Dr. Jay Burstein Dekalb Clinic 217 Franklin St. Dekalb, IL 60115 815-758-8672 Dr. Jay D. Burstein is a Board Certified Urologist specializing in painful voiding syndromes and incontinence.

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Created: Jan 14, 2002

Q & A with Dr. Jay : Dec 2001

Please remember that Dr. Jay does NOT give personal medical advice via the web. Always review any information that you receive on-line with your personal medical care provider. Only your personal doctor can and should make medical recommendations to you.

In this issue:

176: Has there been any thought (or therapeutic trials) of the use of anti-asthma steroids (e.g., beclametasone diproprionate) as instillations into the bladder?
177. Is a bloody brown discharge normal
178. Can DMSO aggravate herpes
179. IC or Overactive Syndrome? What's the difference?
180. Are IC and chronic back pain related or two different problems?
181. Can IB be misdiagnosed as severe SI dysfunction and piriformis syndrome?
182. Acidic foods vs. alkaline-forming metabolites
183. Pain increases prior to ejaculation
184. Treating IC when you have drug sensitivities
185. Fatigue & IC. Is it common?

176. I am a retired physician. My brother in law has IC. At one point in his multiple investigations, a respected Urologist gave him an injection of Decadron that produced a few days of complete remission of his frequency and pain. My question: has there been any thought (or therapeutic trials) of the use of anti-asthma steroids (e.g., beclametasone diproprionate) as instillations into the bladder? These steroids are minimally absorbed from the bronchial tree. Determining dosages would be a problem, as would the vehicle for the steroid. This therapy would fit a presumption of hypersensitivity to something in the urine causing the symptoms, and in many ways the symptoms and subsequent changes in the bladder wall are similar to chronic asthma.

A: Good thinking here. Steroids have long been used as part of the "cocktail" formulation of DMSO instillation therapy for IC. Presumably, the DMSO carries the steroid to the deeper levels of the bladder where the anti-inflammatory action may be more effective. This method of delivery avoids high circulating levels of steroid that can be harmful. I know of no studies that have evaluated the use of asthma medications for IC.

177. I almost always have a brown bloody discharge from my urethra area(I previously had a hysterectomy so I know where it is coming from) with every flare up, is this normal with IC?

A: Bleeding from or around the urethra is NOT NORMAL. IC is never associated with bleeding and if your symptom persists, you need to contact your gynecologist and urologist to determine the exact cause of bleeding.

178. I have genital herpes. I also have IC and have been treated with DMSO 4x in the last 6 weeks. Every time I've noticed an outbreak of herpes, but the last time is the worst case I've ever had! They're on my legs and very lower back, on the edges of my mouth. I haven't had sex since the DMSO started so I know that can't be the problem. Is there any connection between DMSO and herpes?

A: There does not appear to be any CAUSITIVE relationship between herpes and DMSO. Surprisingly, DMSO has been advocated for the TREATMENT of herpes virus-both "cold-sores" and genital types. It seems that the DMSO acts as a carrier of other medications (such as peroxide) to the deeper layers of skin so that it may affect the nerve roots. I do not prescribe or recommend any of these approaches.

179. I was recently diagnosed with IC. After reading the research and literature on the syndrome, I am not confident that I suffer from IC. I have absolutely no pain or discomfort. My symptoms include urgency/frequency. I sometimes, sometimes more frequently than others, have incidents with incontinence. Since childhood I would wet the bed or have accidents in school. Now as a 23 year old adult, I find I still wet the bed on occasions and still have accidents during the day. Generally, I have them when I can't find a bathroom in time or the line for the bathroom is too long. The doctor mentioned hemorrhages and an inflamed bladder after my cystoscopy. Is there a chance I was misdiagnosed, and I actually suffer from Overactive Bladder syndrome.

A: Interstitial cystitis is a spectrum disorder comprising urinary frequency and pain of varying severity. The glomerulations, or hemorrhages that your doctor described need not be present to diagnose IC, and can even be present in patients without symptomatic bladder disease as has been described in recent studies. Currently, overactive bladder describes symptomatic urinary frequency and urgency with or without urinary incontinence. Your symptoms should respond nicely to the variety of anti-cholinergic/anti-spasmodics available as prescription such as Hyoscyamine, Detrol and Ditropan.

180. Are IC and chronic back pain related or two different problems? I have been diagnosed with IC for 4 years now and my flare-ups are pretty regular--right before, during and after my cycle. But when I have a flare up my lower back HURTS really bad and once I get the bladder under control it gets better a couple of days later. I am tired of hearing it is all in my head and I have read all of the questions and answers up until now and you give pretty straightforward answers and I appreciate that so much. I only wish I was closer and there would be no questions about who my doctor would be. Thanks for you time and answer!

