What Is the Treatment for Bladder Pain?

Interstitial cystitis, or bladder pain syndrome is a severe, unexplained (diagnostic exclusion of any known cause) bladder inflammation syndrome characterized by chronic pain in the bladder. Pain and severely reduced quality of life are no less than rheumatoid arthritis, chronic cancer pain, or kidney dialysis. The effects of various treatment methods applied so far, including cystectomy, are not very satisfactory ^[1] .

Bladder pain syndrome

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Interstitial cystitis, or bladder pain syndrome

The current cause of IC / BPS is unknown. Nevertheless, some explanations have been proposed by current medical research, including:

Although the disease was first thought to be an idiopathic disease in menopausal women, more and more men and women were diagnosed in their twenties. In fact, it is not uncommon for IC / BPS to affect people of all ages, genders, and socioeconomic backgrounds. First application of Skene from 1887

The diagnosis of IC / BPS is a process of exclusion based on clinical symptoms. American Urological Association (AUA) guidelines recommend careful review of medical history, physical examination, and laboratory tests to evaluate IC / BPS symptoms and other potential abnormalities ^[1]

Mainly through drugs, diet, psychological adjustment or surgery.

Bladder pain syndrome medication

1. Amitriptyline is a tricyclic antidepressant and is one of the most effective drugs for treating IC / BPS.
2. Cimetidine is a H2 receptor blocker, suitable for patients with non-ulcerative IC / BPS.
3. Hydroxazine is an H1 receptor antagonist and an anti-allergic drug. In the process of using IC and BPS with hydroxyzine hydrochloride, patients with migraine headaches, irritable bowel syndrome and allergic diseases can also be improved.
4. Sodium pentosan sulfate (Elmiron) is the only oral drug approved by the US FDA for the treatment of interstitial cystitis.
5. Immunosuppressants: such as azathioprine, cyclosporine A, and methotrexate, which have been reported to have good curative effects, but have large side effects.
6. Non-steroidal anti-inflammatory drugs and glucocorticoids have obvious short-term effects and relapse after stopping the drug.
7, analgesics: tramadol, morphine, fentanyl, belladonna and other opioids and papaverine can temporarily relieve symptoms, but the controversy is large. Intravesical infusion of lidocaine is also an alternative analgesic treatment.
8. Vitamin D3 analog BXL628 can improve symptoms of urinary urgency caused by smooth muscle contraction, but the effect is not good.
9. Quercetin may be effective for IC / BPS.
10. Dextroamphetamine, effective for pain and frequent urination.
11. Dimethyl sulfoxide (DMSO) is the only bladder infusion drug approved by the US FDA for IC treatment so far. Garlic-like odor appears in most patients after DMSO infusion, which is why many patients refuse the treatment.
12. Capsaicin analogues (RTX) block C fibers by depleting neuroamines at the end of C nerve fibers.
13. Sodium hyaluronate, as the main component of the protective layer of the bladder mucosa, has a good overall therapeutic effect.
14. Botox A has analgesic effect, but it needs repeated injections.
15. Chondroitin sulfate is another main component of the protective layer of the bladder mucosa, which has a certain effect on the treatment of IC / BPS.
16. The main action mechanism of heparin for IC treatment is to use it as a component of the protective layer of the bladder mucosa to replace the protective layer of the bladder mucosa that may be damaged.
17. BCG and interleukin, its mechanism of action lies in its immune modulation effect. ,
18. Sodium oxychlorobenzene sulfonate, which is perfused under anesthesia when used, will itself cause pain.
19. The replacement of the protective layer of the bladder mucosa by a chitosan sulfate derivative is also a treatment method, but it is an experimental stage.

Non-drug treatment of bladder pain syndrome

1. Bladder dilatation IC / BPS has a long history, and it also has a clear diagnostic significance, and is a first-line method.
2. Transurethral resection and electrocautery of ulcerative interstitial cystitis can be used as the first choice.
3. Sacral neuromodulation (SNM) provides a brand-new approach for the treatment of bladder pain syndrome. By implanting a neural regulatory system (bladder pacemaker) to regulate the afferent neural pathways, the purpose of improving symptoms is achieved. It has been reported in the literature that the long-term effectiveness of sacral neuromodulation for interstitial cystitis (bladder pain syndrome) is 73%.

4. Posterior tibial nerve stimulation (PTNS) is an emerging treatment that can benefit some patients.
5. Acupuncture also plays a role in the treatment of IC / BPS.
6. Hyperbaric oxygen therapy is optional, but the effect is not satisfactory.
7. Bladder enlargement is suitable for patients with frequent urination but mild pain.
8. Total bladder resection and diversion of urinary flow. This type of treatment will remove the bladder, which is an irreversible treatment. It needs to be very careful. Unless the patient is ineffective after various treatments, bladder contracture, frequent urination and pain are very serious, it is not recommended.
As you can see, these various types of treatment methods are only part of the method for treating IC / BPS. At present, none of the above treatments will definitely be effective for patients, but temporary treatment failure is by no means equivalent to no effective treatment method. . By switching to another treatment method or choosing a combination treatment method, we have significantly improved the symptoms of some patients with severe interstitial cystitis / bladder pain syndrome by as much as 70% ^[6] .