Bladder pain

What is bladder pain?

Bladder pain is a common condition, primarily in women, that can be attributed to a few different factors. These can include a urinary tract infection, Bladder stones, Crohn’s Disease or even bladder cancer.

But by far the most common cause of bladder pain is a condition known as Interstitial Cystitis (IC), or as it is sometimes referred to, Painful Bladder Syndrome (PBS). It occurs when your bladder becomes inflamed or irritated and is likely to be at its most painful with a full bladder. Painful Bladder Syndrome affects around 3-6% of Australian women (Poise.com.au, n.d.) with the condition presenting mostly between the ages of 40-60 years old (myVMC, 2006).

Until recently, Painful Bladder Syndrome had been hard to diagnose. For that reason, the number of people suffering the condition have been unclear, although estimates suggest it could be more than 60,000 Australians (myVMC, 2006). PBS can also, to a lesser extent, affect men and children.

Bladder pain symptoms

One of the main reasons PBS has been hard to diagnose is because the symptoms are very similar to those of a bladder infection. However, because no bacteria is found during a urine test, and there is generally no response to antibiotic treatment, your doctor may suggest Painful Bladder Syndrome as the main culprit of your bladder pain.

Women with PBS experience bladder pain when their bladder fills and find brief relief when they urinate. So, in order to be as pain free as possible, a woman with PBS can go to the toilet between 15-40 times over a 24 hour period. Consequently, sleep deprivation becomes an added complication to this painful condition. The symptoms can also be irritated further premenstrually and with sexual activity.

Generally though, symptoms of PBS can include:

  • frequent urination—including having to get up to go to the toilet during the night
  • an urgent need to urinate
  • urinary incontinence or leaking
  • pain (abdominal, urethral, vaginal or perineal)

Other characteristics that may contribute to PBS include:

  • a scarred or stiff bladder
  • glomerulations (pin point bleeding)
  • ulcers (Hunner’s ulcers) and lesions in the bladder

Bladder pain is often crippling and many women find they are unable to work full time with some suffering from related mental and emotional health issues.

Diagnosing bladder pain

Unfortunately, diagnosing bladder pain often takes a long time as other possible causes are usually excluded first.

There is no single diagnostic test for Painful Bladder Syndrome. However, your doctor/specialist will want to thoroughly examine your medical history along with giving you a pelvic examination and ordering a series of urine tests. This is done to rule out other treatable conditions before they consider a diagnosis of PBS.

The most common of these conditions in both men and women are urinary tract infections and bladder cancer. For men, other common diseases your doctor might look for include chronic prostatitis or chronic pelvic pain syndrome. For women, endometriosis is a common cause of pelvic pain.

So, diagnosis of PBS is generally attributed to:

  • pain related to the bladder, usually accompanied by frequency and urgency of urination, and;
  • absence of other diseases that could cause the symptoms

Your doctor/specialist will probably order diagnostic tests that help rule out other causes of bladder pain, including:

Urinalysis and urine culture — examining urine under a microscope and creating a culture can identify the primary organisms that are known to infect the urinary tract and that may cause symptoms similar to PBS.

Culture of prostate secretions — rarely performed procedure where prostatic fluid is obtained and examined it for signs of a prostate infection, which can then be treated with antibiotics.

Cystoscopy under anaesthesia (with bladder distention) — a cystoscope (an instrument made of a hollow tube about the diameter of a drinking straw with several lenses and a light)  is used to see inside the bladder and urethra. Your doctor might also distend or stretch the bladder to its capacity by filling it with a liquid or gas. This is painful for people with PBS and usually performed under anaesthesia.

Cystoscope biopsy — a biopsy is taken during a cystoscopy to help rule out bladder cancer.

Main causes of bladder pain

The exact causes of Painful Bladder Syndrome are unknown, with a number of theories being put forward. One such theory suggests an event may act as a trigger to bring on the pain.

