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Easing chronic bladder pain.

By definition, interstitial cystitis (IC) is a chronic irritable bladder condition manifested by varying degrees of urinary urgency, frequency, and bladder/pelvic pain that tend to occur together in the absence of other more common, identifiable causes (for example, gynecologic conditions and so on).

Expanded research over the past 20 years, spurred by the dedicated efforts of the Interstitial Cystitis Association, has resulted in much greater awareness of this disease, more confidence and assurance in the diagnosis, and better therapies.

The newly diagnosed interstitial cystitis patient is usually offered multimodality-specific therapy in the form of agents such as pentosan poly-sulfate sodium (Elmiron) to restore the protective mucosal glycosaminoglycans layer of the bladder, tricyclic antidepressants such as amitriptyline (Elavil) to reduce pain and relax the bladder, and antihistamines--especially hydroxyzine (Atarax and Vistaril)--to suppress histamine release from bladder wall mast cells.

Other commonly used and helpful nonspecific treatments include urinary analgesics to reduce bladder pain such as phenazopyridine hydrochloride (Pyridium), anticholinergic/antispasmodic therapies (Ditropan, Detrol, Levbid) to decrease frequency and urgency, and on occasion muscle relaxants such as Valium and Flexeril to reduce pelvic floor muscle spasticity.

Medications introduced into the bladder have been a mainstay of IC therapy for years. Dimethylsulfoxide (DMSO) or RISO-50 has been used since the 1960s as an intravesical agent, which has anti-inflammatory, analgesic, muscle-relaxing and tissue-penetrating effects. Often, its effect is enhanced by steroids, heparin sulfate, sodium bicarbonate, and antibiotics--the so-called DMSO cocktail. Some patients have had relief of bladder pain by self-installations of short-(Xylocaine) and long- (Marcaine) acting local anesthetics on an as-needed basis.

Antiseizure medications such as Neurontin and Tegretol have over time helped to relieve the neuropathic pain of some patients.

Conservative therapies for IC are always worth considering and may be complementary to any treatment strategy. Dietary changes, which reduce acid and potassium-rich foods, may help reduce symptoms. Stress reduction, biofeedback, bladder-holding exercises, pelvic floor physical therapy, acupuncture, and transcutaneous electrical nerve stimulation (TENS) may be of considerable benefit.

In more difficult and resistant patients, bladder nerve stimulation and modulation (InterStim)--although involving a surgical procedure--has helped alleviate the urgency, frequency and pain in some patients.

When patients have not responded favorably to the above options (less than 10 percent of all IC patients), input from pain management experts may be necessary. Most urologists are not comfortable managing severe, chronic pain and consequently under-treat many IC pain sufferers. The pain-management pros have been a godsend in these instances. Even though these patients may become dependent on chronic use of long-acting narcotics, they are not addicted, and many can lead productive, functional lives after the pain is under control.

With available management strategies, only a small number (1-2 percent) today should require major surgical procedures such as bladder removal and urinary diversion.

The growing interest and research in IC should equate to a much brighter future for all IC patients.
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Author:Mosbaugh, Phillip
Publication:Medical Update
Geographic Code:1USA
Date:Feb 1, 2005
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