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Interstitial Cystitis (Painful Bladder Syndrome)
Interstitial Cystitis (IC) is defined by symptoms--frequent urination day and night and increasing pain as the bladder fills - according to the International Continence Society. The syndrome includes IC, which has been estimated to affect as many as 700,000 people, mostly women. Estimates for IC vary widely, but as many as 10 million people may suffer from this condition.
Medical Treatments
A new study will test an FDA-approved antidepressant (Elavil) for its potential to alleviate bladder pain for which there is no known cause and no effective therapy. Thousands, if not millions, of patients may benefit. The study is funded by the National Institutes of Health (NIH).
Ten medical centers in the United States and Canada are recruiting adults newly diagnosed with either painful bladder syndrome (PBS) or interstitial cystitis (IC) to learn if the oral drug amitriptyline (Elavil) will reduce the pain and frequent urination that are hallmarks of the conditions. The centers make up the Interstitial Cystitis Clinical Research Network, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at NIH.
Other Diseases of the Bladder
IC can be easily confused with many different bladder diseases, such as a UTI, because the symptoms of frequency and urgency are common to most bladder conditions. It is almost normal for a female IC patient to be initially misdiagnosed with bacterial infection (cystitis). Men with IC symptoms are often misdiagnosed as prostatitis or bladder outlet obstruction (1) patients.
The nebulous terms of urethritis, urethral syndrome, trigonitis, overactive bladder, and painful bladder often add more confusion for patients, because the medical community itself continues to debate the precise definitions of each disease. Hanno (3), for example, refers to urethral syndrome as short-term lower urinary tract symptoms that resolve before a physician can perform formal diagnostic tests. Childs and Egan (4) refer to urethral syndrome patients as those who experience UTI symptoms but with no apparent infection.
As IC patients endure the diagnostic process and seek "a name" for their condition, it is often helpful to understand the other bladder conditions that IC can be mistaken for, such as:
- Urinary Tract Infections
The terms urinary tract infection (UTI), bacterial cystitis and cystitis are used interchangeably to describe bladder infections, if verified by urinalysis and/or urine cultures. Bladder infections can cause frequency, urgency, painful urination, abdominal pain, fever and other symptoms.
- Urethritis
Urethritis is used to describe an inflammation or infection of the urethra in men and women. Inflammation can be caused by direct trauma to the urethra or can be an irritation from spermicides, soaps, douches or bath oils. Some sexually transmitted diseases, such as chlamydia, can also cause a urethral infection and urethral discharge that may also be labeled as urethritis (5).
- Urethral Syndrome
As mentioned earlier, urethral syndrome can be used to describe the symptoms of a UTI when urinalysis fails to reveal infection. Some physicians, such as Hanno, believe that urethral syndrome is short, rather than long, term. Many IC patients, including the authors of this book, have received urethral syndrome diagnoses before the IC was actually discovered.
- Trigonitis
Trigonitis patients may experience similar symptoms of frequency, urgency and/or pain. Trigonitis is diagnosed when physicians discover that the trigone (a triangular portion of the bladder that contains the openings for both the ureters and the urethra) appears inflamed and/or has a "cobblestone like" appearance. Some urologists don't believe in trigonitis because they believe that the cobblestone appearance is normal to the trigone. Others believe that an inflammation of the trigone may have a direct role in urethral syndrome (4).
- Prostatitis
There are several types of prostatitis diagnosed in men, including bacterial prostatitis (acute and chronic), non-bacterial prostatitis, and prostatodynia. The latter two account for 95% of all prostatitis diagnoses and usually have symptoms of perineal (or nearby) pain, reduced urine flow (and related symptoms), and possibly impotence and pain before, during or after ejaculation (6).
- Dysuria & Nocturia
Dysuria describes pain with urination. Nocturia describes frequent urination during sleep or nighttime hours (7).
- Overactive Bladder Syndrome & Urge Incontinence
Overactive bladder syndrome and urge incontinence patients may have frequency, urgency and episodes of incontinence. It is theorized that overactive bladder is the result of a neurological dysfunction, or smooth muscle disease, of the bladder. It is called detrusor hyperreflexia when a neurological cause is known and detrusor instability when there is no neurologic abnormality (8).
- Interstitial Cystitis, Painful Bladder Syndrome, Freqency-Urgency-Dysuria Syndrome
Interstitial cystitis, painful bladder syndrome and frequency-urgency-dysuria syndrome, are used interchangeably to describe urinary frequency, urgency and/or feelings of pain or pressure around the bladder, pelvis and perineum. IC patients usually have additional findings of small hemorrhages (called glomerulations) or ulcers within the bladder. In addition, patients may have a decreased bladder capacity and painful sexual intercourse. Women may flare during their menstrual cycle. Men may have scrotal or penis pain (9).
Is IC Progressive?
This is often the first question that an IC patient asks. However, there is no easy answer. Hanno (3) states that IC does not progress continuously but reaches its final stage rapidly and then continues without significant change in symptomology. Parsons (1) believes that patients diagnosed with infection, urethral syndrome and/or IC may represent the same disease process, yet are caught in the early, mid or later stages of the disease.
References
1. Parsons L. Evaluating and Managing Interstitial Cystitis. New Jersey:University Research Associates, 1997
2. Ho N, Koziol J, Parsons CL. Epidemiology of Interstitial Cystitis, in G. Sant (Ed.), Interstitial Cystitis. Philadelphia: Lippincott-Raven Publishers, 1997; 9-15
3. Hanno P. Interstitial Cystitis and Related Diseases, in Campbell's Urology, 7th Ed. Philadelphia: W.B. Saunders Company, 1998; 631-662
4. Childs S, Egan R. Microbiology and Epidemiology of Recurrent Lower Urinary Tract Infections. Infect Urol 1998;11(3):88-92
5. University of Michigan Health System Health Topics 8/98.
6. Prostatitis: Disorders of the Prostate, NIDDK Publication, 1998;
7. Mirriam Webster Medical Dictionary 1997;
8. Payne C. Epidemiology, pathophysiology, and evaluation of urinary incontinence and overactive bladder. Urology 1998;51(2a suppl):3-10
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