Acute infection, bladder stone, urethritis, vaginal abnormalities such as bartholins gland cysts and urethral diverticula can cause painful urination. A bladder capacity of 750 is good. Some bladder cancers look like little berries on a talk. IC does not, however, relate to bladder cancer in any way. As to potential long term effects, in some cases the bladder becomes scarred and may not be able to empty completely, but these patients demonstrate "end-stage " disease and typically were never appropriately treated for IC. If a patient does receive treatment their symptoms tend to stabilize but the flare phenomenon is unpredictable and can be quite severe.

41. My urine has a strong odor just like ammonia. Why is this and what can I do about it? I have urine sticks at home (exactly like the ones in urologists offices) that show infection and nothing is showing up there. Oh, also, is it true that if the urine sticks don't show anything you still should have an urine culture done? Thank you for any info you can give me on this.

A: Normal urine is composed of UREA which breaks down into ammonia. If the smell is overwhelming it may be due to leaving your specimen exposed to air or you may have concentrated urine and need to drink more water. Urine dip sticks come with various types of tests. The nitrite test can become falsely positive with medications such as pyridium and other urinary antiseptics. The leukocyte esterase test can be positive by contamination with vaginal secretions-that's why it's important to do a "clean catch" technique when giving a specimen. I hope this answer helps.

42. My mother is an 83-year-old woman who has fought interstitial cystitis for several years. Her mind is good and she is in good health otherwise. The pain is almost unbearable and we see her becoming more and more frail because of pain medication. She has had all the recommended tests through the years and really doesnt have the health to have them re-done. Do you recommend any of the new medications for geriatric patients -- or other treatments that would not be so hard on her?

A: These situations are always difficult. Elmiron would be an option. Detrol also has a relatively mild side effect profile. Investigate a pain clinic!!!!

43. What are the best pain Rx to take during a flare-up?? tricyclic antidepressants, antihistamines, or anti-inflammatory?? Which ones and WHY??? Thank you.

A: Managing an IC flare is a very individual thing because patients have different experiences and sensations during their flares and also respond differently to medications. First and foremost, it's important to try to prevent flares. Stick to your IC diet and try not to do things that you know will aggravate your symptoms.

Your approach to handling flares should be based self help and, if needed, medication. Stop and rest if you're having a rough day. Try using heat or ice, depending upon what works best for you. If the pain the intensifies, you may want to consider using a pain medication. Talk with your doctor about how to use an opiate properly.

Antidepressants are a long term pain management strategy and not meant to be used for emergency situations. Antihistamines and anti-inflammatories may help to reduce some inflammation. But, usually, if the pain is intense, a patient will require some type of pain medications. Remember, you have to have a package approach to treating your IC symptoms.: self help, bladder treatments and, if needed, pain medications.

44. I'm very sensitive to most medications, especially antibiotics. I'm now afraid to try anything because they seem to make my bladder worse. Can I treat IC without using any medications?

A: It would make sense to try medications in small, incremental doses to determine tolerance. I'm thinking of elmiron and antihistamines here. Antispasmodics (ditropan etc. may be to harsh) If no medication is effective then try diet and alternative approaches such as meditation / relaxation / stress reduction and pain management techniques. Try getting "The Chronic Pain Control Workbook" from your local bookstore. It has a wide variety of non-medication related resources for you to consider using. Also, you may want to consider consulting a pain clinic. They treat so many patients that they have more experience with drug sensitivities. They may have some options for you to consider that your urologist may not be aware of.

45. What are your thoughts on these nerve stimulators (Interstim, ANS & SANs) as far as their effectiveness and safety?

A: My thoughts are that nerve stimulators are a last resort and only if you have intractable pain. The problem with Interstim and some spinal stimulators is that the leads can migrate and cause pain or irritation in the patient. SANS is easier to do, but we just don't have enough long term data to determine it's effectiveness. From a safety standpoint, we haven't seen any negative effects from the procedure.

46. I have been experiencing pain in the area of my left ovary for several months, my gynecologist has done a sonogram and pap smear (nothing abnormal), the pain eventually travels around my side to my lower left back. Could this be caused by what is called IC pain? Any suggestions or comments?

A: My daughter had this exact clinical picture-guess what ? She had a kidney stone!!! Be sure to see a urologist for a complete evaluation.) If pain is localized, it's important to focus on that organ system. You should have a full ob-gyn work up to make sure that you don't have any other conditions. Rule out everything else! Don't guess!

47. How many bladder distentions can a person have? Can it cause more damage from having to many distentions done? I have had at least 5 and I will have another one on Friday of this week. I would really love to try some other treatments. At the present time I am having a major flare-up and I am passing a lot of blood. Please let me know what you think about the distentions.

A: Distensions can be highly effective and to my knowledge there are no long term side effects of significance. There are now several possible treatments for IC in addition to distentions. You could consider other bladder instillations such as DMSO, marcaine, heparin, or Cystistat. Orally, you can consider using Elmiron, which acts as a bladder coating. If you're having spasms, you could consider using an antispasmodic, such as Ditropan or Detrol. For pain management, the use of an antidepressant is a popular and effective approach. Check out the treatment section of the ICN Patient Handbook for even more information on treatments.

