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Dr. Jay Burstein Dr. Jay D. Burstein
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Created: November 2000
JO & JB
Q & A with Dr. Jay : November 2000
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:
113:
Trigone laser surgery
114: Is fatigue a symptom of IC?
115: Handling that "pressure" feeling.
116: Can symptoms flare with the seasons
117: What causes constant pressure and how can it be treated?
118: Hematuria - Blood in the Urine
119:
Is the incidence of joint pain in IC patients higher than the general
population?
120: Can hysterectomy for endometriosis cause additional
pain?
121: Is rash common with IC?
122: What
is allergic disease and how can it cause IC or symptoms of IC?
123:
Is there any evidence that anti-depressants can worsen symptoms that are
IC in nature?
124: Is
there any cough drop I can buy that won't bother my bladder?
125: Trigonitis: What
causes it? How is it control? Will it go away permanently?
126: Children and IC
113. I have been dealing with what I thought were bladder infections increasing in frequency over the past two years. A kidney ultrasound came back normal; one culture was positive and one negative. The nurse practitioner gave me a copy of an article from a women's magazine describing a condition they refer to as chronic bladder syndrome, with a kind of laser surgery done to the trigone to treat the condition. Have you heard of anything like this?
A: This sounds like a very unusual way to treat chronic inflammation of the bladder and is certainly not standard of care at this time. As you stated, it appears your problem is recurrent infections, not IC and I would recommend a second opinion or evaluation by a specialist.
114. My doctor thinks I may have IC, due to frequent symptoms which produce negative results with urinalysis. I've had these symptoms for several years on and off (frequency, urgency, mild burning,etc.). I don't have bladder pain, but I occasionally experience abnormal fatigue along with the other symptoms. It's the type of fatigue where I need to lie down for a few hours. My doctor says this isn't a usual symptom. Is this reported by other IC patients?
A: Fatigue is not listed in the NIDDK definition of IC. (National Institute of Diabetes, Digestive and Kidney Diseases) However, fatigue can be a significant symptom of those patients who experience severe frequency and nighttime voiding that results in sleep deprivation.
115. I'm nineteen years old and was very recently diagnosed with IC. The first treatment I received was a cystoscopy. After the surgery I felt normal for 7 months. Now it's coming back. My question is that my one and only symptom is the pressure feeling. Is there a best way to handle this?
A: IC symptoms can run the spectrum from mild to severe. It appears your symptom is mild and should be responsive to treatment, but I have no answer for your question- the answer needs to be obtained by discussing the options with your physician .
116. I have had IC for 4 years and I am currently taking Elmiron and Elavil, which control a significant amount of the pain. I have noticed that around September my symptoms seem to worsen and this usually continues through to March when the symptoms get remarkably better for no apparent reason. I also get about 2-3 migraines a year and they tend to follow the same pattern (Sept.& March). I can't help wonder if there is some hormonal influence occurring around the spring and autumn equinoxes. Before I took Elmiron my symptoms were always worse during my period, and almost nonexistent in the days right before my period. Do you know why this is happening?
A: Monthly hormonal fluctuations are known to cause symptom flair in some IC patients. Your situation is interesting in that there is a seasonal variation and this might reflect an allergic component to your symptom complex. The presence of mast cells in the bladder lining of IC patient's as determined by biopsy is thought to result in dilating surrounding blood vessels and increase inflammation just as a seasonal nasal allergy causes the same changes. Talk to your doctor. An antihistamine may be of benefit during these times of flair.
117: I'm 23 and for 4 yrs I've been going through this problem. No Dr. knows what is wrong and tests always some back negative. I feel constant pressure on my bladder, all the time. I also get hemorrhoids allot. I even have a slight vaginal discharge, but my doc tells me everything is fine. I've gotten a cystoscopy before, nothing is wrong. I want to have a baby soon, not sure if it's ok to. Where do I go from here? Please help me.