A: Your symptoms certainly are typical for IC and appear very responsive to flair control. Lower back pain is a well-known and common associated symptom of the complex of IC

A: SI dysfunction and piriformis syndrome are very specific diagnoses. The Sacro-Iliac joint (back side of the hip below the back-bone) can become separated during trauma such as a car accident and cause chronic back pain. The piriformis is a small muscle located under the main muscle of the buttock and is responsible for outward rotation of the leg. If the piriformis goes into spasm or becomes too tight, it can cause pressure on the main nerve of the leg (sciatic nerve) and cause leg numbness, tingling and pain. Chronic low back pain can also be a symptom of the syndrome.

Neither of these conditions describes any degree of bladder dysfunction and are not known to be associated with IC. However, if you have significant bladder pain and or severe urinary frequency you should be evaluated for unrelated bladder disease such as IC.

182. I understand that IC patients are advised to avoid acidic foods, and there are products out to de-acidify foods now, however, most foods that are acidic (tomatoes, citrus) in the upper GI are actually alkaline-FORMING foods in the tissues (ie Rheumatoid arthritis patients are encouraged to eat alkaline-forming foods). Whereas, animal protein sources are acid forming. My question is - at what point in the system does the body convert acidic foods into alkaline-forming metabolites. Wouldn't it be before they reach the bladder, therefore alkalinizing the urine, not acidifying it?

A: Most digestive metabolism takes place in the liver but ultimately the kidneys determine the acid content of urine. The kidneys have a variety of functions. A few include control of blood pressure, control of blood volume, control of urine volume, and control of blood and urine levels of sodium potassium, glucose and calcium. The kidneys also maintain control of acid-base balance by actively alkalinizing the blood and acidifying the urine. Some IC patients can be sensitive to acidic foods but surprisingly they often do not significantly increase the acidity of the urine. Why this causes symptoms is unclear but may be explained in some cases as food "sensitivity" or, as postulated by Dr. Parsons, by excess potassium in the urine. Even though the physiology can be confusing, contradictory or just plain doesn't make sense, many patients find relief using food additives such as Prelief, baking soda or potassium citrate. The real answer why these work is - "we don't know why they work".

183. I am a 42-year-old male who was recently diagnosed with IC based on my history and symptoms. Of all the symptoms I have the one that puzzles me the most is: If I have not ejaculated in several days I begin to have more burning than normal in the scrotum along with increased episodes of urination. Typically my response to this is to ejaculate. Often I will have pain during the ejaculation and a heightened pain some hours later. Any thoughts on this?

A: The seminal vesicles as are sack-like structures that lie beneath the bladder on each side and attach to the prostate. Their main function is to add liquid to semen and the ejaculate. If the seminal vesicles become inflamed, the condition is called seminal vesiculitis and can produce symptoms of urinary frequency, urinary burning, testicular pain and pain during and after ejaculation. Some of these symptoms can also be caused by pelvic floor muscle spasm, which is often associated with IC. An ultrasound examination can be used to help differentiate this condition. Since the seminal vesicles lie directly behind the rectum, a "trans rectal ultrasound" (TRUS) can be performed by gently inserting a probe into the rectum. The resulting images would show an enlarged, dilated seminal vesicle. Various treatment options can be tried that would include antibiotics, anti-inflammatory medications, muscle relaxants and relaxation techniques.

184. How can I treat my Interstitial Cystitis if I have a lot of drug sensitivities?

A: Many people cannot tolerate certain medications for a variety of reasons, none of which are for reasons of significant allergic reactions. The reasons for the majority of intolerance to medication is unknown, but here are a few suggestions:

• Many people cannot tolerate the various fillers and dyes used in medication so several alternative generics need to be tried.
• If gastro-intestinal upset occurs, try dissolving the medication in water then drink it slowly
  
• Pay particular attention to dietary triggers.
  
• Take medication with food.
  
• Begin medication with low doses and gradually increase to tolerance.
  
• Be sure to try DMSO bladder instillations. Start with low concentration and build up to tolerance.
  
• Consider all non-medication treatment options such as relaxation techniques, pelvic floor myofascial therapy and transcutaneus nerve stimulation (TENS).

185. Are you aware of an association of fatigue with IC? I have just been diagnosed with IC but have had symptoms for years. I have had fatigue symptoms for years as well and am currently awaiting further investigation. I did see a specialist for fatigue before with no results. It is sudden, more of a "zombie like fatigue" than a tired yawning type of fatigue. It is not the type of fatigue that you get after a hectic day. I did notice an association with bladder symptoms and this zombie fatigue. The fatigue is relieved with a short nap when I can get it. For eight years I have been trying to sort this out. I also wonder if there is a chance than there can be any association with IC and excess stomach acid. I take Losec and also noticed that this worsens when I have both the IC and fatigue symptoms.

A: IC can be associated with other medical conditions. The most common are migraine headache, irritable bowel syndrome, vulvodynia and Fibromyalgia. Fibromyalgia is typically associated with muscle and skeletal aches and pain and chronic fatigue. There are a host of other illnesses that can produce fatigue. A partial list includes metabolic disease such as diabetes or liver disease, depression and anxiety disorders, renal disease, anemia, and sleep disorders. Patients with prolonged symptoms of fatigue who have minimal findings on medical examination should be evaluated for Chronic Fatigue Syndrome. You need a complete medical evaluation to find the cause.