48. I was diagnosed last September with IC and have been taking Elmiron and Amitryptline ever since. It has been very effective in controlling the pain and frequency, however, I notice of late that my vision is blurred at imes...sometimes it is worse than other times. Could my vision impairment be a result of either or both medications? I've been diagnosed as borderline for having glaucoma and I'm concerned that the medication may cause manifestation of the eye disease....any insight you have would be appreciated.

A: The side effects such as dizziness or blurred vision can sometimes go away after a week of treatment . HOWEVER, since your symptoms are persistent you need to see an ophthalmologist immediately to rule out any primary eye disease.

49. I have just been diagnosed with interstitial cystitis and vulvodynia. My Doctor prescribed Flomax as part of my treatment. Can you tell me if about this and if there will be any side effect? She stated it is generally prescribed for males!! Should I be concerned?

A: This medication is one of the commonly used "alpha blockers" prescribed for men with symptoms of an enlarged prostate gland. (Others include Cardura and Hytrin). These act by inhibiting the firing of certain nerve fibers located near the bladder neck which can help relieve the discomfort of over-active muscle tone in this area. Flomax has minimum side effects and may be useful in treating pelvic floor overactivity in women and men.

51. I was diagnosed with IC in August of 99 and recently saw my gynecologist due to some burning, stinging and discomfort in the vulva area. My urologist suggested I see a gynecologist to have an exam in this area. I was diagnosed with a bartholin gland cyst and now am healing from an incision and catheter that is in place for four weeks. My question is could this have attributed to not being able to completely void at times because of the size and location of the cyst?

Yes, the bartholins gland, if infected, can produce an obstruction. The tenderness and irritation can spread widely through the introitus and/or towards the urethra, causing obstructive symptoms.

52. My pain feels like it is coming from either the back of my bladder or between my vagina and bladder. I have no frequency and the pain goes down the back of my legs to my feet. It also feels like electricity in my legs. Upon examination my bladder does not hurt. When I lay down the pain gradually gets better. I have been told I have IC but could it be a nerve?

Sounds like sciatica. It doesn't sound like IC to me. I recommend a neurological evaluation.

53. I feel like I'm not emptying my bladder completely. I hear this is common - it's the worst feeling. What is the best way to fix this particular problem and why do you think it happens? Does this mean I have pelvic floor dysfunction. Finally, is it possible I am emptying - it just doesn't feel like I am? Thanks

The floor of the bladder has no pain fibers. It has stretch fibers that we interpret as the urge to urinate. So, when the bladder wall is inflamed for any reason, the initial reaction is usually an intense need to urinate. So, if I cut your trigone, it wouldn't hurt you.. you'd just have to go to the bathroom. Any irritating effect on the lower part of the bladder will cause that need to void.

Try to avoid forcing or straining your urine out. I know that you feel like you're full but the odds are the bladder is empty and straining will only damage those muscles. You should also ask your doctor to verify that you are emptying your bladder, either with a catheterized specimen or an ultrasound.

54. About 5 weeks ago I was treated for a UTI, but urgency has persistently bothered me. My urologist keeps telling me to go home and wait for it to stop. I don't think it's getting any better. Is it possible that I just have inflammation left over from the UTI that may take 4-6 weeks to go away?

This is a tricky question. What we don't know is if you were actually diagnosed with a UTI via culture. A typical UTI has a 72 hour natural history. The body can usually wash out the infection. Often, you'll come to the doctor half way through the symptom course and we'll give you an antibiotic and you'll probably start feeling better very quickly.

If you have persistent symptoms, then a secondary cause has to be evaluated. If the inflammation has continued, we'd want a repeat urinalysis. We call this chronic urethritis or chronic cystitis. Sometimes we'll see little polyps at the bladder neck which is an evidence of long term inflammation, kind of a battlefield between the immune system and bacteria (an inflammatory response). And, because it's at the base of the bladder where you don't get pain but urgency, this makes it all the more important to have a follow up.

55. I have pseudomembranous cystitis (an inflammation of the bladder) which I am told is a completely different disorder than IC - I have been following the IC diet and other recommendations from this site and believe they have helped - would there be diet and supplement implications that would not apply to my condition or would they be the same for IC and what I have (or any inflammation of the bladder)?

Pseudomembranous trigonitis is another word for squamous metaplasia. "This typically occurs on the trigone or floor of the bladder in women and is a normal variant occurring under hormonal influence. " (Campbell's Urology, 7th edition, p. 2338) It's a normal variant of the trigone and isn't, in my opinion, a pathological condition nor should you worry about it.

It makes sense that the IC diet would help because it is low in acid and irritants. It's hard to tell from your letter how you were diagnosed because this isn't a typical clinical diagnosis. I don't treat any pseudomembranous trigonitis patients in my clinic. I would encourage you to discuss this with your urologist further.