End the Struggle: Effective Bladder Pain Syndrome in India

Bladder pain syndrome

Bladder Pain Syndrome (BPS) or Interstitial Cystitis (IC) is a persistent disorder that leads to pain, discomfort, or pressure in the bladder and the nearby area of the pelvis in most cases without the presence of an apparent infection. It has a great impact on quality of life and may be confused with frequent urinary tract infections (UTIs).

Causes & Risk Factors

Its precise cause is not known, but may include:

• Bladder lining problems (and thus the bladder becomes more sensitive to the urine irritants)
• Autoimmune reactions
• Nerve hypersensitivity
• History of bladder infection or injury.
• Pelvic dysfunction of the muscle of the pelvis.
• More common in women than men

Symptoms

• Constant pain/pressure in the pelvis or bladder.
• Diligence and frequency of urination (usually in small amounts)
• Pain which becomes more severe with filling of the bladder and moins pain with voiding.
• Sexual pain in the process.
• Flare and remit (not persistent) symptoms.
• Bacteria in urine culture negative (contrary to UTI)

Bladder pain syndrome treatment

The following is a list of a simple breakdown of the treatment of Bladder Pain Syndrome (BPS) / Interstitial Cystitis (IC). Treatment is generally individualized and stage-by-stage depending on severity because there is no singular cure.

Lifestyle & Self-Care (First-Line)

• Changes in diet: Do not contain bladder irritants (coffee, tea, alcohol, spicy foods, citrus, artificial sweeteners).
• Bladder training: Increase gradually the time between urinations.
• Stress management: Yoga, meditation, breathing deeply.
• Fluid balance: Do not take too much water but keep the body hydrated.
• Heat/cold treatment: On the pelvis, warm compresss or ice packs to treat pain.

Physical Therapy

• Pelvic floor therapy in order to loosen pelvic tight muscles.
• Triggers and Myofascial release.
• Pelvic floor strengthening (such as Kegels) exercises should be avoided because they can increase symptoms.

Oral Medications

• Pentosan Polysulfate Sodium (Elmiron®) - used to heal bladder lining.
• Amitriptyline -it decreases bladder pain and Urgency to urinate by relaxing nerves.
• Antihistamines (Hydroxyzine, Loratadine) -decrease inflammation of the bladder wall.
• NSAIDs (pain relievers, acetaminophen) - in case of symptom attacks.

Bladder-Directed Therapies

• Intravesical instillations (medications that are instilled directly into the bladder):
• Lidocaine (for pain relief)
• Dimethyl Sulfoxide (DMSO)
• Heparin (fills the bladder lining)
• Bladder hydrodistension (stretching of bladder under anaesthesia) - in rare cases pain is relieved.

Nerve Stimulation/Pain Management

• TENS (Transcutaneous Electrical Nerve Stimulation) - ions nerve pain.
• Sacral nerve stimulation (implant in severe cases).
• Multimodal analgesia in the case of chronic pain.

Surgery (Last Resort, Rare)

• Wealthy option only adopted after failure of other options.
• Surgeries can involve bladder augmentation or perineectomy (extremely uncommon).

Interstitial cystitis bladder pain syndrome

Bladder Pain Syndrome (BPS) / Interstitial Cystitis (IC) is a long-term health condition of the bladder that produces pain, pressure, or discomfort within the area of the bladder and pelvis and may be accompanied by urgency and frequency of urine. It is not bacterial, like a urinary tract infection (UTI), and not responded to by antibiotics.

Key Features

• Bladder/pelvic pain of more than 6 weeks, and not due to an infection or other identifiable cause.
• Urinary urgency and frequency (increased urgency and frequency in the severe forms) urine is frequently voided 20-60 times a day.
• Pain which increases with the filling and decreases with passing of urine.
• Sexual pain in sexual intercourse (dyspareunia).
• The symptoms are usually intermittent (flares and remissions).

Chronic bladder pain relief

Chronic bladder pain (also a common symptom of Bladder Pain Syndrome / Interstitial Cystitis) can be extremely annoying, yet there are a number of strategies one can employ to control symptoms and gain relief, starting with self-help and including medical interventions.

