Bladder problems are quite common in women. For instance, women are more prone to urinary tract infections (UTI's) than men and this is attributed to the basic female anatomy. The shorter length of urethra and its proximity to the rectum makes it easier for bacteria to travel to and inhabit the bladder, thereby causing infections. Due to a similarity in symptoms, it is not a surprise that a severe condition such as Painful Bladder Syndrome is often misdiagnosed as UTI before proper treatment is offered.
Painful Bladder Syndrome - also called Interstitial Cystitis (IC), is a severely debilitating disease of the urinary bladder characterised by excessive urgency and frequency of urination, bladder pain and chronic pelvic pain, which could be mild or very severe. It affects almost 1.2 million people in the US, 90% of whom are women and has a long lasting and adverse impact on quality of life.
Interstitial Cystitis and UTI: Symptoms and Differential Diagnosis
Diagnosing IC often poses a challenge to physicians owing to its similarity with UTI. Subsequent urine analysis presents a “clean” urine which essentially means that there is no detected problem and hence no treatment required. The National Institute of Health therefore intervened and defined the criteria for accurate diagnosis as follows:
- Bladder and pelvic pain
- Urinary urgency and frequency
- Diminished bladder capacity (less than 350 ml)
- Identification of Hunner’s ulcers (large inflammations on the bladder)
Some patients may also develop symptoms such as pain in the urethra, vagina and pain during intercourse. To confirm the diagnosis, further tests performed are:
- Complete pelvic examination
- A urine test to negate UTI
- Potassium sensitivity test to assess pain levels and degree of urgency experienced when potassium solution is placed in the bladder
- Cytoscopy
Ruling out other disorders like bladder cancer, vaginal infections, endometriosis and kidney stones is done before signing off on IC.
Recognising Triggers
Women with IC often experience flaring of symptoms when exposed to certain triggers that markedly worsen bladder problems. The good news is- there is no reason to despair! Being observant helps one identify those triggers, their pattern of onset, duration and related symptoms. Flares can be a consequence of the following triggers:
Hormonal
Hormone levels are very volatile in women due to either menstrual cycles or menopause. Research points out that there is a connection between decreased oestrogen levels and enhanced activity of mast cells that line the bladder. This activity triggers increased secretion of histamine, a chemical known to cause inflammation which also affects the muscle sphincter governing urination. However, this is often short term and avoiding dairy products those few days can help alleviate the symptoms.
Diet Induced
Most of what we eat or drink is filtered through urine. There is a direct correlation between certain foods we consume to the severity of a flare. Foods that are known to cause flares are those that:
- Are acidic (fruit juices particularly cranberry, citrus and tomato, sodas or diet sodas)
- Irritate already sensitised bladder nerves (coffee, regular and green teas high in caffeine)
- Trigger histamine production (chocolates)
- Are high in potassium
Its best to identify foods, control those cravings and strike an acid-alkaline balance in your body.
Vibration
Travelling, driving a car or flying are well know triggers. Most IC flares are a consequence of pressure that a vibration puts on the already sensitised bladder, leading to patients complaining of an inability to sustain long drives without painful spasms. Limiting your drives to shorter distances is recommended.
Sexual Intimacy
Increased levels of frequency, urgency or pain intensifies 24-48 hours after intercourse in women. Pelvic floor muscle spasms are also common post intercourse. Interstitial Cystitis Network offers tips to bypass IC flares associated with an intercourse.
Lifestyle Choices
Smoking and alcohol have become an integral part of lifestyles today, despite the fact that their disadvantages beat advantages. Tobacco is known to constrict bladder vessels making it harder for inflammatory substances to be flushed out. Beer and wine on the other hand contain histamine. Needless to say, its best one puts an end to their smoking and alcohol consumption.
Varied protocols ranging from the use of oral medications to bladder baths and electric nerve stimulation are useful, but only to manage the condition. Research is ongoing to identify the causes and find a sure-fire cure for IC. For most people, IC can cause social embarrassment, loss of employment, depression and a host of other problems. Respecting your bladder and keeping it away from triggers, following a treatment protocol, seeking support from family or support groups will help you get a life beyond your bathroom.
References
Interstitial Cystitis: Urgency and Frequency Syndrome, JULIUS F. METTS, M.D., University of California, Davis, School of Medicine
mayoclinic.com
The IC/ PBS diet guide: Interstitial Cystitis Network
