Interstitial Cystitis, AKA Painful Bladder Syndrome

 

Dr. Colene Arnold

Oh, my Bladder, Oh, my Bladder
Oh my Bladder hurts again
I feel pain & frequency
Dreadful leakage, urgency

In a pickle, always looking
For the bathroom, once again
I won’t make it, another minute
Once the key goes in the hole

Oh, my Bladder, Oh, my Bladder
Oh my Bladder hurts again
I feel pain & frequency
Dreadful leakage & urgency

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Now that you’ll be humming that tune, all day, give me a few moments to try to distract you with why I’ve got you singing about your bladder. 

If you’ve opened this blog I suspect you or someone you know suffers from some form of bladder dysfunction, you are not alone! My focus today is on a syndrome that masquerades as a urinary tract infection, or UTI. You know all too well what its’ like, peeing every hour, sometimes urgently, sometimes not where you intend to go & sometimes it hurts. The pressure, the burning, it’s just got to be an infection this time. That’s what Kate thought as well.

But do you, did she? Kate saw her Doctor, she provided a urine sample again, started the antibiotics, again. Two days later she got the voicemail that she didn’t have an infection and she should stop the antibiotics, have a good day,……click.

Now what? This scenario plays over and over again. Oh my bladder, oh my bladder….Not again! Cultures all negative, no sexually transmitted infections, negative cystoscopy with the Urologist. After years of getting nowhere, Kate stumbles upon a website, Interstitial Cystitis Association, www.ichelp.org, where she finds information that suggests that 4 to 12 million other folks in the United States have the same symptoms that she has and it has a name or two or three, Interstitial Cystitis, Painful Bladder Syndrome, Bladder Pain Syndrome. She doesn’t care about what they call it, she just wants to know how to make it better. Symptoms of Interstitial Cystitis vary from person to person, and even within any one individual. They can be mild or severely debilitating. Persons with IC can have intermittent symptoms that come and go or they can remain for extended periods of time. Certain triggers can cause a flare of the disorder after long periods of quiescence. “The initial evaluation typically consists of a patient history & physical exam. The four key diagnostic clues that may indicate IC are bladder and pelvic pain or discomfort, urinary frequency and urgency, symptoms that persist for longer than six weeks, negative results of lab tests checking for urinary tract or other infection.” www.ichelp.org.

Interstitial Cystitis. The paper reviews diagnostic principles, general guideline statements and statements regarding treatment. http://www.auanet.org/guidelines/interstitial-cystitis/bladderpain-syndrome-(2011-amended-2014) There are several helpful treatments and most clinicians tend to follow an algorithm. For the majority of patients, a combination of treatments is the best approach. As physicians we have an oath that we take upon graduation which includes “to do no harm”. This approach takes into consideration risks and benefits. The least invasive, more conservative options, should be recommended and trialled first. This should include self care practices and behavioral modifications such as the following first line treatments.

First line treatments:
-bladder retraining
-healthy sleep
-hydration
-dietary modifications, avoiding triggers -stress management to improve coping techniques

Second line treatments:
-referral to a Gynecologist or Urologist who has a special interest/training in this disorder.
-referral to a Pelvic Floor Physical Therapist who has special training regarding the pelvic floor.
-Medications such as antihistamines, amitriptyline, pentosan polysulfate may relieve some of the symptoms associated with the disorder.
-Intravesical treatments, aka bladder instillations, with a variety of medications such as lidocaine, heparin, triamcinolone, DMSO have been proven to be effective in reducing symptoms utilizing an antiinflammatory approach.

Third line treatments:
-Cystoscopy under anesthesia for short duration with low pressure hydrodistension if first and second line treatments have not provided acceptable symptoms control and quality of life.

Fourth line treatments:
-Botulinum toxin A treatments
-Trial of a Neurostimulator

Fifth line treatments:
-Cyclosporin A orally

Sixth line treatments:
-Major surgery

Complementary therapies include biofeedback, diet based therapies including anti-inflammatory diets, massage, yoga, pilates, herbal remedies, acupuncture, mind body medicine.

Kate, who’s name has been changed, sought treatment at our facility after 8 years of intermittent symptoms with an increased frequency of flares. She was evaluated with a history and physical exam, found to have spasm of the pelvic floor due to misalignment of her pelvis, chronic constipation and longstanding pain associated with her bladder. She benefited from life style modifications including dietary changes with increasing her water intake, reducing carbonated beverages, artificial sweeteners and caffeine, initiated pelvic floor physical therapy, as well as bladder instillations and an antihistamine. She has reduced the stress in her life which has helped her cope more positively with her symptoms during treatment and she plans to continue with yoga and a focus on self care.

There are many options today for our patients suffering from Interstitial Cystitis. Here at Inner Balance Pelvic Health & Wellness Center we will assist you as you navigate the process and celebrate with you as you gain control over your bladder once again!

 

Women in Medicine Month: Dr. Colene Arnold

 
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The below article was recently featured by the New Hampshire Medical Society:

In honor of Women in Medicine Month, NHMS asked members to contribute stories of women physicians in the state. This week we feature Dr. Colene Arnold, with a special thank you to her business partner Leslie Parker, MPT, for sharing Dr. Arnold's story!

As an Obstetrician & Gynecologist, Dr. Arnold has worked on the Seacoast of New Hampshire for 14 years. While working full time with Garrison Women's Health Center and with Goodwin Community Health Center she recognized a significant increase in the use of opioids in pregnant women, and as with every section of the population, not enough facilities to treat this vulnerable group of women.

 
 

She responded by cofounding Hope On Haven Hill, an 8-bed, nonprofit, charitable residential facility for pregnant women with addiction and their newborn babies. She worked tirelessly learning about and then forming the nonprofit, recruited a dynamic Board of Directors, spent countless hours writing grants and fundraising, then moved her family out of their home to be able to convert their lovely, historic residence into a space that 8 women and their babies now call home, while they receive the necessary treatment to recover from their addictions. The doors opened in December 2016, and the rooms have been full with a waiting list since the inception. 

Helping women with addiction has been a passion for Dr. Arnold. This dedication blends well with another area of interest that she has as a Gynecologist, which is treating women with Chronic Pelvic Pain. Her goal in this area is to treat women with the respect that they deserve and to provide them with a compassionate healthcare professional that they can trust to help them heal from the physical and oftentimes emotional trauma that has contributed to their pain. While treating patients that frequently have already seen up to 10 different providers, have had multiple imaging studies, all too often without an answer for why they have pain, other than it might just be in their heads, she once again felt the need to do more than she was already doing. She recognized that a comprehensive approach to treatment of Chronic Pelvic Pain was essential to help women regain control and last month, along with myself, she opened Inner Balance Pelvic Health & Wellness Center in Newington, NH. She brought together likeminded practitioners with backgrounds in pelvic floor physical therapy, psychology, sexual health therapy, nutrition, therapeutic massage, therapeutic yoga and Reiki to join forces, under one roof, to collaborate on the best approaches to bring about healing once again in a vulnerable population of women.  

Dr. Arnold has accomplished so much in such a short amount of time. I'm grateful to be with her on this journey to wellness in her latest venture to bring about transformation from the emotional and physical pain that prevents many from achieving their full potential. 

With Gratitude,

Leslie Parker, MPT