Interstitial Cystitis: A Never-Ending "Got to Go" Feeling
Got to go? Hurry, hurry… run to the bathroom, better get there quick before a leak. Hurry, hurry… cross the legs while standing in line. Please hurry…finally an open stall. Let 'er rip. Ahhhh Wait a minute, still got to go?! Yep, that’s what it feels like if you have interstitial cystitis.
That “got to go” feeling never goes away, which can be quite uncomfortable and painful. Normally when the bladder is empty, the bladder is relaxed and comfortable. For others, even when the bladder is empty, there is an urge to urinate. A constant sense of urgency is a very uncomfortable problem. Commonly, a bladder can be irritated by bacteria causing a urinary tract infection. Sometimes the problem is more serious like bladder cancer or a tumor. For others, bladder pain is caused by interstitial cystitis (a.k.a painful bladder syndrome, pelvic floor dysfunction, pelvic floor myalgia, and chronic pelvic pain). “Interstitial” means within the tissue. “Cystitis” means inflammation of the bladder. Within the tissues of the bladder is inflamed tissue. In other words, those with interstitial cystitis have one pissed-off bladder.
Why does the bladder get so angry? No one knows the exact mechanism that leads to chronic bladder pain and that is why the diagnosis is of interstitial cystitis is not widely accepted. However, most professionals can agree that a major mechanism for bladder irritation is inflammation. When a doctor directly looks at the bladder (during a procedure called a cystoscopy), the bladder lining in someone with chronic bladder pain is red and inflamed. Interestingly, the lining of the bladder is a type of mucosal lining like the lining of the mouth. Mucosal inflammation, similar to what can be observed in the bladder, can also occur in the esophagus, intestines, stomach, and vagina. And this tissue inflammation leads to common diseases like irritable bowel syndrome, vulvodynia, gastritis and reflux disease. Because many of these conditions coexist with interstitial cystitis, some have raised the question of why some people have a generalized chronic inflammatory condition that affects many areas in the body, not just the bladder.
Thus, another major theory about the origin of interstitial cystitis is that the nervous system becomes sensitized and that nervous system sensitization promotes inflammation. This process has been coined “Neurogenic Inflammation.” After a trigger event like childbirth, multiple “alarm” signals get sent through the peripheral and central nervous system. These signals wind up the nerves into frenzy and inflammatory signals get sent back to the tissues. As a result of these haywire signals, the tissues become inflamed, tense and painful. The resulting pain leads to anxiety and anxiety re-triggers the nervous system “alarm.” This neurogenic inflammation cycle is thought to be a major mechanism causing interstitial cystitis and many other painful conditions.
Understanding why the bladder gets so pissed off is one matter, treating this uncomfortable problem is another. Since the underlying cause is inflammation, the key for treating interstitial cystitis is to stop the inflammatory process. Some doctors use medications to calm the nerves in order to stop the neurogenic inflammation. Other treatment protocols focus on the tissues like the muscles that become tense and inflamed. Whether treatment is focused on the nerves or the muscles, interstitial cystitis is very difficult to cure unless one eliminates triggers and controls anxiety. Anxiety, anxiety disorders, post-traumatic stress and depression are all commonly found in not only those with interstitial cystitis, but also other conditions with inflamed mucosal linings and neurogenic inflammation. Thus, treatment of interstitial cystitis might also focus on psychological approaches for treating pain. Many treatment programs use a multi-disciplinary approach to treat the irritated nerves, the tense muscles, and the anxious patient. A combination of methods seems to be the best way to soothe a pissed off bladder.
If your bladder is pissed-off and you suspect that you have interstitial cystitis, the first priority is to make sure the urine is clean of bacteria. Without this first step, a urinary tract infection can be misdiagnosed as interstitial cystitis and interstitial cystitis can be misdiagnosed as a urinary tract infection. After giving a urine sample, a doctor should check a post-void residual to insure that the bladder is emptying completely. Next, a specialist (usually an urologist) will want to do a urodynamic test and cystoscopy to evaluate the bladder function and look at the bladder lining. Once other possible diagnoses are ruled-out, then and only then can a conclusion of interstitial cystitis be reached. Even though a sense of urgency is present, interstitial cystitis is a diagnosis of exclusion and controversy which requires time to evaluate. Take the time to talk to your doctor if you have chronic pelvic pain or a constant urge to urinate. That never-ending “got to go” feeling can be treated successfully with a good understanding of the possible causes and treatment choices. The end result will be a comfortable bladder and a happy you.
Christina Lasich, M.D., wrote about chronic pain and osteoarthritis for HealthCentral. She is physiatrist in Grass Valley, California. She specializes in pain management and spine rehabilitation.