2 August 2011 | Mr Keng J Ng | Consultant Urological Surgeon | The Portland Hospital
Cystitis is a very common cause of pelvic pain in women. It is frequently due to bacterial infection. However, there is another important form of cystitis called interstitial cystitis which is not so well recognised and often results in delayed treatment.
What are the symptoms of interstitial cystitis?
Women who suffer bacterial cystitis usually describe the sensation like ‘passing razor blades’ in the water passage (urethra). Such sensation subsides after a course of antibiotics. However, on many occasions, women may experience persistent urethral sensitivity describing a ‘pulling, pinching or stabbing’ sensation, especially at the start and towards the end of passing urine. This urethral pain is different from the burning sensation of bacterial cystitis. Such urethral sensitivity is due to interstitial cystitis.
What causes it?
Interstitial cystitis is due to small cracks in the bladder lining. This results in urethral discomfort on and off, with patients describing good and bad days. Such pelvic discomfort is often influenced by the menstrual cycle, with the symptoms usually worse just around the time of menstrual period, so it is often confused with period pain. Interstitial cystitis may also lead to the need to urinate frequently, lower backache, groin discomfort and painful sexual intercourse. Occasionally, patients may also suffer bowel disturbance like bloatedness similar to irritable bowel syndrome.
How can interstitial cystitis be treated?
Interstitial cystitis can, in fact, be treated easily when recognised early. A simple minor telescope operation (cystoscopy and hydrodistention of bladder) can numb the bladder temporarily to allow further treatment to seal the cracks of the bladder lining. The main therapy that follows focuses specifically on healing the lining of the bladder, relaxing the bladder muscle spasms and calming the sensitive nerve endings. Newer forms of treatment, such as Botox bladder injections have shown promising results. Once treated, the bladder should be ‘good as new’. During the initial treatment, patients will be asked to temporarily follow a smart diet to help reduce the acid and potassium content of the food and drink. Acid and potassium in the urine can pass through cracks in the bladder lining and sting the deeper nerve endings, causing pain. These irritated nerve endings can then react badly by releasing nasty chemicals, which in turn lead to further damage and cracks in the bladder. This eventually sets up a vicious cycle of in inflammation which prevents the bladder lining from healing naturally.
Bacterial and interstitial cystitis may sometimes occur together and cause severe symptoms not relieved by courses of antibiotics. In such cases, special combination treatment to eradicate the bacteria and protect the bladder lining is essential for complete cure of the pelvic pain.
Mr Keng-Jin Ng is a consultant urological surgeon with special interests in female urology and minimally invasive surgery. He trained at The Institute of Urology, London as a clinical research fellow and was a senior registrar based at St Thomas’ Hospital, London.
Mr Keng-Jin Ng is available for private consultation at The Portland Hospital, London and can be contacted via his private secretary on 0796 225 4569 or email urology@DrNg.co.uk.