What is Interstitial Cystitis/Painful Bladder Syndrome?

Interstitial Cystitis, or Painful Bladder Syndrome, are terms used to describe uncomfortable or painful bladder symptoms that may include or mimic recurrent urinary tract infections, feelings of urgency and frequent need to urinate (including at night), burning, pain, pelvic pressure or discomfort. A wide range of symptoms make the condition difficult to diagnose initially, and it may take years before a proper diagnosis is reached. This condition may range from mild feelings of urgency and frequency with intermittent burning or discomfort to severe, unrelenting, debilitating pain and significantly reduced bladder capacity with blood in the urine and ulcerations of the bladder wall. The cause of this condition is unknown, and is probably multifactorial including environmental, genetic, immunologic and structural factors. It is not unusual for a sufferer to also have similar associated conditions such as irritable bowel syndrome, endometriosis, migraine headache, vulvodynia/vulvar vestibulitis, or fibromyalgia.

How is it Diagnosed?

The initial diagnosis may be presumptive rather than related to a specific diagnostic test.  The clinical signs and symptoms may point to the diagnosis. A cystoscopy is usually performed at some point in order to determine whether any ulcerations are present, and some practitioners perform a hydrodistension to make the diagnosis. This is somewhat controversial as repeated hydrodistensions may cause scarring and shrinkage of the bladder capacity, and an initial hydrodistension may give a false positive reading. The presence of Hunner lesions (small ulcers of the bladder wall) are considered definitive diagnostic findings.

What Can be Done to Treat It?

Treatment is usually done in a stepwise fashion, beginning with the simplest and least invasive and proceeding as needed/indicated to more complex or invasive treatments.

Dietary

Avoidance of PERSONAL bladder irritants is paramount under all circumstances with IC. Many individuals will learn from experience that tomatoes, coffee, tea, chocolate, or spicy foods may worsen or cause symptoms.  The key to finding and following the proper diet usually lies with elimination of all potential irritants at first (not an easy task for most) and gradually adding back potential irritants one at a time in order to determine which foods or liquids are on the “OK” list. Often, the list of foods/drinks to avoid includes bowel irritants as the bladder and bowel are often irritated by the same or similar substances. See the attached list or go to www.ic-network.com for a list of foods to avoid. You may also want to consider food sensitivity testing for a more accurate listing of your foods and substances to avoid.

Pelvic Therapy

Very often, when a painful condition exists in the pelvis the pelvic musculature and connective tissue become inflamed, irritated, spastic and tight. This leads to a vicious cycle of more pain and more clenching. The worst thing for this is to try to do Kegel exercises or “pelvic strengthening” exercises. The most important thing to do in a situation like this is to find a well-trained pelvic physical therapist who can help with reducing the muscle spasm and inflammation that has developed in the tissues. Myofascial pain, referring to the muscles and connective tissue, is extremely common and a significant contributor to the discomfort felt with interstitial cystitis/painful bladder syndrome. Therapy may consist of hot baths in Epsom Salt, intravaginal muscle release, stretching, sometimes in conjunction with muscle relaxants. This is an often overlooked but extremely important aspect of treatment. There are multiple studies demonstrating the importance of physical therapy in pelvic pain disorders including IC/PBS.

Supplements

There are several supplements that have been useful to treat either recurrent urinary tract infection or interstitial cystitis/painful bladder syndrome. Pre-lief is quite helpful for some individuals. Also, freeze-dried Aloe Vera extract can be helpful for some individuals, particularly in reducing recurrent urinary tract infections. Of course, allergies to just about anything are possible, so it is important to consider a possible sensitivity or allergy if the supplement doesn’t help or seems to worsen symptoms. D-mannose has been used to reduce the ability of bacteria to stick to bladder walls and cause infection, so is often recommended to help prevent UTIs. While cranberry products such as Utiva ® , Ellura ® and Theracran ® may be helpful in preventing UTIs, they may irritate a bladder when IC/PBS is present, so should be approached with caution. Supplements designed to treat IC which contain Quercetin, chondroitin sulfate and sodium hyaluronate have been helpful for many. There are several brand names containing a mixture of these ingredients with other things such as herbal extracts, and though data are lacking in the absence of an allergy or known interaction may be worth considering.

Medications

Elmiron ® is the only prescription oral medication in the USA with a specific indication for Interstitial Cystitis. It is taken 3 times daily and may take up to 3 months to take effect.  Other medications used may include amitriptyline, cymbalta, hydroxyzine, cimetidine or ranitidine. RIMSO-50 is a liquid form of DMSO (dimethylsulfoxide) that can be instilled directly into the bladder and is approved to treat IC. There are potential side effects (sometimes serious) with some of these medications so again, they should be approached with caution and monitored closely.