A: One clue might be the hemorrhoids. If you are repeatedly straining to have a bowel movement you can cause trauma to the pelvic muscles which could lead to uncomfortable sensations and, perhaps, even a "pressure like" feeling. You need to see a urologist or other specialist who has a special interest in IC to make sure that "no stone is unturned". A diagnosis of IC should not be overlooked. If you persist in having bowel symptoms, pursue that as well with your appropriate physicians.
118: I'm helping my sister who is 51 years old find information for us to understand better what is going on with her. Her doctor is just as puzzled as we are, and I'm trying to search everything and anything to help find out what is going on with my sister. Here's what we know so far, From 1982 to now she has has large amount of microscopic hematuria in her urine, Bladder Polyps as well which are removed each year. This past July they began to block the neck of the bladder. She's been told she also has Chronic Cystitis Glandularis, This past July the report showed Atypical Transitional Cells Pathologist recommended tissue studies. Study showed neg. Now they will do a Urine Cytology in 6 months. Her doctor is puzzle as to what is going on, her blood count drops which they think is due to the large amount of Microscopic Hematuria in the urine. If you can lead me to where I can research information or anything that will help us solve this puzzle would be more then greatly appreciate. God Bless and Thank you for all your time and help.
A: It appears that your sister has benign inflammation of the bladder as a cause of the microscopic blood in the urine. This evaluation is very important and needs to be complete. Be sure to encourage her to continue seeing her doctor. For an excellent discussion on hematuria be sure to point your browser to www.urologychannel.com. This topic is listed on the home page. (This site also hosts my website at www.jaybursteinmd.com)
119: I am still a bit curious about the connection between joint pain and IC. My uro told me that I'm not the only one of his patients that has reported joint pains that came along at the same time with IC. And, on the message board at this site, I've found others with IC who also has concomitant joint pain. In your opinion, does there seem to be a connection, occasionally, between IC and joint pain? I'm just kind of wondering if the incidence of joint pain in IC patients is higher than the general population.
A: There is no recognized association between IC and joint pain. Your symptoms may be concurrent and incidental without causative association. Fibromyalgia is associated with IC but this disease is characterized by non-joint pain.
120. I had a hysterectomy for endometriosis in July. I have had pain in the abdomen and back every since now they say I have IC. Why would this have caused this?? Is this common?
A: Endometriosis and IC are both diseases that can cause pelvic pain. Endometriosis does not cause IC. However, in rare cases, endometriosis can implant on the bladder wall and produce symptoms similar to IC. These implants can be visualized with cystoscopy, which is why this procedure is so important in the evaluation of chronic pelvic pain.
121. If you were to have a bladder infection, would it be common to have a rash in that area?
A: No
122. I have recently been diagnosed with IC and I was reading some information about IC and came across an article with allergic disease. I have chronic sinusitis, asthma, tender stomach, (upsets easily) and have been on a lot of prescription medications for UTI's and am allergic to almost all of them. The allergy is also to foods: strawberries, watermelon, Kool-Aid and other powdered drinks, shellfish, and curry among others kinds. Also, mold, feathers, mildew and so on. What is allergic disease and how can it cause IC or symptoms of IC? I was wonder if I need to see my doctor regarding this disease. Thanks for your time.
A: About 40% of IC patients have allergies. This is an associated finding in that IC is not thought to be caused by allergic reactions. For example, an allergic response occurs when an allergen (say dust or pollen) causes mast cells (located in the nasal sinuses) to release histamine. In turn, the histamine causes an inflammatory response including dilation of blood vessels and the familiar symptoms of "stuffiness and runny nose". This is why antihistamines are so effective for symptomatic relief. Now to make matters more confusing, several studies have documented an increased number of mast cells in the bladder lining of IC patients. The big question that is still debated is whether mast cells cause IC or if their presence merely reflects an inflammatory response from another cause. Also, increased mast cells have not been shown to be a reliable marker for IC. You should definitely discuss this with your physician. .
123: Is there any evidence that anti-depressants can worsen symptoms that are IC in nature?
