Why Frequent UTI’s Might Be Interstitial Cystitis or Bladder Pain Syndrome

“Why do I always get bladder infections?” As a Urogynecologist, I see many women in my office with complaints of “frequent UTIs”. For months, or in some cases, years, they will have symptoms such as painful urination, frequent urination, voiding small amounts, getting up a lot at night to void, lower abdominal pain or pain during or after sex.

However, when a urine culture is checked, it returns a negative for infection result. One of the possible reasons for these women is that they have a chronic condition called Interstitial cystitis, otherwise known as Bladder Pain Syndrome.

What is Interstitial Cystitis (IC) or Bladder Pain Syndrome (BPS)?

Rather than an infection, IC/BPS is a chronic inflammatory condition. It is thought to be due to the bladder being deficient in its normal “slime layer”, a mucous-like coating that keeps the bladder from being irritated by urine. IC/BPS is like having a diaper-rash inside the bladder. Because the bladder is irritated, IC/BPS symptoms can mimic those of a bladder infection.

Why does IC/BPS occur?

The exact reason IC/BPS occurs is unknown. It is more common in women, and it can also be associated with other chronic conditions such as endometriosis and irritable bowel syndrome. Flare-ups can be triggered by eating certain foods, stress, sex, or during a woman’s period.

What foods cause IC/BPS flare-ups?

The Interstitial Cystitis Association has a more comprehensive list of foods, and instructions on following an elimination diet to identify potential trigger foods. But in general, inflammatory foods to avoid include: Coffee, tea, soda, chocolate (especially dark chocolate), alcohol, citrus juices, cranberry juice, artificial sweeteners, smoked or cured meats, hot peppers, and spicy foods.

How is IC/BPS diagnosed?

To diagnose IC/BPS, your doctor will likely take a history and possibly ask you to fill out a symptom questionnaire. Also, they will probably perform a physical exam, a urinalysis, and urine culture. Further tests could include a procedure called a bladder instillation, or another procedure called a cystoscopy.

What is a bladder instillation?

A bladder instillation is a procedure usually performed in the doctor’s office where a small catheter is placed into the bladder. After the bladder is empty, the doctor infuses a medication into the bladder, and the catheter is removed.

The instillation can be performed once, or weekly for several weeks. The medications used can be either a solution of lidocaine (a local anesthetic) and heparin (which is thought to act by simulating the bladder’s mucous coating), or another medication called DMSO (di-methylsulfoxide) which is thought to decrease inflammation in the bladder.

If the patient develops symptom relief with these treatments, the diagnosis of IC/BPS can be presumed.

What is a cystoscopy?

A cystoscopy is a procedure where a long, thin instrument with a cystoscope lens is placed through the urethra into the bladder. Water is used to fill the bladder, and the doctor looks through the lens to visualize the inside.

Cystoscopy can be done in an office setting using a local anesthetic gel, in a surgical center or a hospital setting under general anesthesia. My personal preference to diagnose IC/BPS is in an ambulatory surgery center or hospital with the patient under anesthesia.

This surgical site selection allows me to better evaluate the lining of the bladder. During the cystoscopy, I will fill the bladder to stretch it. This distension would be uncomfortable if the patient were awake. The overfilled bladder allows the surgeon to see the presence of small areas of bleeding, called glomerulations. These are present in a patient with IC/BPS, whereas a normal bladder will not have them.

By demonstrating the presence of glomerulations, I am able to confirm the diagnosis of IC/BPS. Additionally, distending the bladder often provides symptom relief to the patient. Finally, for patients who have had long-standing IC/BPS, they may develop Hunner’s Ulcers inside the bladder. If these are seen during cystoscopy, they can be injected with steroids to provide symptom relief.

Are there medications to treat IC/BPS?

There are several medications to treat IC/BPS. There is one medication which is approved to treat IC/BPS. It is called pentosan sulfate; the trade name is Elmiron. There are several medications that have been used off-label to help manage IC/BPS symptoms. These include:

1. Anti-histamines such as hydroxyzine
2. Tri-cyclic anti-depressants such as amitriptyline
3. Neuro-modulators such as gabapentin.

What if I don’t have IC/BPS?

The symptoms of IC/BPS can also be caused by several other conditions. cystitis (bladder infection), overactive bladder (OAB), and less commonly bladder cancer can all have similar symptoms. That is why it is important to see a physician who is experienced in diagnosing and treating these conditions if your symptoms continue despite routine treatments.

These other conditions are treatable but may require other tests and treatments.

Where can I get more information?

Your doctor can give you more information and help you with the diagnosis and treatment of your symptoms. In addition, the following websites provide valuable resources.

• American Urogynecologic Association
• Interstitial Cystitis Association
• Interstitial Cystitis Network

This article was contributed by MacArthur Medical Center’s Dr. Kevin O’Neil and originally published on Medika Life