Pelvic Pain–Is it your bladder?

Over the years, I have seen countless women struggle through their lives with chronic pelvic pain.painpelvic

PAINFUL BLADDER SYNDROME-click here for good site

CRITERIA AND MANAGEMENT GUIDELINES==click here

They have good days and bad days, but the bad wear them down, and relationships suffer, and their quality of life is not great!

While most women –and many doctors – will attribute pelvic pain to some pathological (something wrong), process of the reproductive(womb and ovaries) system, the bladder is often overlooked as a source of SIGNIFICANT pain.  I think that since we were knee-high, we are told, as women, that our problems must be due to “hormones”, or “around that time of the month”, or “THAT time of the month”.

I feel I spend a lot of time defending the uterus and ovaries–they are getting the blame many times for just being in the wrong place at the wrong time–so to speak.

I am CERTAINLY not suggesting that conditions like endometriosis, pelvic inflammatory disease, prolapse, vaginal dryness etc are not causes of pain–they most certainly ARE—but the bladder is not given enough credit.

Medical students and gynecology residents often do not get a lot of education about painful bladder syndrome.  When I have 4th year students rotate with me, they are watched as they interview women about their history.  Typically, the question will be, “Do you lose your urine when you cough or sneeze?”     The typical response will be, “YES!”

END OF QUESTIONS!

This is just the beginning of the questions!  As soon as you hear ANYTHING related to bladder, you need to DIG the history out.

When you get that FIRST urge to pee (and yes–say PEE–who the heck says ‘urinate’ or ‘void’?), how long do you have to get to the bathroom, before you are leaking?

Can you squeeze, and stop the leakage, or once it starts is the only thing that saves you from getting wetter is getting your pants down faster?

Does it HURT you to hold your pee more than 5 minutes?

At the end of peeing , do you feel something like a ‘Charley Horse’ in the bladder area?

Do you lose a large amount of pee, or just a few drops?

Do you feel your stream is a good stream, or just a dribbling type stream?

Do you have to sit down again on the same trip, because you feel another urge shortly after getting up?  (“Two-sit trips”)

Can you sit through a movie at the theatre?

Can you go for a nice afternoon drive around the countryside, or are you a little afraid to go?  Do you restrict your fluid intake if you are planning a drive?

Is intercourse painful?  Do you avoid intercourse for fear of pain?

Do you ever have to jump out of the car–and run into the bushes?  It is amazing how many women have to do this!

Do you avoid going out with friends, or out to shop, because you worry about losing your pee?

How much are you spending on pads or incontinence underwear a month?      It is nothing for women on FIXED INCOMES to be spending $80-100 a month on pads, and underwear.

Are you coughing, sneezing or laughing when you are sitting down, and get urge to pee and lose urine?

The way I look at this issue is that if the problem was due to a “dropped bladder” as most women think, then the ONLY time there is any loss of pee is when they put a stress on the bladder such as a cough, laugh, or lift or jump—there is NO URGE!!!  There is also NO PAIN with dropped bladder!

When URGE is uncovered, then STRESS loss of pee is almost always there too.  Basically the bladder is “trigger-happy”, so if you cough or sneeze you basically “pull the trigger”–you lose pee.  The DIFFERENCE is the loss of pee does not stop then the cough ends, and the loss of urine is greater that a few drops.

Overactive Bladder is when you get the strong urges, and have to rush to the bathroom–often dribbling along the way.  If you are younger, and pretty fast, you may make it and not get wet.  As  you age, you may not move fast enough to prevent wetting your pants.  PEEING IN YOUR PANTS IS NOT A NORMAL PART OF AGING!!

Overactive bladder does not, by itself, cause PAIN.  When I hear PAIN, and bladder symptoms, then I am looking for…..

INTERSTITIAL CYSTITIS / PAINFUL BLADDER SYNDROME

A condition that ruins lives, relationships, and is just miserable.  You may have some minimum tenderness of the bladder with overactive bladder.

