2 minute read
Chronic Pelvic Pain & Urinary Symptoms
by Chrissie Seals, WHNP, Salud Spa
Many women suffer from chronic pelvic pain and urinary symptoms.
It is estimated that 5% to 10% of women have
Interstitial Cystitis (IC). IC — a chronic condition not caused by bladder or urinary tract infection — may cause pain with intercourse, getting up at night to urinate, feeling the urge to urinate frequently, burning with urination, bloating and a feeling of heaviness from the hips to the thighs.
Symptoms may worsened by eating certain foods or by stress.
A hysterectomy for pelvic pain often alleviates some discomfort. This chronic condition often overlaps with endometriosis, adenomyosis, urinary incontinence and fibromyalgia.
There is not a quick lab test to diagnose or surgery that will correct the issues.
There is a questionnaire that identifies patients who may benefit from treatment called the PUF
Score, Pelvic Pain and Urinary
Urgency Frequency Patient
Symptoms Scale. It can easily be located online.
It is believed that IC symptoms are caused by a diminished glycosaminoglycan (GAG) component of the lining of the bladder that may have a genetic origin. The protective lining acts as a barrier from substances that would commonly irritate the bladder and cause symptoms. Without the protective component, microscopic irritation acts like a paper cut in the bladder.
Some women have Hunner’s ulcers, which are bloody ulcers caused by chronic irritation.
Many successful protocols include diet modification, select medications and bladder treatments performed in a medical office. Avoiding citrus, spicy foods, caffeine, alcohol and tomatoes is recommended. Symptoms can be mitigated for some by taking medication that buffers the effect of these foods.
Hydroxyzine is a histamine blocker, so blocking the release of histamines in the bladder may lessen symptoms. Many patients do well with a medication known as amitriptyline in a very low dose that blocks the body’s communication of pain, decreases urinary symptoms at night, and may improve sleep with mild sedation.
Bladder instillations are a simple office procedure covered by most insurance plans that entails cleansing the urethra and completely emptying the bladder.
In my experience, 80% of patients report symptom relief within 20 minutes lasting up to 10 to 14 days. Bladder instillations may be repeated weekly; remission of symptoms frequently is achieved within six treatments.
I recommend an approach that evaluates for infection, anatomical issues and addresses the psychological impact of dealing with chronic pain and bladder symptoms.
