Pelvic Pain - Interstitial Cystitis
Interstitial cystitis (I.C.) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. It is also known as Painful Bladder Syndrome (PBS). The average age of onset for IC is 40 years, with 25% of patients under the age of 30.
Sometimes patients suffer severely from this disorder and their overall quality of life is poor. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate (urgency), a frequent need to urinate (frequency), or a combination of these symptoms. People with severe cases of IC/PBS may urinate as many as 60 times a day, including frequent nighttime urination (nocturia).
“Pain levels can range from mild tenderness to intense, agonizing pain. Pain typically worsens as the bladder fills and is then relieved after urination. Pain may also radiate to the lower back, upper legs, vulva and penis. Women's symptoms may fluctuate with their menstrual cycle, often flaring during ovulation and/or just before their periods. Men and women may experience discomfort during or after sexual relations. During flares, patients may also experience the “IC Belly,” a sudden and random swelling of the lower abdomen.” (© 1996-2009 Interstitial Cystitis Network,Interstitial Cystitis Network, PO Box 2159 Healdsburg, CA 95448, A Division of J.H. Osborne, Inc.)
Pain may change in intensity as the bladder fills with urine or as it empties. The pain may also be experienced with vaginal intercourse and also get worse during menstruation. Symptoms may disappear without explanation or coincide with an event such as a change in diet or treatment. Even when symptoms disappear, they may return after days, weeks, months, or years.
Your goal is to work with a physician who specializes and has an interest in treating patients with IC/PBS. Dr. Jeffrey Schock, specializes and has an interest in treating patients with IC/PBS. He recognizes that many women and men “suffer in silence” with chronic pelvic pain / IC /painful bladder syndrome (PBS). As a Board Certified Urologist in Metro Detroit, his expertise directly involves the genitor-urinary organs and therefore the pelvis.
Dr. Schock provides compassionate / understanding care and offers personalized treatment with multiple modalities. His only motivation is to improve the quality of life to IC patients.
Dr. Schock also understands the wide variety of treatments that are available so that if one doesn't work, another treatment can be suggested. This is especially true since many IC patients may have similar / concomitant conditions such as: endometriosis, fibromyalgia, vulvadynia, prostatitis, chronic pain, etc.
Treatment Can Help!
Current therapies for I.C. are aimed at relieving symptoms and many people are helped for variable periods by one or a combination of treatments. Firstly, patients should avoid all potential irritants and consume only “bladder friendly foods.” The IC-network provides an excellent diet form which can be downloaded here: Bladder Diet
Next, patients should consume more water, and relax / avoiding stress if possible. Many relaxation techniques are available to help patients with stress reduction; thus decreasing some of the potential pelvic pain of IC.
During an IC/PBS flare up, there are a variety of treatments that can be instituted. Bladder (rescue) instillations in the office with medications such as Xylocaine, Marcaine, bicarbonate, heparin, corticosteroids, and others can be employed. Also, oral medications which relax the bladder muscle sometimes can help and be added. Dr. Schock also utilizes local anesthetics such as pyridium and Urised type products to “numb” the urinary tract.
There are a variety of oral medications which have been found to stabilize the bladder wall lining and decrease the pain of nerve endings. Many of these options are listed for your convenience on the IC-network website.
Sacral Nerve Stimulation InterStim® therapy is a reversible treatment for people with urge incontinence caused by overactive bladder who do not respond to behavioral treatments or medication. Stimulation of this nerve may relieve the symptoms of urgency and urge incontinence. Many patients who suffer with Overactive Bladder symptoms also have associated pelvic pain / IC / PBS. They tend to have frequent urgency episodes to “avoid the pain.”
At Dr. Jeffrey Schock’s office, patients first undergo an office “test” to first see if the treatment may help. This office-based procedure is termed percutaneous nerve evaluation (PNE). This “Office Interstim Test” is a stimulation period where the patient is allowed to evaluate whether or not the therapy is effective in controlling her symptoms. There are two techniques that exist in performing the test stimulation. Dr. Schock prefers the PNE/”Office Interstim Test” because it is extremely well tolerated, requires only 15 minutes in the office, and evaluates patient response on both S3 pelvic nerves. The procedure involves placing a temporary electrode wire through the S3 sacral foramen under local anesthesia. The wire is secured with tape and connected to an external generator the patient wears for a trial period of 3-7 days. If patients have at least 50% improvement in their symptoms during the test phase, they are candidates for chronic implant of the lead and implantable pulse generator (IPG). The advantage of the PNE is that it is an incision free procedure performed in the office utilizing local anesthesia, and does not require hospitalization. Although not indicated just for pelvic pain, many patients who also suffer with bladder symptoms and undergo this test procedure, report significant improvement in i.c./ pelvic pain symptoms. The patient also has the option of undergoing the formal two step staged Interstim hospital based test.
For more information on IC / PBS :