Q. I am constantly running to the bathroom. It hurts and burns when I urinate. My doctor says I don’t have a bladder infection — I have interstitial cystitis. What is really going on down there?A. Normally, we are not aware of our bladder until it becomes distended and we feel the urge to void. With interstitial cystitis, urine collecting in the bladder causes irritation, urgency and pain, probably because the internal walls of the bladder are damaged.
Urine seeps through the wall’s normal coating, and certain fibers in the bladder wall are activated. This ultimately causes a secretion of inflammation-producing substances — histamines, leukotrienes and prostaglandins. As a further insult, the nerves in the bladders of women with interstitial cystitis, or IC, are easily stimulated and therefore more likely to “feel” pain.This disorder is common. About 700,000 Americans have IC; 90 percent of them are female, Caucasian and pre-menopausal. Most women are diagnosed with this disorder between the ages of 42 and 46, but they often notice symptoms five to seven years before they receive appropriate treatment.There is no test for IC. Your history is important for diagnosis, so it’s up to you to be specific in relating your symptoms to the doctor. Women with IC void an average of 16.5 times a day, compared with a normal 6.5 times. Alcohol, spicy foods, artificial sweeteners, and smoking can exacerbate symptoms.Your doctor will first rule out the possibility of kidney infections, vaginal infections, and endometriosis. She will also perform a pelvic ultrasound and check for kidney stones with a special X-ray called an IVP. If these tests are negative you should be referred to an urologist for cystoscopy, a procedure in which a thin scope is inserted through the urethra for a magnified view of the internal walls of the bladder. A biopsy of the bladder wall can be done at this time. Fluid is then pushed into the bladder to fill it to capacity. Interestingly, this hydrodistention often helps improve the symptoms of IC within two to four weeks. So although the test is done for diagnostic purposes, it can also be therapeutic.Another diagnostic test that urologists employ is called the PST. That’s when potassium chloride is instilled into the bladder. Patients with a normal bladder surface do not react to this, whereas those with IC have significant discomfort.Now onto treatment... there are several. An oral medication, pentosan polysulfate sodium (Elmiron is the brand name), contains a substance that is similar to a naturally occurring sealer on the bladder’s surface. This medication may replenish the defective layer and prevent inflammatory processes. Elmiron is usually taken as a 100 mg capsule three times a day. It can take up to six months for significant pain relief.
An older therapy, dimethylsulfoxide, or DMSO, is administered directly into the bladder. This is an anti-inflammatory analgesic with muscle-relaxing properties. It seems to decrease nerve sensitivity and increase bladder capacity. This drug is passed through a catheter into the bladder, where it is retained for 15 minutes before being expelled. Treatment is either weekly or biweekly for six to eight weeks. If improvement occurs, it usually does so within four weeks.Other treatment options include analgesics, antidepressants (particularly amitriptyline and other tricyclics) antihistamines, antispasmatics and even the anti-epileptic drug Neurontin. Some studies show that instillation of solutions containing heparin sulfate into the bladder can help relieve symptoms. In very severe cases, doctors resort to cauterizing a portion of the bladder’s surface or even surgical removal of the bladder.Dr. Reichman’s Bottom Line: If you are constantly running to the bathroom, have painful urination, and your doctor says it’s not an infection, see a specialist for a complete urinary work-up. IC is a common problem and the right therapy can help ease your pain “down there.”
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.