Bladder Instillations

There are many “recipes” for various bladder “cocktails” to be used in treating IC/PBS and/or recurrent urinary tract infections. Most of the recipes include lidocaine and heparin, many include triamcinolone (a steroid similar to cortisone), sodium bicarbonate, and an antibiotic (usually gentamicin).  We have seen many patients obtain relief both from recurrent urinary tract infections and symptoms of IC with this therapy.

Surgical

Cystoscopy with cauterization of Hunner lesions (ulcerations in the wall of the bladder) and/or hydrodistension (stretching with fluid by filling the bladder to its maximum size) can be done in certain cases. There is evidence that cauterizing the ulcers may help with symptoms. Hydrodistension is somewhat more controversial, as it may relieve symptoms but the relief is often temporary and may result in scarring or damage to the bladder in some cases. It can be a helpful diagnostic tool at times as well.  If there is a question regarding the diagnosis and/or treatment a cystoscopy is usually performed at some point.

Is There a Cure?

Since we don’t know the cause, it is hard to say whether we can find a cure. It is possible that we are seeing several different conditions with similar symptoms. Many individuals undergo a remission of sorts. Until we understand all of the possible causes and their specific treatments, we will not be able to definitively “cure” IC.  However, we can work together to make it livable.

The most important thing to understand is that it is a real condition, you are not “crazy” and while sometimes chronic pain can be depressing, seeing a therapist or psychiatrist will not treat the underlying problem, only the emotional symptoms that come with chronic pain.

Schedule a Consultation

At Laser Skin & Wellness, our urogynecologists take a comprehensive approach in evaluating and treating this condition. We may need to perform additional testing that is outside of the usual spectrum of insurance-covered testing in order to obtain more and better information regarding the cause of the problem. We can thus find better ways to successfully treat the condition.

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Votiva is one of the latest innovations specifically for women’s health. It is a machine by InMode that provides many solutions to an array of concerns women have for vaginal health. This technology is safe, effective, and minimally invasive. At Laser Skin & Wellness, we are offering this new instrument to help women feel great once again.

What is Votiva?

Votiva is a workstation with a variety of machines included, all of which assist in providing a feminine makeover by addressing a range of concerns. Votiva uses radiofrequency energy to heat and stimulate the cells of the vagina and vulva. It increases collagen and elastin fiber production. The Votiva workstation includes three different technologies: the FormaV, Morpheus8, and Aviva. The FormaV helps to improve blood circulation to help with muscle relief pain and relaxation. This therapeutic device addresses sexual dysfunction. The Morpheus8 focuses on subdermal tissue remodeling, dermal treatment, and epidermal resurfacing. Aviva is a minimally invasive procedure that is an alternative to a traditional labiaplasty. Together, the Votiva machine can:

  • Enhance the vaginal tone, strength, and control
  • Tighten the vaginal canal
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  • Reduce vaginal dryness
  • Reduce stress urinary incontinence
  • Improve the appearance of the labia

Who is a Candidate for Votiva?

Women of every age can benefit from Votiva. Many women experience changes in their feminine health due to childbirth and menopause. Loss of vaginal tone, vaginal dryness, and painful intercourse are all common concerns that women face. Votiva is an extremely versatile treatment that can help women feel normal once again.

How Long Does The Votiva Treatment Take?

Depending on your individual needs and concerns, the sessions last anywhere from 20 to 40 minutes. There is very little downtime associated with this treatment. Women will need to abstain from intercourse for at least 3 days following their Votiva sessions. Also, it is important to avoid hot tubs, pools, and baths for those 3 days as well. Your specialist at Laser Skin & Wellness will go over any and all questions you may have regarding this treatment during your consultation.

Schedule a Consultation

To learn more about Votiva and our feminine rejuvenation treatments, schedule a consultation with Laser Skin & Wellness. You can do so by calling or texting our Lake Worth, Florida office at (561) 427-0900 or request an appointment through our online form.

Posted in Blog, painful sex, urinary incontenance, vaginal dryness, vaginal rejuvenationLeave a Comment on Re-thinking Women’s Health with Votiva
Posted in feminine rejuvenation, urinary incontenance, vaginal dryness, vaginal rejuvenation
Posted in feminine rejuvenation, menopause, urinary incontenance, vaginal rejuvenation