What is Bladder Pain Syndrome? Diagnosis and Treatment of Interstitial Cystitis

It is also known as interstitial cystitis (IC), or painful bladder syndrome.

Despite all the researches, urinary tract infection, without any underlying cause such as urinary system stones, is a condition that disrupts the quality of life with serious symptoms such as sudden urinary urgency, constant pressure and urine sensation, constant disturbing pain in the bladder area, frequent urination.

Interstitial cystitis is a syndrome that is unpopular for both the patient and the physician, as its treatment is difficult and there is no serious association in treatment.

It is a rare disease 9-10 times more common in women than men. It is seen in 52-500 per hundred thousand in women and 8-41 per hundred thousand in men.

Bladder pain syndrome is diagnosed as the patient comes with serious complaints and symptoms, and as a result of the researches, conditions such as infection, stones, benign enlargement of the prostate, prostate and bladder cancer are not detected.

It is a condition that seriously affects the quality of life and comfort, such as frequent urination (sometimes every 5 minutes), sudden urge to urinate, the feeling of continuous urination, the feeling of inability to empty the bladder, and persistent pain in the bladder area.

Patients do not want to go out, and there are even those who quit their job due to this disease. Patients may become seriously depressed.

For the diagnosis, a good patient history, physical examination, laboratory analysis, urinary system ultrasonography, urodynamics and, if necessary, cystoscopy should be performed.

Bladder pain syndrome treatment, especially definitive treatment, is unfortunately not available. However, there are treatment alternatives that increase the comfort of life of the patient.

If it can be organized well, good results can be obtained. The treatment consists of 6 steps from the lightest to the severe.

While the least harmless treatments are given in the primary care, the sixth step is the removal of the bladder.

• Conservative suggestions are made, such as patient education, telling the patient about his illness, fluid adjustment, avoiding caffeinated and spicy foods, reducing the activities that increase complaints, and meditation. Approximately 45% of patients benefit from primary care.
• Physical therapy consists of oral medications and treatments given into the bladder. Physical therapy is the procedure where the muscles in the bladder area called pelvic floor are fat. Oral medications include amitriptyline, pentasone polysulfan sodium, antihistamines, and some other medications. Intravesical (intra-bladder) drugs are drugs such as heparin, dimethylsulfoxide (DMSO), hyaluronic acid, lidocaine. At this stage, patients benefit approximately 50-70% from the treatment.
• Cystoscopy: General anesthesia is entered into the bladder by means of a camera cystoscope device. First of all, it is observed whether there is an abnormal situation in the whole bladder. The bladder is filled with isotonic fluid and emptied. The bladder is examined again with a cystoscope. If there are ulcers with signs of interstitial cystitis, they can be removed with another instrument called resectoscope. In addition, swelling of the bladder (hydrodistension) is one of the treatment steps. 40-60% of patients benefit from this pressing treatment.
• Botox application into the bladder and sacral neuromodulation: It is applied into the bladder under general anesthesia with hydrodistension treatment in patients who have not responded to previous steps. Sacchal neuromodulation procedure is also an interventional condition to reduce urinary complaints of the patient.
• Cyclosporine A treatment: Due to its side effect profile, it is recommended to be applied in experienced places. It is a preferred treatment when there is no response to other treatments. Patients benefit close to 70%
• Urinary diversion, that is, removal of the bladder: It is a preferred method when the symptoms and signs of the patient are unbearable when there is no response to any of the other treatments. Since it is irreversible, its results should be discussed thoroughly with both the patient and their relatives. It is a procedure where the bladder is surgically removed and a 40-45 cm piece from the small intestine is removed and turned into a bladder.