A: Ahhh... this is the $10,000 question. You have to remember that the bladder can only speak one language, that of pain, frequency or urgency. So, despite the condition or trauma, bladder patients may experience very similar symptoms.
Prostatitis patients, for example, usually experience perineal (or nearby) pain, frequency, reduced urine flow, and possibly impotence and pain before, during or after ejaculation. Urethritis patients can experience frequency, urgency or pain even though it appears to be an inflammation of just the urethra. Urethritis can be triggered by either infection or sensitivities to soaps, spermicides, bath products or douches. Patients often complain of direct urethral pain, sometimes during urination.
Urethral syndrome is another nebulous bladder term. Doctors have disagreed about the definition of urethral syndrome. Basically, it appears to be used in patients who may have frequency or urgency, but with no infection found.
Trigonitis is another disease which has virtually identical symptoms to IC (frequency, urgency an/or pain). Trigonitis is used when doctors observe that the trigone in the bladder has a "cobblestone like" appearance. Some doctors dispute trigonitis as a disease because they believe that the trigone naturally looks that way.
Overactive bladder syndrome has gotten a lot of media and television exposure recently because of the recent approval of the drug "Detrol." OBS and urge incontinence patients may have frequency, urgency and episodes of incontinence. This disease is believed to be a neurological dysfunction of the bladder. It is called detrusor hyperreflexia when a neurological cause is known and detrusor instability when there is no neurologic abnormality.
Interstitial cystitis, painful bladder syndrome and frequency-urgency-dysuria syndrome, are used interchangeably to describe urinary frequency, urgency and/or feelings of pain or pressure around the bladder, pelvis and perineum.
In patient and physician circles, we often worry far more about treating the symptoms than agonizing or debating over the "name" of the disease. If the patient is in discomfort, they need help regardless of its name.
Q: How is IC diagnosed? IC patients are diagnosed with an analysis of their voiding patterns, their symptoms, via hydrodistention and the elimination of other diseases.
In a best case scenario, patients who are suspected of having IC complete a voiding diary over a period of time that will allow both the patient and physician to see the voiding patterns, urine volumes and pain levels. If a diagnosis is suspected, the physician may then elect to perform other diagnostic tests to rule out other diseases. If these tests come out negative, and the doctor strongly suspects the presence of IC, they may elect to perform a hydrodistention. By distending the bladder with water, they can then view the bladder walls for the characteristic petechial hemorrhages (glomerulations) found in many IC patients. Other new diagnostic testing procedures are currently being researched.
Q:What are the treatments for IC?
A:In the years since the first formal meeting on IC in 1987, scientists have explored many potential and, in some cases, controversial treatments. Unfortunately, no one treatment has yet to be established as a "cure" for IC. Therefore, it is important to understand that most treatments are designed to alleviate symptoms rather than cure disease. IC treatments generally fall into two categories: oral drugs or intravesical therapies medications that are placed directly into the bladder. Oral therapies can include: Bladder coatings (Elmiron-FDA Approved for IC), Antidepressants (Elavil, etc.), Antihistamines (Vistaril, Atarax), Antispasmodics (Ditropan, Detrol), Bladder Anaesthetics (Pyridium, Uristat).
Intravesical therapies include DMSO (FDA Approved for IC), Heparin, Cystistat (approved in Canada, not USA), Silver Nitrate, Clorpactin and BCG, a new treatment currently in testing. In addition, nerve stimulation, hydrodistention/hydrodilation and surgery are used. Surgery, such as bladder augmentation or cystectomy, is usually considered only after all other treatment options have been explored.
Most doctors utilize their own experience with patients to help decide what treatment to recommend. It is comforting to know, however, that if the first selection doesn't help, there are many other approaches to try. More information can be found in our online patient handbook.
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