How Urologists Help Manage Interstitial Cystitis

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic condition that causes bladder pain and pressure. It is more common in women than men.

Your doctor will ask you about your symptoms. They may also take a urine sample. They will check it for blood in the pee or signs of infection.

Bladder Stretching

Bladder stretching is a minimally invasive procedure in which your doctor fills your bladder with sterile water while you’re under anesthesia to stretch the inner lining. They then use a tool called a cystoscope to inspect the bladder lining for cracks that bleed or areas of inflammation (called glomerulations). This is a common test in women with IC/BPS, but men also have it.

Urologist like Marlon Perera, may prescribe medications to help manage your IC symptoms. Many patients find relief from medications that decrease fluid retention and relax the muscles in the bladder and pelvic area. You can also reduce your symptoms with changes in diet. Eliminating irritants from your diet, such as carbonated beverages and foods with high levels of caffeine or vitamin C, may relieve painful urination in some people. Tight and stressed pelvic floor muscles can contribute to bladder pain, so Dr. Perera may recommend physical therapy to teach you how to stretch and exercise the pelvic floor.

Botox® injections

A urologist will inject tiny amounts of botulinum toxin, or Botox, into the muscles involved in your bladder spasms. This is similar to how it’s used to treat wrinkles. Before the injection, your urologist will apply a topical anesthetic (EMLA cream) or spray a coolant on your skin to numb the area. Your urologist also might use a device to numb the site by pushing on the muscles with vibration.

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This procedure is usually done in a doctor’s office. You will be able to go home the same day. You may feel some pain or discomfort during the procedure, but it is usually mild.

The FDA approved one form of Botox to treat IC/BPS in adults in 2012. It is called onabotulinum toxin A (Botox), and it blocks the nerve signals that cause bladder spasms. You can find more information on this treatment at the Botox website.

Another type of Botox that a urologist might use is rimabotulinumtoxinB (Myobloc). It treats neck muscle spasm in people with cervical dystonia, which causes repetitive, uncontrollable movements of the head and neck. It is injected into the affected muscles and can reduce the symptoms of this condition in most people.

A urologist might recommend oral medications to help relieve pain, pressure and urinary frequency in people with IC. These might include pain relievers like ibuprofen and antihistamines. Or they might prescribe a drug called pentosan polysulfate sodium (Elmiron), which is believed to restore the inner surface of the bladder and protect it from substances that irritate the lining of the bladder.

Medication

The pain, pressure and urgency of interstitial cystitis (IC) can seriously disrupt your life. Symptoms can range from mild to severe and come and go over time. IC is not curable, but you can manage symptoms to improve your quality of life.

Your urologist will review your medical history and symptoms before beginning treatment. She will also perform a pelvic exam and a urinalysis to see if you have an infection. A urologist may use a flexible, lighted tube called a cystoscopy to check the inside of your bladder and the surrounding area.

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Medications can help ease pain and pressure from IC. Your urologist can prescribe an anti-inflammatory like pentosan polysulfate sodium, or other medications to help relax muscles in the bladder. She may also prescribe a medication to block nerve signals that cause bladder spasms.

Bladder sensitivity tests can be helpful for some people with IC. During the test, your urologist instills water and potassium chloride solutions into your bladder. You then rate how much pain and urgency you experience after each solution. Having higher sensitivities to these solutions is a sign that you have IC.

In some cases, your urologist can use a surgical procedure to stretch your bladder by filling it with liquid or gas while you’re asleep under anesthesia. A surgical procedure called a bladder augmentation can also increase the size of your bladder by placing a patch of your intestine over it.

Surgery

The exact cause of IC is unknown, but experts believe it may involve abnormalities in the bladder lining. The condition also can develop because of heredity, allergies and infections. Women are more likely to suffer from it, and it tends to flare up during menstruation.

To diagnose IC, your physician will conduct tests and ask you to fill out questionnaires. They’ll look for a history of urinary tract infections and symptoms that include pelvic pain, bladder pressure and frequent urination. They’ll also perform a urinalysis, where they examine your pee for blood and bacteria.

Once a diagnosis is confirmed, your urologist will offer a number of treatment options. These treatments can range from making dietary changes to implementing pelvic floor exercises, to administering medication or Botox® injections to manage bladder spasms. Depending on your symptoms, your doctor may also recommend bladder retraining, where you hold your urine for longer periods of time (every hour at first, then every two hours, etc.) to reduce frequency and urgency.

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Oral medications can also help relieve IC symptoms. The only FDA-approved oral drug for IC is pentosan polysulfate sodium, which binds to the bladder walls and helps replace and repair the lining. The drug can take up to six months to work, but research has shown moderate success in reducing symptoms.

 

Perera Urology
Suite 118/55 Flemington Rd,
North Melbourne VIC 3051
1300 884 673
www.pereraurology.com