Painful bladder is defined as  “an unpleasant sensation (pain, pressure, discomfort), perceived to be related to the urinary bladder and associated with lower urinary tract symptoms of more than 6 weeks’ duration, in the absence of infection or other identifiable causes”  (Amercian Urological Foundation)

There is no known cause for painful bladder syndrome.

There is no known cure–there is control of flare-ups!

There is some research that genetics may play a role.

Seek help if you have any of these issues.  Read about overactive bladder and interstitial cystitis.

Here are some helpful links:

http://www.ic-network.com/

http://www.ic-network.com/conditions/overactive-bladder/

CAFFEINE IS HARD ON THE BLADDER:

list of side effects of caffeine

To make the diagnosis of IC (interstitial cystitis), I get the history, then examine you.  I want to see if there is pain when the bladder area is touched.  Just press above your pubic bone.   Does it hurt?

http://www.computerbusinesses.us/images/blad6.jpg

If I find pain, then I will want to do a bladder instillation.  This is done by mixing some medication up, and putting it into your bladder by using a catheter, which is only left in for a couple of minutes.  This also gives me a chance to get a good urine – right from the bladder-to check for infection.

There are many different “bladder cocktails”.  I use Lidocaine (the stuff your dentist uses), bicarb and Elmiron.   One can use another drug–DMSO.  Some use Heparin in their cocktails.  All cocktails basically do the same thing–numb the bladder!  GET THE PAIN GONE!

I have had women come in with, literally, 9/10 pain, and in 40 minutes have NO PAIN AT ALL!!!  I have had many who are amazed that their chronic BACK PAIN also disappears!

The only thing is–the pain relief is not forever!  You may get a few hours, a few days–even a few weeks.  I have had a few women say they got relief for months!  If the pain returns–you need to get another instillation!

It is crucial to get your diet under control, and stop putting things into your bladder that irritates it!  Initially, follow the diet FAITHFULLY, then if you avhe no pain, try introduding small amount of a food on the “unfriendly list” that you just HAVE to have and see how you are over next 6 hours.

THIS IS A LIST OF FOOD YOU CAN EAT–OR NOT EAT!

http://ic-network.com/downloads/2012icnfoodlist.pdf

The IC network is really the most comprehensive source of information on IC!

If the pain comes back, you need to come back in–even before your appointment–just call–we can get you in!!

If you come back for a repeat instillation, we start teaching you how to do this yourself.    Wa wa wa!

DOING IT YOURSELF IS NOT DIFFICULT, AND GIVES YOU CONTROL AND INDEPENDENCE!  You CAN do this!!!

You do what you need to do –  that’s life!  It gets easier as you get more practice.  Most women find that they may go through a spurt, where they have to do an instillation 2-3 times a week, then they can go for months with no problems!

You may also need to go on medicine to control your sudden urges.  Other meds that help are antihistamines.

There is some evidence showing that there is a histamine problem in the bladder lining.  When we get bitten by a bee–it hurts–because of histamine.  This is why we take an ANTI-histamine.  So, taking a Benadryl at bedtime may help!

This site is pretty darn good at giving a list of meds that can be tried!

http://www.pure-hope.org/Interstitial_Cystitis.htm

Women do better when they read about the condition and do what they need to do.

PELVIC PHYSIOTHERAPY

This is a great way to help with pain.  If you had a sore shoulder, or knee, you would have no problem seeing a physiotherpist for help—well think about it–the pelvis is a MASS of muscles–and when they get tight—it causes pain.

The pelvic muscles really get tight if you have pain with intercourse, because you are bracing yourself for the pain!  If I told you I was going to slam your hand in the door—-you wouldn’t want to put your hand anywhere NEAR that door–and you’d be pretty well tensed up if your hand was there.

PELVIC PHYSIOTHERAPISTS are ones who have gone on to get special training with pelvic issues–like incontinence of urine or bowels, pain after radiation to the pelvis, pain after childbirth, pain due to bladder and bowel issues.

This usually involves 3-6 visits to a physiotherapist, who can teach you muscle relaxation techniques, and ALSO can do pelvic muscle massage–which is a great way to relax the muscles!

