To My Patients,

In December 2003 GYNFO.COM ENEWS featured RECOGNIZING INTERSTITIAL CYSTITIS. To learn more about Interstitial Cystitis visit my website and for more information on urodynamics visit my website E-News section.

          This month E-News presents an Update on Interstitial Cystitis and Overactive Bladder (OAB)

Update on Interstitial Cystitis

          Interstitial Cystitis, or IC, is a painful bladder disorder characterized by urinary frequency, urgency, burning, pain during intercourse, and chronic pelvic pain.  It is often associated with other conditions such as irritable bowel syndrome, endometriosis, fibromyalgia, and chronic fatigue syndrome.  It is estimated that millions of people may have this condition and are undiagnosed.

          Quality of life of patients with IC is significantly impaired compared to healthy individuals.  The symptoms can affect a patient’s psychological status and well-being.  The cause of IC is uncertain, although there is a growing consensus that a neurogenic inflammatory condition exists in these patients.

          The diagnosis is made by exclusion.  Patients complain of urinary frequency, urgency, getting up at night to urinate, pain during intercourse, and pelvic pain.  A urinalysis will generally reveal no abnormalities or show white blood cells in absence of an infection.  A PUF questionnaire scores the severity of a patient’s symptoms and its impact on daily activities.  Urodynamic testing provides information regarding the patient’s voiding problems.  A potassium sensitivity test can be performed in the office, but it can be painful to those with this condition.  A more humane testing includes out-patient cystoscopy with bladder distension with water.  This can be diagnostic as well as giving temporary symptom relief.

          Medical treatment includes life-style, nutrition, and fluid-intake modifications.  Elmiron is an oral medication that is the only FDA approved drug.  It takes 4-6 months to work and has few side-effects. In addition to Elmiron, most patients benefit from a second medication that can include amitriptyline, muscle relaxants, antihistamines, and adrenergic blockers.

Overactive Bladder (OAB)

          The term, Overactive Bladder (OAB), has replaced the older terminology such as irritable bladder, spastic bladder, and urethral syndrome, just as Irritable Bowel Syndrome (IBS) has for spastic colon or colitis.

          Symptoms include one or all or the following: urinary frequency, urgency, and urge incontinence.  It is a neurological problem where the involuntary nerve stimulation to the bladder overrides the voluntary nerve mechanism.  It can have a significant affect on a patient’s quality of life.  It is estimated that about 30 million Americans have this problem and is more common than diabetes or asthma.

          It is important to rule out a bladder infection which can produce the same symptoms, but is usually associated with burning and bladder pressure.  Also, OAB is different from Interstitial Cystitis (IC) where the protective coating in the bladder is disrupted and results in frequency, urgency, and pain that is relieved with urination.

          Treatment includes bladder drills (or timed voiding), reduction in foods that can trigger symptoms, and the use of antispasmodics.  The medications include Detrol LA, Ditropan ER, and Oxytrol patches.  A new drug called Duloxetine will be available soon.  These drugs are efficacious but can produce a dry mouth as a mild side effect.

          A new minor surgical procedure, Interstim, uses a nerve stimulator that is implanted under the skin.  It has been very successful in those patients who did not respond to conservative measures or the traditional medications.

          If you have any concerns that you might have either of these condition, please call our office to schedule an appointment for an evaluation.

Randy Birken, MD
www.gynfo.com