Your bladder is a hollow, muscular organ that stores urine. The bladder expands until it's full and then signals your brain that it's time to urinate, communicating through the pelvic nerves. This creates the urge to urinate for most people.
With interstitial cystitis, these signals get mixed up, You can feel the need to urinate more often and with smaller volumes of urine than most people.
Interstitial cystitis most often affects women and can have a long-lasting impact on quality of life. Although there's no cure, medications and other therapies may offer relief.
Let’s take a look in more detail at the symptoms of each condition.
There are several common symptoms with interstitial cystitis. The first is a feeling of pain in the bladder and/or groin area. There may also be immense pressure in the area that accompanies the pain. It’s also common to experience burning and pain while urinating. In many cases, you may find yourself going to the bathroom more frequently. And you may also feel a constant urge to go to the bathroom even if you’ve already gone.
The main vulvodynia symptom is pain in your genital area, which can be characterized as:
- Burning
- Soreness
- Stinging
- Rawness
- Painful intercourse (dyspareunia)
- Throbbing
- Itching
Your pain might be constant or occasional. It might occur only when the sensitive area is touched (provoked). You might feel the pain in your entire vulvar area (generalized), or the pain might be localized to a certain area, such as the opening of your vagina (vestibule).
Vulvar tissue might look slightly inflamed or swollen. More often, your vulva appears normal.
A similar condition, vestibulodynia, causes pain only when pressure is applied to the area surrounding the entrance to your vagina.
Next, let's look at what causes these conditions?
What causes interstitial cystitis?
The exact cause of interstitial cystitis isn't known, but it's likely that many factors contribute. People with interstitial cystitis may have a defect in the protective lining (epithelium) of the bladder. A leak in the epithelium may allow toxic substances in urine to irritate your bladder wall.
Other possible but unproven contributing factors include an autoimmune reaction, heredity, infection or allergy.
It’s important to get a proper diagnosis to make sure you have this condition and not something like a UTI or a calcium oxalate stone. You should talk to your doctor about your symptoms and run various tests. It’s possible that you may need an X-ray or CT scan to rule out other potential problems with your kidneys. The symptoms can often be similar to issues with your tubules or calcium oxalate stones that have built up in your kidneys.
What causes Vulvodynia?
Vulvodynia is not caused by an active infection or a sexually transmitted disease. Through continued research efforts, they move closer to discovering the underlying cause(s) of vulvodynia. Researchers speculate that one or more of the following may cause, or contribute to, vulvodynia:
- An injury to, or irritation of, the nerves that transmit pain from the vulva to the spinal cord
- An increase in the number and sensitivity of pain-sensing nerve fibers in the vulva
- Elevated levels of inflammatory substances in the vulva
- An abnormal response of different types of vulvar cells to environmental factors such as infection or trauma
- Genetic susceptibility to chronic vestibular inflammation, chronic widespread pain and/or inability to combat infection
- Pelvic floor muscle weakness, spasm or instability
Treatment Options
How Do You Treat Interstitial Cystitis? No simple treatment eliminates the signs and symptoms of interstitial cystitis, and no one treatment works for everyone. You may need to try various treatments or combinations of treatments before you find an approach that relieves your symptoms.
Physical therapy
Working with a physical therapist may relieve pelvic pain associated with muscle tenderness, restrictive connective tissue or muscle abnormalities in your pelvic floor.
Oral medications
Oral medications that may improve the signs and symptoms of interstitial cystitis include:
- Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), to relieve pain.
- Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax your bladder and block pain.
- Antihistamines, such as loratadine (Claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms.
- Pentosan polysulfate sodium (Elmiron), which is approved by the Food and Drug Administration specifically for treating interstitial cystitis. How it works is unknown, but it may restore the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It may take two to four months before you begin to feel pain relief and up to six months to experience a decrease in urinary frequency.
Nerve stimulation
Nerve stimulation techniques include:
Transcutaneous electrical nerve stimulation (TENS). With TENS, mild electrical pulses relieve pelvic pain and, in some cases, reduce urinary frequency. TENS may increase blood flow to the bladder. This may strengthen the muscles that help control the bladder or trigger the release of substances that block pain.
Electrical wires placed on your lower back or just above your pubic area deliver electrical pulses — the length of time and frequency of therapy depends on what works best for you.