Some of these triggers may be:

  • Bacterial infection
  • Bladder overextension due to long periods without going to the bathroom
  • An injury to the nerves in or surrounding the bladder or spinal cord
  • Problem due to a surgical procedure or physical injury

Others theorise the symptoms of PBS may arise from several different abnormalities in the bladder itself — specifically: the bladder surface, the blood supply to the bladder or to microorganisms present in the bladder.

And yet more suggest bladder pain bladder may result from autoimmunity (where the body attacks its own healthy cells), or from the release of histamine from elevated numbers of mast cells in the bladder.

Bladder pain treatment

The fact is, scientists haven’t found a cure for PBS yet, nor can they tell whether people will respond to some treatments better than others.

The good news on bladder pain (especially Painful Bladder Syndrome), is that in more than 50% of cases the body rights itself without explanation (Poise.com.au, n.d.). However, even when symptoms disappear because of a change in diet or other treatments are employed, they may return after a few days, weeks, months, or even years. Unfortunately, scientists have no idea why.

Because the causes of PBS are unknown, current treatments are aimed at relieving the symptoms of bladder pain.

The severity of your bladder pain may mean trying a combination of different treatment options to see what works best for you. It also makes sense to discuss your options with your doctor. Treatment options might include a combination of both lifestyle changes and medical treatments.

Lifestyle changes may include:

  • Change of diet (reduce intake of high acid food/drink like spicy foods, caffeinated soft drinks, alcohol and chocolate)
  • Give up smoking
  • Gentle stretching exercises
  • Bladder training

Medical treatments may include:

  • Prescription medicine
  • Physical therapy
  • Bladder Distention
  • Bladder Instillation (also called a bladder wash or bath)
  • Electrical Nerve Stimulation
  • Surgery (as a last resort and only if pain is debilitating)

-    fulguration and resection of ulcers

-    augmentation, (bladder enlargement)

-    cystectomy (bladder removal)

You should always see your doctor before trying any treatments, but these little tips might help ease your bladder pain, and they can be done in the safety and comfort of your own home:

  • Putting a hot water bottle on the perineum (the area between your anus and the vagina)
  • Relax in a squatting position with your knees drawn up towards your chest
  • Drink 8 glasses of water a day to ensure your urine doesn’t become too concentrated and cause irritation
  • Wear loose pants and skirts to help you stay comfortable.

Naturally, if your bladder pain is persistent or if a particular symptom concerns you, see your doctor as soon as possible.

 

Kimberly-Clark Australia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice. 

Sources

Kidney.niddk.nih.gov, (2011). Interstitial Cystitis / Painful Bladder Syndrome - National Kidney and Urologic Diseases Information Clearinghouse. [online] Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/index.aspx [Accessed 3 Apr. 2015].

Macon, B., Solan, M. and Krucik, MD, G. (2012). Bladder Stones: The Bad, the Ugly, and the Good. [online] Healthline. Available at: http://www.healthline.com/health/bladder-stones [Accessed 3 Apr. 2015].

 Poise.com.au, (n.d.). Bladder Pain and Interstitial Cystitis - Female Incontinence - Poise. [online] Available at: https://www.poise.com.au/female-incontinence/bladder-pain [Accessed 3 Apr. 2015].

 Womhealth.org.au, (2011). Interstitial cystitis fact sheet - Women's Health Queensland Wide. [online] Available at: http://www.womhealth.org.au/conditions-and-treatments/202-interstitial-cystitis [Accessed 3 Apr. 2015].

Webmd.com, (2014). Bladder Pain: Common Causes, Treatments, and Tests. [online] Available at: http://www.WebMD.com/pain-management/bladder-pain [Accessed 3 Apr. 2015].

 Siamak N. Nabili, M. (2014). Bladder Infection: Get Information on Treatment and Symptoms. [online] MedicineNet. Available at: http://www.medicinenet.com/bladder_infection/article.htm [Accessed 3 Apr. 2015].

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