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.

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, trauma to the bladder, spinal cord injury or another reason, but research hasn't defined the exact cause. Women are much more likely than men to have the condition.

A main symptom of IC 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 (it also has several side effects and is on the FDA watchlist because of studies suggesting the drug may damage vision). 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, acetaminophen, or Azo 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.

Bladder distention. While you are asleep under anesthesia, the doctor fills your bladder with a liquid to stretch its walls. Bladder distention is a technique used to diagnose IC, but it also helps relieve pain for some patients, possibly because it increases the bladder capacity or interferes with the nerves that transmit pain signals from the bladder.

Nerve stimulation. For some patients, a technique called transcutaneous electrical nerve stimulation (TENS), or sacral neuromodulation, helps relieve pain and the urge to urinate. Electrodes placed on the skin or implanted in the body send electrical impulses to the nerves controlling the bladder. This technique can help strengthen the muscles controlling the bladder, and may trigger the release of chemicals that block pain.

Botox. Botulinim-A toxin may be administered if other treatments have not provided relief for symptoms. Following treatment, you may have to self- catheterize periodically.

Acupuncture. Limited research has shown that acupuncture may provide relief to some people with interstitial cystitis.

Surgery. If other treatments aren't working and your bladder pain won't go away, the doctor may recommend surgery as a last resort.

The following lifestyle changes may also help relieve IC:

Diet. Certain foods, such as tomatoes, citrus fruits, coffee, chocolate, or alcohol, may worsen symptoms of IC for some people. To identify which foods, if any, irritate your bladder, keep a diary of what you eat during the day. When you have flare-ups of bladder pain, see if you can find a pattern in your diet.

Bladder retraining. This method can help if you're constantly feeling the urge to urinate. Keep a diary of when you use the bathroom. Gradually try to increase the time between bathroom trips, for example, by 10-minute increments. Eventually you'll be able to go longer periods of time without urinating.

Stress management. People with IC often report worsening of symptoms related to increased physical, mental, or emotional stress.

Urinary Tract Infection

The urinary tract is normally sterile, but sometimes bacteria can sneak in through the urethra, which connects the bladder with the outside of the body. A urinary tract infection can affect any part of the urinary system, including the bladder, ureters, urethra, and kidneys. However, it is most common in the bladder (cystitis). Women are much more likely than men to develop a bladder infection.

Symptoms of a bladder infection may include:

• Pain or burning during urination
• Urgent need to urinate
• Pain or tenderness in the abdomen
• Cloudy, bloody, or foul-smelling urine
• Low-grade fever
• Frequent need to urinate
• Blood in the urine

Doctors diagnose urinary tract infections by taking a urine sample and testing it for bacteria.

Antibiotics can be prescribed for a few days to treat a bladder infection. Also, drink plenty of fluids to flush bacteria out of your urinary tract.

Bladder Cancer

Just as cancer can form in other organs, it can develop in the bladder. The most common type of bladder cancer is transitional cell carcinoma, which begins in the innermost layer of tissue lining the bladder.

In addition to bladder pain, other symptoms of bladder cancer can include:

• Blood in the urine
• Pain during urination
• Difficulty passing urine
• Frequent urination or urgent need to urinate
• Lower back pain

The following tests may be used to diagnose bladder cancer:

Cystoscopy. The doctor inserts a thin, lighted tube called a cystoscope into the bladder. During the test, the doctor can remove tissue samples from the bladder to be checked in the lab for cancer (biopsy). Bladder washings may also be performed to check for the presence of cancer cells. A procedure called fluorescence cystoscopy is another way doctors can check for cancer.

Imaging tests. A CT or MRI scan is used to take detailed images of the bladder, which are sent to a computer screen. Your doctor may inject a special dye to help the bladder show up more clearly. Intravenous pyelogram (IVP) is a series of X-rays taken of the kidneys, ureters, and bladder using a contrast dye to highlight these organs.

Urinalysis and urine culture. The doctor tests a sample of your urine for bacteria and other substances that can indicate disease.

Urine cytology. The urine is examined under a microscope to look for abnormal cells.

Treatment for bladder cancer depends on how aggressive the cancer is and how far it has spread (metastasized). If the cancer is small and has not spread, treatments may include:

• Surgery to remove the tumor (transurethral resection of the bladder is most commonly done)
• Chemotherapy
• Intravesical therapy (treatment that prompts the immune system to go after the bladder cancer) delivered into the bladder

For bladder cancer that is more advanced, treatments may include:

• Surgery to remove part of the bladder
• Surgery to remove all of the bladder (radical cystectomy)
• Chemotherapy before surgery to shrink the tumor, or after surgery to destroy any remaining cancer cells
• Combination of chemotherapy and radiation in patients who cannot have surgery

Because bladder pain can have many possible causes, it's always a good idea to make an appointment with your doctor to have it checked out.

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