Sacral nerve stimulation. Your sacral nerves are a primary link between the spinal cord and nerves in your bladder. Stimulating these nerves may reduce urinary urgency associated with interstitial cystitis.
With sacral nerve stimulation, a thin wire placed near the sacral nerves sends electrical impulses to your bladder, similar to what a pacemaker does for your heart. If the procedure decreases your symptoms, you may have a permanent device surgically implanted. This procedure doesn't manage pain from interstitial cystitis, but may help to relieve some symptoms of urinary frequency and urgency.
Bladder distention
Some people notice a temporary improvement in symptoms after cystoscopy with bladder distention. Bladder distention is the stretching of the bladder with water. If you have long-term improvement, the procedure may be repeated.
Medications instilled into the bladder
In bladder instillation, your doctor places the prescription medication dimethyl sulfoxide (Rimso-50) into your bladder through a thin, flexible tube (catheter) inserted through the urethra.
The solution sometimes is mixed with other medications, such as a local anesthetic, and remains in your bladder for about 15 minutes. You urinate to expel the solution.
You might receive dimethyl sulfoxide — also called DMSO — treatment weekly for six to eight weeks, and then have maintenance treatments as needed — such as every couple of weeks, for up to one year.
A newer approach to bladder instillation uses a solution containing the medications lidocaine, sodium bicarbonate, and either pentosan or heparin.
Surgery
Doctors rarely use surgery to treat interstitial cystitis because removing the bladder doesn't relieve pain and can lead to other complications.
People with severe pain or those whose bladders can hold only very small volumes of urine are possible candidates for surgery, but usually only after other treatments fail and symptoms affect quality of life. Surgical options include:
Fulguration. This minimally invasive method involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
Resection. This is another minimally invasive method that involves insertion of instruments through the urethra to cut around any ulcers.
Bladder augmentation. In this procedure, a surgeon increases the capacity of your bladder by putting a patch of intestine on the bladder. However, this is performed only in very specific and rare instances. The procedure doesn't eliminate pain and some people need to empty their bladders with a catheter many times a day.
How Do We Treat Vulvodynia?
Vulvodynia treatments focus on relieving symptoms. No one treatment works in every case. For many, a combination of treatments works best. It can take time to find the right treatments, and it can take time after starting a treatment before you notice relief.
Treatment options include:
- Medications. Steroids, tricyclic antidepressants or anticonvulsants can help lessen chronic pain. Antihistamines might reduce itching.
- Biofeedback therapy. This therapy can help reduce pain by teaching you how to relax your pelvic muscles and control how your body responds to the symptoms.
- Local anesthetics. Medications, such as lidocaine ointment, can provide temporary symptom relief. Your doctor might recommend applying lidocaine 30 minutes before sexual intercourse to reduce your discomfort. Using lidocaine ointment can cause your partner to have temporary numbness after sexual contact.
- Nerve blocks. Women who have long-standing pain that doesn't respond to other treatments might benefit from local nerve block injections.
- Pelvic floor therapy. Many women with vulvodynia have tension in the muscles of the pelvic floor, which supports the uterus, bladder and bowel. Exercises to relax those muscles can help relieve vulvodynia pain.
- Surgery. In cases of localized vulvodynia or vestibulodynia, surgery to remove the affected skin and tissue (vestibulectomy) relieves pain in some women.
The list includes injury to the nerves in the area, allergy/sensitivity to fabrics or chemicals, vaginal infections, yeast infections, and overuse of certain medications. The best thing that you can do if you think you have this condition is to talk to your gynecologist about it. You want to make sure that this condition is what’s affecting you and not something else.
Other Complications from Vulvodynia
While vulvodynia isn’t a life threatening condition, it can still have a negative impact on your life. There are many things that can lead to pain. This includes inserting tampons, sitting for a long time, wearing tight pants, and sexual intercourse.
You may also experience pain throughout the day or in short bursts. This can be manageable in the short term. However, as the condition persists, it can have a negative impact on your mood and psychology.
Other complications might include:
- Anxiety
- Depression
- Sleep disturbances
- Sexual dysfunction
- Altered body image
- Relationship problems
- Decreased quality of life
A Supplement That May Help Your Condition Is Also Impacted By Calcium Oxalate Crystals
Kidney C.O.P. Calcium Oxalate Protector has a formula that was optimized to inhibit the rate of calcium oxalate crystal growth by 99%.