A: This would be an unusual side effect of medication. During clinical studies it is common for drugs to cause a variety of side effects that appear unrelated to the intended effect of the medication. Sure… in some cases an anti-depressant, which is supposed to relieve symptoms of IC, could in rare situations, actually make them worse.
124: I was diagnosed with IC less than two months ago. I have researched the network and haven't found any information on fighting the common cold with IC. I am curious as to what I can do to relieve my sore throat. Is there any cough drop I can buy that won't bother my bladder? And is there anything over the counter I can take? I usually take Echinacea. Can I take this?
A: To my knowledge, it is unusual for cold remedies to adversely affect IC. In fact, constituents in cold remedies can actually relieve some of the symptoms of IC. These would include antihistamines and anti-inflammatory agents. Two products used as drying agents to help symptoms of "runny nose" are phenylpropanolamine (likely to be banned by the FDA in over the counter formulations) and pseudephedrine. These stimulate receptors in the nasal blood vessels causing them to shrink. The same type of receptor is found in the bladder neck region. When these are stimulated, the bladder neck contracts a bit. This can be used to treat incontinence but may cause a side effect of difficult bladder emptying and therefore may aggravate symptoms in some IC patients. Unfortunately there is no regulation of herbal products so I cannot give any opinion as to their effectiveness. Echinacea is typically well tolerated. You will need to judge its effectiveness and determine whether it adversely affects your symptoms.
125: I have been diagnosed with trigonitis. I read in one of your Q&A that it is not associated with IC. I find that very comforting. I was told it was the floor lining of the bladder that is irritated. What causes it? How is it control? Will it go away permanently? I find very little info about this condition. Is there any info?
A: Trigonitis is a non-specific reference to changes seen on a portion of the bladder floor called the trigone when evaluated with a cystoscope. This is a triangular structure with boundaries between the two ureteral orifices (the openings that bring urine down from the kidney) and the bladder neck (the funnel portion of the bladder where it meets the urethra). Two findings affecting the trigone are commonly seen during cystoscopic examination: 1) cystitis cystica and 2) squamous metaplasia. Here is the long answer to your question!
Cystitis cystica develops from an enfolding of normal bladder lining cells (urothelium). The center then liquefies producing visually distinct small cysts. These are benign and have been found in 60% of normal bladders at autopsy. These changes are associated with inflammation may or may not be associated with symptoms and, in many cases, probably represent normal findings.
Squamous metaplasia is also called "pseudomembranous trigonitis". It occurs when normal bladder lining cells (urothelium) are replaced with squamous (skin-derived) cells. It appears as a white, patchy, bumpy area on the trigone and bladder neck region: kind of like a thin white membrane. The trigone is derived (embryologically) from the same origin as the vagina and therefore responds to changes in estrogen levels. The changes in the trigone as described above are actually due to low levels of estrogen and do not represent a pathologic or disease state. This is typically found in postmenopausal women but can also be found in younger women with fluctuating levels of estrogen and in men treated with hormones for prostate cancer. Autopsy studies have shown squamous metaplasia to occur in the bladder of nearly half of women and fewer than 10% of men. This then represents a normal finding and is not associated with inflammation and does not produce any symptoms.
Why so many patients
are told they have "trigonitis" is a question I cannot answer. However,
if symptoms persist, a distinct, pathologic diagnosis is mandatory by
obtaining further studies, such as hydro distention to rule out IC, or
even seeking a second opinion.
126. I have had symptoms of IC since I was 4 years old. I am now 40 years old. My daughter is 5 years old and just started to have allot of frequency in going to the bathroom. She has the urge to urinate and then only a few drops come out. I don't want to she her suffer like I do. Is there anything that can be done for a child before this develops into a real problem?
A: IC is rare in children but certainly needs to be considered in cases of unexplained urinary frequency. In this age group a more common cause is a benign condition called extraordinary urinary frequency syndrome of childhood. Be sure your child is fully evaluated by an urologist with experience in pediatric problems.