What causes Painful Bladder Syndrome – Interstitial Cystitis (PBS-IC)?
Its cause is unknown. Unlike “common” cystitis, which are caused by bacteria and are sensitive to antibiotics, PBS-IC is believed not to be caused by bacterial infection and does not respond to conventional antibiotic therapy.
What are the symptoms of Painful Bladder Syndrome – Interstitial Cystitis?
The characteristic symptoms of PBS-IC are:
- Frequency: Day and/or night frequency of urination (up to over 40 times a day in severe cases). In early or very mild cases, frequency is sometimes the sole symptom.
- Urgency: The sensation of having to urinate immediately, which may also be accompanied by pain, pressure or spasms.
- Pain: Can be in the lower abdominal, urethral or vaginal area. Pain is also frequently associated with sexual intercourse.
Men with PBS-IC may experience testicular, scrotal and/or perineal pain, and painful ejaculation.
How to diagnose PBS-IC?
Unfortunately, to date no commonly recognized specific diagnostic test exists. A diagnosis is usually based upon:
- Symptoms: urgency, frequency, or pelvic/bladder pain.
- Findings of Cystoscopy (examination of the inside of the bladder and other parts of the urinary system by means of an instrument).
- Exclusion of other bladder diseases (urinary tract infection UTI, tumor, tuberculosis, etc).
Diagnosing PBS-IC can be difficult for the physician and a long, frustrating experience for the patient. It is not uncommon that patients have to consult numerous doctors and specialists over a period of several years to obtain an accurate diagnosis.
Patients can be classified into two distinct categories.
The great majority (90% – 95%) of patients are diagnosed with “early non-ulcerative” PBS-IC. Patients with “classic ulcerative” are believed to have the second, more severe PBS-IC, and may also have already reduced bladder capacities and stiffened bladder walls.
Why is it difficult to diagnose PBS-IC?
The diagnosis of PBS-IC is difficult for various reasons:
- The origin of the syndrome has been controversial. It is only recently that the theory of deficiency in the bio-protective layer of the bladder is established and prevalent.
- Different definitions and terminologies are being used: irritative bladder syndrome, urgency/frequency syndrome, pelvic pain syndrome, non-bacterial cystitis and so on.
- Different diagnosis criteria exist.
- PBS-IC can be easily confused with many different bladder diseases, such as an urinary tract infection (UTI), because the symptoms of frequency and urgency are common to most bladder conditions. It is almost normal for a female patient to be initially misdiagnosed with bacterial infection (cystitis). Men with PBS-IC symptoms are often misdiagnosed as prostatitis or bladder outlet obstruction patients.
Deficiency in the blood-urine barrier of the bladder
There is a protective layer of the bladder, so called glycosamionoglycan (GAG) layer, providing a biobarrier against micro-organisms, carcinogens, crystals and other agents present in the urine. This bio-film on the inner surface of the bladder wall is identified as the primary defence mechanism in protecting the transitional epithelium (outmost layer of tissue or organ) from urinary irritants.
However, studies show that in PBS-IC patients this protective layer is deficient, allowing substances in the urine to penetrate the bladder wall and trigger PBS-IC symptoms.
Consequently, a great deal of research effort has been placed into the development of protective bladder coating such as Cystistat (sodium hyaluronate), which coats the bladder, restores the protective layer of the bladder and therefore reduces irritation.
How many people are suffering from PBS-IC?
- Approximately 16-500 per 100,000 of the female population.
- Approximately 90% of PBS-IC patients are women.
- The average age of onset is 40 years.
- A late deterioration of symptoms is unusual.
- 50% of PBS-IC patients have pain when travelling by car.
- Almost 2/3 of patients are unable to work full time.
Is diet important?
Reasonable amounts of fruit and vegetables are always important. Try to eliminate spicy foods from your diet. Information from studies show that the following foods and beverages increase the level of pain: alcohol, carbonated beverages, all foods containing caffeine (tea, coffee, chocolate etc), high acid foods and beverages (oranges, grapefruit, lemons and tomatoes), aged cheese, yogurt and pickles. Artificial sweeteners, sugar and aspirin are also known irritants.
Get on with Life
Cystistat contains sodium hyaluronate, which is the major component of the protective layer of the bladder. It is a solution that is instilled in a safe and simple procedure directly into the bladder. It acts as a temporary replacement for the defective GAG layer. Cystistat should only be administered by qualified medical personnel or patients who have received appropriate training.
Minimal side effects
As Cystistat is administered by intra-vesical instillation, it causes very few, if any, systemic side effects. Cystistat has been used in the treatment of several forms of cystitis with an excellent safety profile.