Bladder pain syndrome

What is it?

Interstitial cystitis (IC) or bladder pain syndrome is a painful, chronic condition of the bladder. The cause of this condition is unclear. It is believed that a defect in the bladder mucosa makes it possible for certain substances in the urine to cause chronic irritation (tingling). As a result, the bladder wall stretches less easily over time and the capacity of the bladder decreases.

Symptoms

• urge to urinate
• frequent urination: people with IC are often consumed with thoughts of, for example, the question of where to go to the toilet.
• Pain in the lower abdomen, typically when the bladder is full; the pain is often worst just before or just after urination.

Sometimes, the symptoms come on all of a sudden for no apparent reason, but they can also start after a surgery.

The symptoms are very similar to those of a bladder infection: making it not always easy to know the difference between bladder pain syndrome and a real bladder infection.

How is the diagnosis determined?

Diagnosing bladder pain syndrome is not always easy. After numerous examinations, the pieces of the puzzle gradually fit together and the image/diagnosis becomes clear.

• In women, a vaginal inspection is required to check that the symptoms are not caused by a problem in the vagina or urethra. Very often this examination shows high tension in the pelvic floor muscles.
• Furthermore, the doctor tests the urine to rule out infection by bacteria or bladder cancer.
• To confirm the diagnosis, a visual inspection of the bladder, a cystoscopy, must be performed. Sometimes, red spots are visible in this examination, typical of (chronic) inflammation. Often, however, there are no obvious abnormalities and even the cystoscopy is normal.
• In addition to standard cystoscopy, a hydrodistention test can be performed in the operating room under anaesthesia. In this test, the bladder is completely filled with water. This gradual filling can cause miniscule bleeding at the level of the bladder mucosa. On visual inspection, these small haemorrhages look like a so-called 'crying bladder'.
• As all of the above tests are often normal or not entirely clear, the doctor sometimes decides to take a biopsy of the bladder mucosa. Pieces of tissue are removed from the bladder mucosa for a microscopic examination. This is done during a cystoscopy under anaesthesia in the operating room. This biopsy allows the doctor to determine the severity of the inflammation, exclude any other bladder diseases and confirm the diagnosis of IC by microscopic examination.

Treatment

The treatment of IC consists of informing the patient, making dietary changes and other external provocative factors and medication. Full recovery is not always possible, but there are treatments to reduce the symptoms.

Diet

Avoiding sour and spicy foods, carbonated drinks and caffeine can help. Many other dietary components can cause or exacerbate the symptoms, such as tomatoes, chocolate, alcohol, artificial sweeteners. Finding the specific nutritional components that play a role in your personal situation requires careful observation. Quitting smoking often also has a positive effect on the symptoms.

Exercises

Some people get better by introducing specific habits, such as urinating at fixed intervals or using relaxation exercises to extend the intervals between two urination sessions.

Relaxing pelvic floor muscle physiotherapy with a physiotherapist can sometimes bring relief.

Learning general relaxation exercises to reduce stress can also have a relieving effect.

Medication

Painkillers and anti-inflammatory medication and other drugs: by taking these medications, an attempt is made to relax the bladder and reduce the urge.

A pain specialist or pain team can be helpful in fighting the pain. In addition to the modern treatment with pain medication, other ways of controlling pain (nerve blocks, acupuncture) are possible.

Other treatments

• Laser treatment through cystoscopy under anaesthesia: the pain spots and ulcers in the bladder can be treated with a laser.
• Botox injections into the bladder mucosa; this is also done under anaesthesia in the operating room.
• Bladder rinses inhibit inflammation and/or restore the protective sugar layer of the bladder mucosa.
• Neurostimulation: by implanting a neurostimulator, the nerves leading to the bladder are stimulated with electrical stimuli, which reduces the urge to urinate.

In exceptional cases, when the bladder capacity is greatly reduced (the bladder is severely damaged) and there is a lot of pain, surgery may be necessary. The bladder can sometimes be enlarged or needs to be removed completely. The urologist then makes a urine stoma or a new bladder from a piece of the intestine.

The sex therapist and/or psychologist are sometimes involved in the treatment because of the social and psychological strain this condition can sometimes cause.

Latest publication date: 12/12/2023
Supervising author: Dr Ameye Filip