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Painful Bladder Syndrome

What is Painful Bladder Syndrome?

Painful bladder syndrome is a condition in which pain at lower abdomen arises with painful urinary symptoms. This occurs due to discomfort in the bladder and that spread to the pelvic region.

The symptomatic uniformity is not maintained in very cases, even one suffering from Painful bladder syndrome experience varied the intensity of pain during the period of suffering. The condition persists for prolong period. This chronic Painful bladder syndrome is difficult to diagnose.

Alternatively, painful bladder syndrome is also known as Interstitial cystitis^1,2,3.

Symptoms

Painful bladder syndrome is a chronic condition and the symptoms are almost similar as urinary tract infection and kidney stone. Persisting the pain symptom in lower abdomen or in pelvic region for more than 6 weeks is a primary symptom of Painful Bladder Syndrome.

The symptoms of painful bladder syndrome are changed with time. In some cases, pain and the associated discomforts are self-limited and without treatment they abolished.

The pain symptom varies, which may range from dull ache to piercing pain.
Pain during micturition is common.
The pressure in urinary bladder after filled up with urine worsen the pain symptom
Pain in the lower abdomen extends to the lower back, pelvis area and urethra (the canal which excretes urine from the bladder).
Female genital organs, including vulva, vagina and posterior part of the vagina get pain in case of affected women.
Male genital organs, pain occurs at the penis, testicles, scrotum and posterior part of the scrotum.
Polyurea means frequent urinate. In normal individuals excrete almost 1.5 to 2-liter urine per day, but patients with painful bladder syndrome excrete 7-8 times more urine per day.
Patient with painful bladder syndrome urinate 40 to 60 times
Nocturia (frequent urination during the night) which also disturb normal sleep hours.
The urinary urge is continued for prolonged period.
During menstrual cycle, worsen the pain symptom in females
Painful sexual intercourse^1,2,3,4

Incidence

Painful Bladder Syndrome is most common in female than male. Among total incidence of Painful Bladder Syndrome, 90% of patients are female. Average prevalence rate showed that people above 40 years of age mainly get affected with Painful Bladder Syndrome².

Causes

The exact cause of the Painful Bladder Syndrome development is not known. Some possible causes are expected to provide an effect on Painful Bladder Syndrome:

Urine is not completely removed from bladder due to dysfunction of the bladder.
Inflammatory chemicals secretion cause bladder irritation
Certain chemical present in urine causes damage in the bladder
Neurological problem in bladder wall
Autoimmune disease in bladder
Fibromyalgia can be a cause of Painful Bladder Syndrome
Painful Bladder Syndrome may associate with irritable bowel syndrome
Hereditary involvement may involve in painful bladder syndrome development^2,3,4.

Triggering Factors

Drinking alcohol
Mental stress or strenuous physical activity
Menstrual cycle
People with white skin with red hair has greater risk
Increasing age
Association with another chronic pain syndrome like fibromyalgia or irritable bowel syndrome ^2,3

Diagnosis

The diagnosis of Painful Bladder Syndrome is tough because a similar type of symptoms is also associated with other disorder of urinary bladder. Although, the initial diagnosis is based upon the symptomatic analysis. The included symptomatic approaches are:

Pain in bladder in association with polyurea and persistent urge for urination
Absence of other disease condition, which causes pain in lower abdomen

The following diagnostic tests are also performed – urinalysis, urine culture, cystoscopy, biopsy of the bladder wall and urethra, and distention of the bladder under anesthesia.

Urinalysis, urine culture are conducted for analyzing the presence of infection.
Cystoscopy is conducted for evaluation of cancer cell presence in the bladder
During cystoscopy, small tissue sample is collected for biopsy test to conduct^1,5

Treatment

Following are the treatment options available for Painful Bladder Syndrome:

Distention of bladder

This process is applied for diagnosis purpose. But researchers found this technique also assist to relief the symptoms of Painful Bladder Syndrome. Usually, the condition worsens at the initial stage and but gradually condition become improves within 2 to 4 weeks.

Bladder wash

Bladder wash or bladder instillation is the process in which bladder is filled with solution 10 to 15 minutes prior to emptying.

Medication

Elmiron (Pentosan Polysulfate Sodium) is an FDA approved the drug for treatment of Painful Bladder Syndrome. But this drug has blood thinning property. Therefore, patients should stop the medication prior to conduct any surgery.
Aspirin and ibuprofen are prescribed to control mild discomfort associated with Painful Bladder Syndrome.
Amitriptyline is a tricyclic antidepressant drug, may assist in reducing pain symptom, enhance bladder capacity, and diminish the frequency of urination and nocturia.
Combination therapy with acetaminophen and codeine (narcotic) may need to prescribe for controlling severe pain.
Some experts also recommend anti-histaminic drugs to provide symptomatic relief.
Transcutaneous electrical nerve stimulation (TENS), is the process in which mild electric pulses penetrate into the body for minutes to hours. The wire is attached either on the lower back or just above the pubic area. This process is conducted for two or more times a day. Electric pulses provided through TENS may enhance blood flow to the bladder, toughen pelvic muscles that assist manage the bladder or reduce pain symptoms by triggering the discharge of pain blocking substances.

Exercise

Gentle stretching exercises help to decrease the symptoms of Painful Bladder Syndrome^1,2,3,4.

Complications

In Painful Bladder Syndrome, the continuous irritation leads to cause stiffness. In some patient, glomerulations develop and cause bleeding from the bladder wall. Almost 10 percent patients with Painful Bladder Syndrome also have Hunner’s ulcers. In Hunner’s ulcers, the skin of the bladder wall become broken¹.

References

Interstitial Cystitis/ Painful Bladder Syndrome; National institute of Diabetes and digestive and Kidney diseases; National Kidney and Urologic Diseases Information Clearinghouse
Interstitial Cystitis (Painful Bladder Syndrome); https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome
Interstitial Cystitis; http://www.webmd.com/urinary-incontinence-oab/interstitial-cystitis#1
Interstitial Cystitis, (2016); Mayo Clinic Staff; http://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/symptoms-causes/dxc-20251948
Interstitial Cystitis; Urology Care Foundation; http://www.urologyhealth.org/urologic-conditions/interstitial-cystitis