Introduction
Painful Bladder Syndrome ('PBS') describes a long-term (chronic) condition whereby the patient experiences pain percieved to be related to the bladder along with other urinary symptoms such as a persitent urge to urinate. The condition mainly affects women aged 40-60, although it does occur outside this age range and can also affect men. It is estimated that there are around 60,000 with the condition in Australia with 90% of these being women.
Causes
It is not fully understood what causes PBS/IC. It may be linked to autoimmune disorders or it may be linked to vascular conditions which affect blood supply to the bladder. Some things may also trigger PBS episodes, including consumption of alcohol, caffeine or spicy food, hormonal changes and even sexual activity or stress.
A number of other conditions can give symptoms of a painful bladder such as urinary tract infection ('UTI'), bladder stones, Crohn's Disease, overactive bladder syndrome and (rarely) bladder cancer. However, the most frequent cause of long term bladder pain is Interstitial Cystitis ('IC'), which is a condition where the bladder becomes inflamed for unknown reasons. The terms 'Interstitial Cystitis' and 'Painful Bladder Syndrome' are often use to describe the same condition.
Symptoms
Symptoms of PBS/IC can be very similar to those caused by other urinary conditions. However, the most common symptoms is that of pain when the bladder is filling which is relieved by urinating. Where there is no evidence of infection from a urine test and antibiotics do not improve the condition, it is more likely to be caused by PBS. Other common symptoms in addition to pain in the bladder/abdominal area are:
- Urgent need to urinate often (it is not uncommon for some with the condition to need to urinate 15-40 times during a 24-hour period, although anything over 8 times a day is a potential indicator).
- Incontinence.
- Haematuria.
Onset of symptoms can be gradual or sudden, and in the early stages sufferers often have passing bouts of these symptoms, referred to as 'flares', which typically last 3-14 days.
Tests / Diagnosis
PBS can be difficult to diagnose since it shares the same symptoms with a number of other urinary tract conditions. Unfortunately, there is no single test to identify the condition and diagnosis is generally a case of excluding other potential causes (listed above).
After an initial review of symptoms, medical history and a physical examination, more tests may be required. This may include:
Urine sample / analysis
To test for infection and/or abnormal cells in the urine.
Cystoscopy
This involves the insertion of a camera into the urethra and through to the bladder to inspect the urethra and the lining of the bladder, and if necessary take a tissue sample (biopsy).
Bladder Hydrodistension
This test is conducted under general anaesthetic at the same time as a cystoscopy and involves the bladder being filled with a sterile fluid and stretched. Specific changes are often seen in the lining of bladder which may indicate PBS/IC when this is performed.
Treatment
There are numerous treatment options for a painful bladder. Initially medications will be tried often in conjunction with review by a pelvic floor physiotherapist. If this fails to provide significant benefit, then instillations of different medications into the bladder are used to try to reduce the inflammation in the lining of the bladder and encourage a new healthy lining to regenerate. If this too fails to control the symptoms and the symptoms are debilitating, consideration is then given to removing the bladder.