Urinary discomfort may be bladder pain syndrome

Posted: February 1, 2021

[caption id="attachment_15529" align="alignright" width="450"] Bladder pain syndrome can affect the young and old, and typically women are diagnosed more often than men.[/caption] Imagine going to a movie with friends, but instead of enjoying the entire show, you're getting up to go to the restroom every 20 minutes. You feel like you have to go, but when you sit on the toilet, barely anything comes out. This cycle has been going on for a while. When you visit your doctor, your urine is checked for an infection, but nothing shows. You may have a condition called bladder pain syndrome, or BPS. "You may know bladder pain syndrome from its older name, interstitial cystitis," said Marshfield Clinic Health System Urogynecologist Dr. Jason Cruff "The term cystitis means inflammation of the bladder, usually caused by a bacterial infection. Women affected by BPS do not have an infection, though. In fact, such patients are usually misdiagnosed as having recurrent bladder infections." BPS can affect the young and old, and typically women are diagnosed more often than men. The bladder is not the only structure affected. Some women experience pelvic muscle spasm, vaginal/vulvar pain, painful intercourse and even irritable bowel syndrome. "Unfortunately, we do not know the exact cause of BPS," Cruff said. "We think it has something to do with an imbalance in the bladder nerves. Instead of a woman feeling a normal fullness and urge to go to the bathroom, she feels intense pain and discomfort. That's why she's always running to the restroom. She doesn't want her bladder to get too full."

Treating Bladder Pain Syndrome

Urogynecologists like Dr. Cruff manage this distressing condition. The good news is there are no special tests required. Doctors can usually diagnose BPS based on the description of your symptoms, a physical exam and urine studies. Other tests may be ordered, but they are meant to rule-out other conditions that may mimic BPS symptoms. "The first step to treating BPS is to calm the mind," Cruff said. "It sounds simple, but patients with BPS usually have a lot of emotional stress and anxiety in their lives and this can negatively affect the female pelvic floor." Cruff recommends his patients try a variety of alternative treatments to de-stress including:

• meditation
• yoga
• mindfulness

While working on the mind, dietary changes are encouraged to limit irritating substances inside the bladder. These may include:

• spicy foods
• certain acidic fruits
• aged meats
• artificial sweeteners
• alcohol
• caffeinated drinks

Pelvic floor rehabilitation may be recommended to relax spastic muscles. After conservative therapies are tried, non-narcotic medications may be prescribed to help calm the bladder nerves. In patients who cannot hold much urine in their bladders because of pain, an outpatient procedure called cystoscopy with hydrodistention may provide relief. This involves low-pressure filling of the bladder while under anesthesia to help raise the pain threshold of the bladder. "There are other more advanced therapies for difficult to treat BPS symptoms such as bladder Botox® and InterStim® therapy, but in my experience, most patients do well with multiple lower level treatments," said Cruff. "The most important aspect to treatment is setting realistic expectations. BPS is a difficult condition to treat, and a cure may not be possible, but I work with the patient to help improve her symptoms to such a point where she can have her life back." If you feel like you always have a bladder infection, but antibiotics don't work and symptoms persist, call your primary provider for a referral to see a urogynecologist.