Using every specialist, med and diet we can–can save your quality of life, your marriage/relationship, and really help reduce or eliminate the pain.  We do NOT think you have to “learn to live with pain”–we often have to think outside the box–and try new things that may help!

Occasionally, we will have a “tough cookie”–who is doing everything right, but still has urgency of urination and/or pain.   These women are referred to a urologist, to see if they may be eligible for BOTOX in the bladder!

Sometimes, you have pain in the lower abdomen in a certain spot–I find over the ILIOHYPOGASTRIC NERVE.  there is a point that you can touch with a single finger that sends shock like pain down into the vagina and, sometimes, the upper inner leg.  Women will tell me that they get sudden breath-taking knife – like pain out of the blue!   We can inject this area with some local anesthetic, and see if the pain goes away in a few minutes.  I have had women come in –their jaws are shaking, and their upper lip sweating due to pain, and 5 minutes after a TRIGGER POINT INJECTION of this nerve are PAIN FREE!!  Twenty five years ago, other doctors thought I was nuts—injecting the abdomen???   NOW—–it is COMMONLY done in pain clinics!!

Also–if we see blood in the urine, and you are over 50 you are checked out for bladder/kidney cancer.  If you are under 50, we will repeat the urine when symptoms are improved (about 4-6 weeks)—you will be referred if REPEAT urine shows any blood!

If you have urgency–like a mad urge to pee, then we will try diet changes, and add a medicaton to see if we can calm the nerves to your bladder down, and stop making you want to pee all the time.

This will be a journey——READ, KNOW what is going on and participate in your management.

 

 

9 Replies to “Pelvic Pain–Is it your bladder?”

  1. Jill says:

    Nice blog and thank you for trying to raise awareness for bladder pain. It’s amazing how many women have had completed inappropriate hysterectomies only to discover, after the fact, that their symptoms were from the pelvic floor. So the more we educate others about the role of the bladder and the pelvic floor muscles in causing pelvic pain, the better!

    1. Wow quite a honor to see you read this post–I just threw it together …trying to set up a web page. I refer women to your site ALL the time!! SIX times today alone!!! NOBODY around here interested in IC—so when I started, I saw over a hundred women in the first month of practice—-all but a couple well controlled! Keep up the good work-I always have trouble when you change your web site–but it is best site around by far!

    2. Jill says:

      When I was first diagnosed with IC (at 19) I was terrified of treatment and only received a few hours of relief from installations before my pain worsened. Being young and growing up in a family that didn’t support the use of medication, I wasn’t as interested in installations even if they did provide relief. Dr. Sandland referred me to your site which I have religiously used for the last year. I live by the IC diet, and found alternate methods of managing flare-ups that occasionally occur now. When explaining to other doctors and healthcare professionals, it’s such a relief to have your site to help me explain and teach others. I’m even more excited to have this blog article as reference for a testimonial that unbelieving doctors, professors and friends. Support is ESSENTIAL with this disease.

  2. Angie says:

    Thank you, thank you, thank you! I’ve been dealing with IC for 25 years. I wouldn’t know what a day feels like without pain. I was told, by my urologist, that IC was not hereditary but both of my children have it.

    1. If you still live in pain–have you done self-instillations?–a godsend when suffering–for most!

      1. Angie says:

        I had DMSO instillations in the beginning, which only helped for a short time. I’ve had Botox as well, but it only helped the first time and it’s not covered by Blue Cross. I use lidocaine externally when I have a flare up. At this point, I’m on heavy duty pain meds and use pyridium occasionally. Lydocain instillations have never been offered.

        1. Lidocaine is cheaper and you can learn to do these yourself–and hope fuly be able to get off “heavy duty ” meds—worth a shot!!! You’ll have to drive up for a visit—

  3. It’s onerous to find knowledgeable people on this topic, however you sound like you already know what you’re speaking about! Thanks

  4. I’ve read a few excellent stuff here. Certainly worth bookmarking for revisiting. I surprise how so much attempt you set to make such a excellent informative website.

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