Overview
Bladder pain can be caused by urinary tract infections (UTI), bladder cancer or interstitial cystitis, the inflammation or irritation of the bladder.
Symptoms
Pain varies depending on the condition. A woman may experience vaginal or vulvar pain, or there may be pain with intercourse or while urinating, which are characteristic symptoms of interstitial cystitis. While an infection of the urinary tract and bladder cancer can also cause painful urination, pain is felt in the abdomen for the former and in the lower back for bladder cancer. Apart from pain, some of the other common symptoms include urinary urgency and frequency,irritable bowel syndrome,foul-smelling, cloudy or bloody urine, and mild fever.
Diagnosis
When a patient visits the clinic with a painful or overactive bladder, the doctor will review your history, perform a thorough physical exam and order urine analysis, a cystoscopy (a lighted tube may be used to view the bladder for abnormalities) and imaging tests to diagnose the cause of pain.
A thorough physical examination and cystoscopy are critical to the diagnosis of interstitial cystitis. Urine analysis helps rule out other conditions and confirm a urinary tract infection. A biopsy can be performed during the cystoscopy to remove tissue samples to rule out bladder cancer. Imaging tests such as CT and MRI scans help confirm the diagnosis.
Treatment
Based on the cause of pain, the doctor will design a suitable treatment plan. The mainstay treatment for urinary tract infection is antibiotics.
If the cause is interstitial cystitis, then a combination of treatments may be required:
- Medications such as pain relievers, antihistamines, antidepressants and seizure medications
- A diet low in soda, caffeine and spicy foods, which can worsen bladder symptoms
- Physical therapy to strengthen the pelvic floor muscles and ease symptoms.
- Bladder instillations, where a mixture of several medications such as steroids and pain relievers are instilled into the bladder for immediate relief
- Cystoscopy with hydrodistension, involves bladder stretching,
- Neuromodulation involves implanting a pacemaker for treating an over-reactive bladder
- Injecting Botox
Treatment options for bladder cancer include surgery to remove the cancer, which can be performed alone or in combinations with other treatments. Chemotherapy (cancer-killing drugs) and radiation therapy (high-dose radiation) may be performed before or after surgery to destroy the cancer cells. The doctor may also perform immunotherapy (using the immune system) to attack and kill cancer cells. For more information on this, please see our Bladder Cancer page.
Hydrodistension
Hydrodistension may be recommended, which can stretch the bladder beyond its normal capacity. This can improve symptoms of bladder pain or an overactive bladder.
This procedure involves gently stretching the bladder through the use of liquid – it is slowly filled to make it less sensitive. A telescope is inserted into the bladder through the urethra to allow an inspection of the bladder. Fluid is then added until it is very full, and then it is emptied and filled again. This helps to examine whether there are any changes that could indicate the cause of the pain. A biopsy may be taking and a catheter may be inserted. This would be carried out either under a general or spinal anaesthetic, but usually doesn’t require an overnight stay.
Posterior tibial nerve stimulation
For patients with an overactive bladder, addressing the symptoms is often a priority. The nerves responsible for regulating bladder function can be stimulated through a thin needle electrode inserted above the ankle. The patient remains seated for 30 minutes, while a stimulator is turned on, that triggers a sensation in the ankle or foot by mild electrical pulses.
This is often carried out as a series of treatment across 12 weeks, and patients can start to see improvements around five to six weeks after the first treatment.
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