At-Home & Lifestyle Relief

• Dietary modification: Do not take bladder irritants (coffee, tea, alcohol, carbonated drinks, citrus, tomatoes, spicy food, and artificial sweeteners).
• Hydration balance: Take the necessary amount of water to dissolve urine but do not over drink.
• Heat or cold packs: To relieve pain in the lower abdomen or pelvic area apply the heat or cold packs.
• Bladder training: gradually increase the intervals between urination to minimize the frequency.
• Reduce stress: Flare can be aggravated by stress - attempt meditation, yoga, deep breathing.
• Dressing: Clothing should be loose and comfortable in order to prevent strain on the pelvic area.

Physical Therapy/Pelvic Floor

• Pelvic relaxation exercises (do not use Kegels and squeeze muscles tighter).
• Myofascia release / physiotherapist-led trigger point release.
• Light stretching (pelvic tilts, child’s pose).

Medications for Pain Relief

• OTC analgesics: ibuprofen or naproxen (paracetamol or NSAIDs).

Prescription medications:

• Amitriptyline - relaxes nerve pain and increases sleep.
• Hydroxyzine- decreases inflammation of the bladder walls.
• Pentosan Polysulfate Sodium (Elmiron®) - heals bladder.
• Topical local anesthetic (lidocaine gel or patch).

Bladder-Directed Therapies

• Intravesical treatment: drugs (lidocaine, heparin, DMSO) placed directly into the bladder.
• Bladder hydrodistention (stretching of the bladder in anesthesia) - it can help temporarily.

Severe Pain Advanced

• Injections of Botox into the bladder (decrease the muscle overactivity and pain).
• Electrical stimulation of the nerves (TENS, sacral neuromodulation) to prevent the transmission of pain.
• Surgery (extremely uncommon, final resort) in case of failure of all treatment.

Daily Comfort Tips

• Record a bladder diary to determine triggers.
• Apply unscented and mild hygiene (no irritant).
• Relaxation by warm baths or sitz baths.
• Coping with chronic pain support or counselling.

Best bladder pain treatment in India

Treatment Pains in the bladder are best treated based on the cause (e.g., UTI, stones, bladder pain syndrome / interstitial cystitis, endometriosis, cancer, pelvic floor dysfunction).

Bladder Pain Syndrome Treatment:

Lifestyle/ Self-Care (First-line all)

• Diet change → Bladder irritants, (coffee, tea, alcohol, citrus, spicy foods, artificial sweeteners) to be avoided.
• Bladder training → Increase between urinating gradually.
• Stress management - yoga, meditation, breathing exercises.
• Heat/cold therapy Heating pad or ice pack over pelvis.

Physical Therapy

• Physiotherapy of the pelvic floor → Relaxation of tight muscles.
• Myofascial release / trigger point treatment.
• Do not uses Kegel exercises → may only make pain worse.

Medications

Oral medications:

• Pentosan Polysulfate Sodium (Elmiron®) → bladder mucos repair.
• Amitriptyline - nerve pains + sleep.
• Antihistamines (Hydroxyzine, Loratadine) → lessen the inflammation of the bladder wall.
• Flares (Pain relievers NSAIDs paracetamol).

Bladder instillations (intravesical treatment):

• Lidocaine- deadens pain of bladder.
• Heparin → mends the lining of the bladder.
• DMSO → analgesic and anti-inflammatory.

Procedures

• Stretching under anesthesia (bladder hydrodistension) → partial relief in some cases will occur.
• Botox injections → lessen the hyperactivity of the bladder and pain.
• Electrical stimulation of the nerves (TENS, sacral neuromodulation) → inhibits pain.

Surgery (Last Resort)

• Uncommon, only in extreme situations that are not responding to other therapies.
• Treatment: urinary diversion, bladder augmentation or cystectomy (bladder removal).

Supportive Measures

• A bladder diary to monitor triggers.
• Become members of support groups in IC/BPS.
• Wash with mild hygiene products (no scented soaps, no bubble baths).
• Relaxation of warm baths or sitz baths.

Bladder pain syndrome treatment in India with GetWellGo

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