Are you really suffering from cystitis?
Many people visit their doctor for recurrent urinary problems, yet despite treatment, the trouble persists. I recently interviewed Dr. C. Lowell Parson, Professor of Urology at the University of California. He claims many of these patients likely don’t have a urinary infection but are instead suffering from a condition called interstitial cystitis (IC).
According to Dr. Parsons, IC is easy to spot. Patients complain of urinary urgency, frequency and low abdominal or perineal (the area between the anus and the genitals) pain — the same symptoms caused by bacteria in the urine. But in the case of IC, urinary cultures fail to find signs of infection.
Women with IC usually complain of gynaecological problems — often a worsening of pain just before a menstrual period, and a pelvic examination will reveal a tender bladder. Pain may be evident during or after sex — some women, in fact, admit to having shied away from intercourse because sexual arousal triggers pain.
To confirm the presence of IC, urodynamic testing is necessary. Patients with the condition cannot tolerate as much water being placed in the bladder as those with normal bladders, and when potassium chloride isdded, it triggers urinary urgency and pain.
To find out just how common this disorder is, doctors studied 4,000 individuals who had all visited an out patient centre complaining of urinary problems. An amazing 50 per cent were found to have normal urine cultures. As a result, Dr. Parsons claims doctors often wind up treating patients for urinary infections that are, in fact, non existent, adding that "a woman who takes pills once a month for urinary tract infections probably has interstitial cystitis." He adds that women needing antibiotic pills after sex also have interstitial cystitis, not a urinary infection.
Interstitial cystitis in its early stages is an annoyance, causing patients to constantly run to the bathroom to void — as often as 25 times a day once the disease has established a foothold. Sleep is interrupted by the need to urinate, and patients complain of chronic debilitating pain in the lower abdomen, perineal region and thighs.
It’s not known why, but IC primarily affects Caucasians, and nine times more women are likely to suffer from it than men. And although it can occur in young people, most cases occur between 40 – 46 years of age.
What causes this disorder? Mucins and glycoamionoglycans normally form a protective coating in the bladder, preventing urine from leaking into the bladder wall. Dr. Parsons was the first to notice this deficiency in the mucus lining — without this defensive layer, the bladder wall becomes vulnerable to IC.
Dr. Parsons believes this loss of mucin is partly the result of high potassium levels in the urine, or possibly a substance that binds a toxin to the mucus lining. Others believe the initial injury may be the result of a bacterial or viral infection.
Until recently, doctors had little treatment to offer patients with this condition. Now, claims Dr. Parsons, early treatment can help 80 per cent of patients with IC.
He also says all IC patients require some type of antidepressant drug (such as Zoloft) — this won’t cure the disease, but it helps patients cope with the inconvenience of those frequent trips to the washroom. Hay fever sufferers may experience a worsening of IC during the hay fever season and antihistamines may help.
But the main breakthrough in the treatment of IC is Elmiron, a drug which helps strengthen the lining of the bladder and destroy toxic substances in the urine. Elmiron has been available in Europe for 30 years and has minimal side effects. The most common side effect is gastrointestinal distress, although this can be relieved by taking the drug with a small meal.
The usual adult dose of Elmiron is 100 milligrams taken orally three times a day. While symptoms may subside after six to 10 weeks, it may take six to nine months before the condition is completely cleared up. Like most diseases, the key to successful treatment is to catch the problem in its early stages — the sooner treatment begins, the better the chance of relief.