Painful Bladder Syndrome

By Barbara C. Bourassa

Interstitial cystitis(IC), also known as painful bladder syndrome, is a chronic condition that may affect 1 to 2 percent of the general population, according to a study in the April 2007 issue of the Journal of Urology. Because its symptoms often mimic those of other conditions, however, such as urinary tract infections (UTIs) or urinary stones, accurate diagnosis can be difficult to obtain.

As awareness of this baffling condition continues to grow, however, and new treatments are developed for treating its wide-ranging symptoms, sufferers of painful bladder syndrome are finding some relief.

Generally speaking, IC is an inflammation in the bladder wall, not caused by infection, that causes recurring pain in the bladder and the surrounding pelvic region, including the pelvic-floor muscles. Symptoms may include mild or severe pain before or after urination as well as frequent and/or urgent need to urinate. Some people experience pain during intercourse, while others experience pain after consuming trigger foods or beverages such as tomatoes, citrus fruit, coffee, tea, or cranberry juice. Symptoms may vary widely among patients and change with fluctuations in hormones, such as during menstruation, while pregnant, or with the onset of menopause.

For this reason, an accurate diagnosis of painful bladder syndrome can be difficult. "If you're a 22-year-old male and you see your primary care physician, you may be labeled as a prostate problem," says Jill Osborne, an IC patient and founder of the IC Network (www.ic-network.com), an online support group for people suffering from painful bladder syndrome. "For women, the diagnosis may vary depending on who they see. A general doctor may diagnose a UTI and prescribe antibiotics, while an OB/GYN may see it as an issue in the reproductive organs and suggest a hysterectomy. An older urologist may diagnose urethral syndrome or trigonitis [inflammation of the bladder], while many patients are told it's all in their heads."

The symptoms of a UTI and IC may be similar, but there are subtle differences, says Osborne. "The classic sign of IC is feeling like you have a severe UTI, but the urine culture comes back negative, which means there is no sign of bacterial infection. If this happens several times, particularly after intimacy, then it's important to consult with a urologist for a proper diagnosis."

"With a UTI, you may experience urethral burning while you urinate. With IC, patients usually feel the most discomfort as their bladder fills up with urine," Osborne continues. "After urination, IC patients often feel better because urine is no longer irritating their bladder. Some patients also struggle with bladder spasms after urination."

No one knows for sure what causes IC, or why the cells and/or nerves in the bladder can become inflamed, overly sensitive, or chronically irritated. While most researchers agree that IC probably has more than one cause, no one has isolated the exact factor or factors that may actually cause the disease yet, according to information from the Interstitial Cystitis Association (www.ichelp.org).

One theory is that IC is caused by defects in the surface lining of the bladder resulting from an acute injury (surgery or other trauma), a chronic injury (such as a recurrent infection), or a genetic defect. "This defective lining may allow allergic triggers, as well as chemicals, food preservatives, drugs, toxins, and bacteria, to penetrate the bladder lining, causing an immune response," according to www.ichelp.com.

Others, such as Osborne, believe that the cause may stem from a sensitization of the nerves in the bladder: "There are two types of nerves in the bladder—those that handle urinary frequency (alpha afferent) and those that handle pain messages (C-fiber). The alpha afferent fibers are very easy to stimulate and tell us when our bladder is full and needs to be emptied. The C-fibers are normally silent and much more difficult to trigger. Yet, in IC, it appears that the action potential of the C-fibers is modified, and they become much more active, which may explain why I can have a quarter of a cup of urine in my bladder and yet it can still feel full and painful."

And at least one study has linked IC to the adrenal glands. Dr. Tony Buffington, a professor of veterinary clinical sciences at Ohio State University, published a study in the December 2003 issue of Urology revealing that the adrenal glands in cats with IC were nearly half the size of those in healthy cats. (IC affects cats and humans in a similar manner, and many urologists believe that the feline urinary tract is one of the best animal models for the human urinary tract.)

While researchers continue to look for the exact cause of IC, the number-one treatment is a simple one that does not require a visit to the doctor: modifying your diet. A study published in the October/December 2006 issue of Topics in Clinical Nutrition found that elimination of items such as alcoholic beverages, coffee, tea, carbonated beverages, tomatoes and tomato products, and certain spices may help ease the symptoms of IC. The study was led by Dr. Barbara Shorter, RD, of Long Island University, an IC patient herself. Other potentially irritating foods, according to www.ic-network.com, include beer and wine; mayonnaise; peanuts; canned soup; processed meat such as bologna, ham, and hot dogs; and many types of cheese.

"Despite the hype, cranberry juice and green tea are not good choices for a patient to drink because they are very irritating to the wounds found in an IC bladder," says Osborne. "In my experience, the patients who seem to suffer the most are those who refuse to give up that one cup of coffee or diet soda a day. Water is much more soothing for a tender, IC bladder."

If you suspect that you, or someone you know, may suffer from IC or painful bladder syndrome, always consult a physician or medical practitioner, or ask your doctor for a referral to a urologist.

For more information on IC or painful bladder syndrome, visit http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis