Dull ache in pelvic area is getting worse


MEN'S HEALTH MATTERS:Interstitial cystitis is characterised by pain in the lower abdomen

Q I have been experiencing pain in my pelvic area for two years. It has got progressively worse and is now a dull ache at all times. It seems to get worse when I pass urine. I may have to pass urine as frequently as every hour. I have been checked out for urinary tract infections, and my urine is clear. A friend with a similar problem has been diagnosed with interstitial cystitis. My doctor feels that I may have the same disorder. What is interstitial cystitis and how can it be treated?

AInterstitial cystitis or painful bladder syndrome (IC/PBS) is a debilitating chronic inflammatory disorder of the bladder. It is notoriously difficult to manage and is often incorrectly diagnosed as an overactive bladder or recurrent urinary tract infection and as endometriosis in women.

The disorder is characterised by pain in the lower abdomen area over the bladder, which is often worse when you pass urine. Urinary frequency, urgency, and pressure in the bladder or pelvis are often present.

IC/PBS affects men and women of all ages. Although it was previously believed to be a condition of menopausal women, growing numbers of men are now being diagnosed. Up to 90 per cent of patients with the disorder are women between the ages of 30-50.

The cause of IC/PBS is unknown, although theories that the condition may be due to an abnormal autoimmune (a body’s immune response against its own cells) or allergic response have been postulated, while a genetic predisposition has also been proposed.

Research has shown that patients with irritable bowel syndrome and fibromyalgia have an increased risk of IC/PBS, indicating that it may be a localised manifestation of a general condition that causes inflammation in various organs and parts of the body. Regardless of the cause of the condition, the underlying problem is that patients with this condition have a damaged bladder lining (urothelium).

As the symptoms of IC/PBS are similar to those of other disorders of the bladder and there is no definitive test to identify the condition, it can be very difficult to make a diagnosis. The diagnosis of IC/PBS is based on the presence of pain related to the bladder, usually accompanied by frequency and urgency, in the absence of other diseases that could cause the syndrome. The most common of these diseases in both sexes are urinary tract infections.

The diagnosis is aided by urinalysis/urine culture and cystoscopy tests. A cystoscopy entails the passage of an instrument called a cystoscope into the bladder to allow direct visualisation to aid with diagnosis and also allow for stretching of the bladder.

Many IC/PBS patients have things that trigger their symptoms, including having a full bladder, or taking certain foods or liquids. Simple measures such as bladder retraining or avoidance of certain foods or liquids may be sufficient to alleviate symptoms. Foods to avoid are spicy or acidic foods and include alcohol, coffees, teas, herbal teas, all carbonated drinks, concentrated fruit juices, tomatoes, citrus fruit, the B vitamins, vitamin C, monosodium glutamate and chocolate.

Oral medications which may help include pentosan polysulfate (Elmiron), which is believed to provide a protective coating to the bladder. Amitriptyline, a form of antidepressant, non-steroidal anti-inflammatory (NSAIDS) drugs or narcotic pain medications can also help reduce the symptoms.

For patients who do not respond, the next line treatments are bladder instillations or bladder coating therapies. DMSO, a wood pulp extract, has been tried with mixed results as a bladder instillation. Bladder coating treatments have shown some positive results and these treatments include Cystistat (sodium hyaluronate) and Uracyst (chondroitin). These treatments are believed to replace the deficient protective layer on the bladder wall.

Surgical procedures for the management of IC/PBS include bladder hydrodistension (a procedure which stretches the bladder capacity). Unfortunately, the relief achieved by bladder distensions is only temporary. Occasionally, major surgery is required as the symptoms are so debilitating and in this case a large proportion of the bladder will be removed and replaced with a patch of bowel.

Other complementary therapies include neuromodulation (with a TENS machine), acupuncture and biofeedback, a relaxation technique aimed at helping people control functions of the autonomous nervous system.

  • This weekly column is edited by Thomas Lynch, consultant urological surgeon, St James’s Hospital, Dublin, with a contribution from Dr Derek Hennessy, urology registrar, St James’s Hospital, Dublin
  • Please send your questions to healthsupplement@irishtimes.com