we understand the etiology of IC, using the mast cell, or epithelial dysfunction theory. Many of these neurotransmitters are measurable.
We do measure higher levels of norepinephrine, nerve growth factor, substance P and NK-1 in the urine of IC patients. That is just further evidence that what I have just proposed to you is really going on. I would now like to try to get you off the path of going into the cave, where it says, "Abandon all hope, ye who enter here.
I will then talk about a more advanced stage of IC, which I call mature, or advanced IC, which involves the development of pelvic floor dysfunction along with interstitial cystitis.
When we talk about pain, the first line therapy for bladder and pelvic floor pain are the tricyclic antidepressants. I am always very careful when I suggest going on an antidepressant to my patients, because their first notion is that I think they are crazy and they need an antidepressant. The dosages of antidepressants that we use for the treatment of pain are miniscule compared to what the psychiatrists use for the treatment of depression.
We start with 10 mg and rarely go above 25 mg. The low dosages operate at the level of the spinal cord and probably the brainstem. Although it doesn't take away your pain, it behaves like a radio volume knob; turn that knob to the left, you still have the pain but you don't feel it as much. Many of the side effects associated with the tricyclics are ones that we welcome. We want Elavil to give us antihistamine side effects, we want Elavil to have a soporific effect to make you sleepy.
Elavil has been on the market for a long time and there have not been any studies, but we do know it works and it can be first line therapy for pain with IC. There is a new class of medications, called neuroleptics. The anesthesiologists who treat chronic pain discovered that they work well in the treatment of neuropathic pain, which is what IC patients have.
We start with mg three times a day of Neurontin, and go up to mg three times a day, and sometimes higher. I was at an IC support group a few years ago and a patient said that Neurontin was the only drug that had made a difference in his life. Sometimes we have to use narcotics. Many of you have heard Dr. Brookoff speak, and he has convinced me and other urologists that you need to treat the pain of IC. If you have to give narcotics, then you do that. People who have chronic pain do not become addicted to narcotics.
They need the narcotics to function normally. We like to start with Vioxx and Celebrex, which are non-narcotic antiinflammatory agents. This drug needs to be used carefully, but it is an excellent drug that gives pain relief, and you only have to take it twice a day. In my practice, if OxyContin is not holding my patients, I send them to the pain center at Roosevelt Hospital. I would like to talk about pelvic floor dysfunction PFD. PFD is something that we see in IC in the advanced or "mature" forms.
Although I don't have numbers, in my experience, it takes at least two years for an IC bladder to evolve into an IC bladder with pelvic floor spasms.
In a very advanced case of IC, there is also damage to the nerves that cause spasm and dysfunction of the pelvic floor muscles. The sensory and afferent nerves from the bladder return to the spinal cord, where they share nerve roots with the same nerves that go down to the pelvic floor muscles; the levator and pubococcygeal muscles. When these nerves are stimulated by IC or "up-regulated", there is some transference of activity, and the nerves that these are attached to that send signals to other places, also get up-regulated.
That is how PFD occurs. When Dr. Lowell Parsons speaks to doctors, his favorite phrase is, "It's the bladder, stupid. I feel it may be a little more than just the bladder and it may involve the pelvic organs and the pelvic muscles surrounding the bladder as well. With chronic bladder inflammation from IC there is a "reawakening" of these aberrant nerve endings that go to the pelvic muscles around the bladder and cause those muscles to go into spasm. That is what PFD is all about; abnormal spasm of the pelvic floor muscles associated with chronic inflammation of the bladder and prostate.
Men who have chronic inflammation of the prostate can have PFD. We also find a similar situation in vulvodynia and vulvar vestibulitis, which is a "cousin" disease to IC, in female patients. Up-regulation of the nerves that go to the vagina also feed back on the nerves to the pelvic floor and cause PFD as well. To summarize, some of the conditions we see associated with PFD are: IC, vulvodynia and vulvar vestibulitis and chronic pelvic pain syndrome, which is a new catchword for IC in men.
I may be on somewhat thin ice right now, but I have seen in my practice that patients who have had recurrent urinary tract infections UTI that are documented by positive cultures could also, over time, develop spasm of the pelvic floor muscles. That supports the notion that inflammation doesn't have to be IC of the bladder can irritate the pelvic floor muscles as well. The symptoms of PFD are: urinary urgency and frequency, chronic pelvic pain, dyspareunia pain with intercourse , low back pain, dysfunctional voiding, constipation and, in men, ejaculatory discomfort.
When I give this talk to urologists, I spend a lot of time teaching them how to examine the patient. I tell them how to rule out vaginal infections, vulvodynia, and urethral diverticuli.
I then teach them how to evaluate for IC. To very gently, move the examining finger against the anterior vaginal vault along the urethra, until they are just underneath the bladder base. To gently lift up on the bladder base. Unfortunately when we do that to an IC bladder, it can hurt quite a bit. When you do that to a bladder with a UTI, it bothers the patient, but it is nowhere near the kind of reaction we get in an IC patient.
The next step is to evaluate for the presence of PFD. They put their finger up against the floor of the bladder and rotate the finger laterally to feel the muscles of the pelvic floor. If they move their finger to a 3 o'clock position laterally, they will feel the levator ani muscle going straight up and down, almost like a guitar string. Very gently, they are to press on that muscle or strum it as if it were a guitar string.
In a patient with PFD, there will be an extremely dramatic response to that exam, often more than occurred when we felt their bladder. Obviously you can do that same exam in a man, through the rectum.
Instead of swinging down, you swing the finger up to feel the same muscles. The more we look for PFD in men, the more we find it. It is present more often than we ever imagined. How is PFD treated? We start with skeletal muscle relaxants. These are benzodiazepines that relax the muscles that are in spasm in PFD. Biofeedback, electrical stimulation, body work and massage therapy can also be used. I work closely with a therapist who does Hellerwork. This allows her to get into the muscles with massage therapy and does trigger point therapy as well as myofascial release.
Whitmore uses a physical therapist who does intravaginal massage and trigger point release. There are a lot of ways to get to these muscles that are in spasm. Biofeedback is not a treatment, it is an education! We teach the patients to find the muscles that are in spasm in their own body, and how to relax those muscles. You are not necessarily going to feel better after biofeedback, you will feel better when you do the exercises. Biofeedback is used for many things; IC, vulvodynia, frequency and urgency without IC, urge incontinence, stress incontinence, and PFD from prostatitis.
There are biofeedback units for the office and for home use. I utilize an EMG vaginal probe. There are two silver rings around it that measure muscle activity. For men, we have a smaller rectal probe. For women who have trouble accommodating the probe, there are smaller tampon-size probes. The purpose of biofeedback is to teach identification and isolation of the pelvic floor muscles.
Patients are taught contraction and relaxation exercises, which are a variant of Kegel exercises, but with an emphasis on relaxation. We are not trying to stop incontinence, we are trying to teach you to relax the muscles. By doing these kinds of exercises with my biofeedback therapist, you eventually learn how to find these muscles without looking at a computer screen and how to do the relaxation on your own.
Once we teach the patients biofeedback, to find the muscles and relax them, they can rent a home device that does electrical stimulation at home. I am a solo practitioner in New York City, but I use resources that are available to me: physical therapists, massage therapists, biofeedback therapists, acupuncturists, and pain management.
This is a multidisciplinary team approach to this very devastating problem that so many of you suffer from.
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