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Bladder Pain

The bladder is the hollow organ in the lower abdomen that stores urine. As the bladder fills, muscles in its walls relax so that it can expand. As the bladder empties during urination, the muscles contract to squeeze the urine out through the urethra. 

Several different bladder problems can cause pain. The three most common causes of bladder pain are interstitial cystitis, urinary tract infection, and bladder cancer.

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Interstitial Cystitis

Interstitial cystitis (IC) is a chronic condition in which the bladder becomes inflamed and irritated. The inflammation stiffens the bladder wall, and makes it difficult for the bladder to fully expand when filling with urine. IC may be caused by a defect in the bladder lining. Women are much more likely than men to have the condition.

A main symptom is pain, which is strongest when the bladder fills and eases when the bladder empties. Pain may also be felt more generally in the lower back, abdomen, or groin. People with this condition may also urinate more frequently or feel an urgent need to urinate, yet they may only pass a little bit of urine each time. Sexual problems may also be related to interstitial cystitis.

Often, a diagnosis of IC is made by ruling out other conditions that cause similar symptoms, such as urinary tract infections, vaginal infections, kidney stones, and cancer. The doctor will take a medical history and perform a physical exam. You may be asked how often you go to the bathroom, if you feel an urgency to go, and when you experience pain.

The following tests may be done:

  • Urine sample
  • Cystoscopy. The doctor will insert a long, thin scope (cystoscope) up your urethra to view the inside of your bladder.
  • An ultrasound or CT scan of the pelvis may be done to rule out other conditions. 

Several treatments may help relieve symptoms of bladder pain and urgency, but finding the one that works for you is often a matter of trial and error. Here are some treatment options:

Medications.Pentosan polysulfate sodium (Elmiron) is the only oral drug that is FDA-approved for treating interstitial cystitis. But, this medication doesn't work for everyone, and it can take several months to take effect. Other medications used to treat IC include the antihistamine hydroxyzine (Vistaril, Atarax), and the tricyclic antidepressant amitriptyline (Elavil). Sometimes, seizure medicines such as gabapentin, (Neurontin) and topiramate (Topamax) are used. Other treatments that have been tried include immunosuppressant medications such as  cyclosporine and azathioprine.  More research is needed to test the safety and effectiveness for all of these treatments. For mild bladder pain, over-the-counter pain relievers such as aspirin, ibuprofen, or acetaminophen may be helpful. Prescription medications are often needed for IC.

Bladder instillation. A thin tube (catheter) is used to fill your bladder with the medications such as dimethyl sulfoxide (DMSO), heparin, steroids, or a local anesthetic. You hold the liquid in your bladder for up to 15 minutes and then release it. This treatment is thought to work by reducing inflammation and decreasing the sensation of pain.

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