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Dr. Jay Burstein Dr. Jay D. Burstein
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Created: Nov. 2000
JO & JB
Q & A with Dr. Jay : October 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:
101:
Urine Markers for IC
102: Can estrogen help with IC?
103: Odors in Urine?
104: Can you please explain the relationship of IC and
Bowel Habits?
105.
What is your opinion on women who would have a hysterectomy to relieve
the pain of IC?
106:
Urethral scar tissue & catheterization?
107: Antispasmodics
108: Do the scars in the bladder get worse with time and
what effect does menopause have on IC?
109: Is the inflammation of IC something that would affect
the surrounding organs or would it remain isolated in the bladder?
110: Is the diuretic further complicating my IC?
111: Could I have crystals in bladder that lodge & cause
pain?
112: are calcium channel antagonists still used to treat IC?
101. I keep reading that there ARE substances in the IC bladder that are or are not in "normal" bladders. I see Gp51, HA(hyaluronic acid), etc. which are being tested for markers. Why are these tests not readily available for patients who understand that this is not a diagnosis but could help them decide what their next step should be. I read an article where HA is more plentiful in the urine of IC bladders which may show that the GAG layer is deficient. I would like my urine tested for these markers and would like to know how I can get this done.
A: Good Question. Actually, markers are used to define and diagnose disease. In some instances they then may be helpful in guiding a treatment plan. As far as IC is concerned, at this time there are no known accurate, reproducible markers available. There are recent exciting results in the field of markers and it appears that several growth factors in the urine of IC patients may prove to be a marker, but at this time there are no commercial laboratories that can provide the testing. All of the work in marker technology is experimental and available only in clinical studies.
102. Can estrogen help with IC. If so, why?
A: Treatment of IC is based on symptomatic relief. It is a spectrum disease and probably has several causes. Estrogen deficiency can cause drying of the external genitalia and urethra resulting in lower urinary tract symptoms of urgency and frequency-not unlike IC. The diagnosis can be made on physical exam with the finding of "atrophic vaginitis" which demonstrates dry, pale, friable skin and local tenderness. Estrogen therapy in this situation can restore normal function and reduce symptoms.
103. Occasionally my urine will have a very strong odor - not ammonia like -rather like raw sewage. It seems to come and go without warning, sometimes lasting a day, sometimes a week. I am prone to urinary tract infections and do suffer quite a bit of persistent pain in my bladder area. Is this foul odor symptomatic of something in particular.
A: Infected urine can certainly have an obnoxious odor. If you have been evaluated and found not to have a urinary tract infection a few comments can be addressed. Several foods can add color and odor to urine. One which comes to mind is asparagus, which imparts a particularly nasty scent. If you cannot identify any food product as a source of your concern then try increasing your water intake. Concentrated urine due to poor fluid intake can result in offensive odor not necessarily that of ammonia.
104. Can you please explain the relationship of IC and Bowel Habits? Is there a relationship and if so what is good advise to heed?
A: Constipation may aggravate the symptoms of IC due to distension of the colon and its proximity to the bladder and pelvic organs. On the other hand, symptoms of spastic colon need to be carefully evaluated. About 7% of IC patients have associated irritable and inflammatory bowel disease. The reason for this is unknown. Other associated diseases include an increased incidence of allergy, fibromyalgia, vulvodynia and migraine headache.
105. What is your opinion on women who would have a hysterectomy to relieve the pain of IC?
A: Unless there is significant uterine pathology, a hysterectomy is not likely to relieve any symptoms of IC. If the uterus is enlarged with benign fibroids it may result in pressure on the bladder causing increased symptoms of IC and perhaps a hysterectomy could be of benefit in this unique situation.
106: I have had IC for 7 years, I have been through everything my urologist has to offer and nothing has worked. I have a really bad problem with scar tissue in my urethra. I have to catheterize myself at home, just to keep it open so I can urinate. It doesn't close up it just gets so bad to where I have to push to get any urine to come out. I have heard that catheterization could cause more scar tissue and make matters worse in the long run. Is there any way to get rid of the scar tissue.
A: Do not worry. Intermittent, self-catheterization using clean technique has been shown to be well tolerated and is associated with few significant long-term side effects. To my knowledge, self-cath does not lead to scarring and is a very good method to assure that your bladder empties effectively.
107. I had an IC episode 15 years ago. I was fine until about 4 months ago when it returned and it is worse now. My symptoms are frequency, urgency, constant bladder pressure and pain. I was taking Ditropan. It worked well 15 years ago but has not been as effective this time around, in fact as of a few days ago it is not helping at all. I've tried a couple of other anti-spasmodic and they aren't helping either. I'm now taking Vicodin, it is the only thing that is helping me. Why would the anti-spasmodic stop working?
A: Antispasmodics help to decrease bladder sensitivity to reduce urgency and frequency. This class of drugs does not provide significant analgesia or pain control. If you continue to suffer be sure to re-evaluate your IC and pain management tool kit as described on the website.
108. I have been diagnosed with IC at the Cleveland Clinic. Do the scars in the bladder get worse with time and what effect does menopause have on IC? How do I get enrolled in a Clinical Study? Please help find a cure for this horrible painful disease. I am 54 yrs old.
A: IC can be a chronic, long- term disease, but there is no hard evidence that it is progressive. Although the natural history is consistent with recurrence of symptoms and "flair," it is highly unusual for the degree of pain and other symptoms to worsen over time. In fact as many as 50% of IC patients have apparent spontaneous remission of symptoms. Another point here is that scarring is not a consistent or common finding in IC. Pathology specimens usually show mild or moderate inflammation, but scarring is rare and if present may represent healing from prior biopsy sites.
109. I had a laparascopy done a few months back during which it was noted that I had excessive peritoneal fluid and the vessels in the pelvis were engorged. (I forget the actual term for the swelling). Is the inflammation of IC something that would affect the surrounding organs or would it remain isolated in the bladder?
A: "Pelvic venous congestion syndrome" causes pelvic pain due to enlarged, congested veins. The symptoms may be similar to that of IC, but these two diseases are distinct and unrelated as to their cause.
110. I was diagnosed with IC about 5 months ago but probably have had it longer. My main problem is frequency and getting up at night. My question: After trying many medications for high blood pressure and also having swelling in my ankles and feet, I am taking Diovan w/HCT. Is the diuretic further complicating my IC? If so is there anything that I can do?
A: Control of hypertension is of utmost importance in your situation. The diuretic you are taking can certainly contribute to frequency and nighttime voiding. It appears that antispasmodics may be an appropriate option to help control your lower urinary tract symptoms. Discuss this with you doctor.
111. Please help--I'm a Fibromyalgia, 51, on Premarin. Since a bladder dilation in Feb., I've had ongoing problems. Burning everyday, only Ultram controls it. Starting to use Premarin topical. I am going thru Hell, this needs to stop soon. I'm also hypoglycemic. Strong history of kidney stones in family, two daughters (l8 & 29) have had them, father had them & his two sisters. Could I have crystals in bladder that lodge & cause pain?
A: Crystals that form in the urinary tract are microscopic and do not cause any symptoms unless the crystals grow significantly to form a kidney or bladder stone. Be sure to mention your family history to your doctor. It may be worthwhile to do some simple screening tests to rule out stone disease.
112. My question is, are calcium channel antagonists still used to treat IC? I couldn't find any *recent* abstracts relating to this.
A: The calcium channel blocker nifedipine has undergone uncontrolled clinical trials for treatment of IC. These were of limited duration and patient enrollment and findings were not convincing of any significant clinical benefit. I do not use this class of medications currently and it seems its use has fallen into disfavor.