By Melissa K. Polizos, MSN, NP-C
Diagnosing and resolving Bladder Pain Syndrome (BPS)/Interstitial Cystitis (IC) can be difficult. However, with a greater understanding of the condition and the range of therapeutic options to address it, we can help more patients gain relief from its unpleasant symptoms.
BPS/IC is marked by mild to severe bladder-related pain, burning pressure or discomfort, as well as lower urinary tract symptoms that last more than six weeks without an infection or other identifiable cause. The condition is more common in women than men and is usually diagnosed in the fourth decade of life.
Symptoms may fluctuate depending on a patient’s activity, diet, stress level and menstrual cycle. Patients often suffer from urinary urgency, nocturia and painful intercourse. Patients may also have concomitant diseases such as irritable bowel syndrome, vulvodynia, fibromyalgia and psych-social comorbidities.
While the causes of BPS/IC are not fully understood, one likely theory is that sensory nerves in the bladder or pelvic area become overly sensitive to pain and pressure due to repeated stimulus, such as inflammation and/or chronic bladder irritation.
Some patients report having had a recent urinary tract infection (UTI), an episode of vaginitis or prostatitis, or bladder, pelvic or back surgery. In other cases, there is no such explanation. Abnormalities also may be present in the bladder lining, such as Hunner’s lesions or ulcers. Those can be discovered via cystoscopy.
Diagnosing BPS/IC requires a thorough physical assessment – with a pelvic exam and urinalysis – and additional testing to rule out another condition, such as a UTI or kidney stones. Be aware that BPS/IC patients may have significant tenderness in their lower abdomen, hips, buttocks, vagina, scrotum or penis, making an exam uncomfortable.
Along with a detailed medical history and discussion of symptoms, patient diaries that track the amount and frequency of daily urination and dietary intake can be particularly useful in diagnostics. A specialist can also measure post-void residual urine with a small catheter or ultrasound.
First line treatment for BPS/IC is focused on patient education, behavioral modification, stress management, pelvic floor physical therapy and oral analgesics for pain management pain. Certain foods and drinks, for example, may exacerbate symptoms: coffee, alcoholic beverages and spicy dishes are common culprits.
Second-line therapies are oral medications such as amitriptyline, cimetidine, hydroxyzine and pentosan polysulfate sodium (PPS), or intravesical instillations such as dimethylsulfoxide (DMSO), heparin, or lidocaine.
Beyond medication, a cystoscopy with low pressure hydrodistension – performed under anesthesia – may temporarily relieve symptoms by gently stretching the bladder to its maximum capacity.
In persistent cases, some patients have seen satisfactory results with neuromodulation/sacral nerve stimulation or intravesical Botox to relax the bladder wall. These procedures must be provided by a specialist experienced in managing BPS/IC, as urinary side effects can result. Gabapentin also may help with nerve pain.
Fortunately, many BPS/IC patients respond well to much less invasive treatments. Early referral to a specialist is always beneficial for any suspected case.
Melissa Polizos is a Nurse Practitioner at the Devine-Jordan Center for Reconstructive Surgery and Pelvic Health, a division of Urology of Virginia. urologyofva.net