One of the problems of current specialized medical care for women involves the separation of bladder and gynecologic conditions. Women with frequent urination, urgency and recurrent bladder infections are often referred to Urologists. When pelvic pain is the main complaint, it is usually the Gynecologist that does the evaluation. Two common disorders can cause symptoms that affect both bladder function and the reproductive tract. One of these conditions is endometriosis, and the testing and treatment for this condition is well-understood. The other condition has been poorly understood until recently, yet may affect as many as 8 million American women. This condition is known as Interstitial Cystitis (IC). Recent research has opened a new chapter in the diagnosis and treatment of IC.
Endometriosis
One of the most commonly diagnosed causes of pelvic pain in women is endometriosis. In this chronic condition, tissue that acts like the lining inside the uterus grows outside the uterus and is responsible for painful periods, painful intercourse, infertility and a number of other symptoms. Endometriosis can occur early in the female life cycle and can be suggested by the pattern of symptoms. Pelvic examination and ultrasound can reveal clues about the presence of endometriosis, but the actual diagnosis typically requires a procedure known as diagnostic laparoscopy. The gynecologist uses a narrow telescope-like device to carefully look inside the abdominal and pelvic body cavities through an incision in the navel to actually see the endometriosis implants. This procedure is done under anesthesia and gives the specialist an opportunity to treat the disease at the same time with surgical tools including lasers. Special drug treatment is also available and even birth control pills, Depoprovera and other therapy is potentially helpful in the treatment. Some doctors specialize in gynecologic problems such as endometriosis and careful, aggressive management usually results in successful outcomes and preservation of the uterus and ovaries. Untreated, the condition gradually progresses, and can result in disabling pain, scarring and occasionally the need for more extensive surgery. Although many natural remedies have been tried, none have proven to be of significant benefit. Since pregnancy temporarily stalls the progression of endometriosis, we see more women with this condition in our current society than we did in the days of early and frequent childbearing.
Interstitial Cystitis
IC used to be a rare diagnosis, but a new understanding of the condition has provided an improved ability to identify women (and men) who suffer from this progressive and often disabling disease process. The typical IC patient complains of bladder urgency, frequency and symptoms of bladder infection (UTI or cystitis). Many patients have some kind of pain associated. The pain of IC can be in any location in the lower abdomen, pelvis, vagina or external genital areas. The pain syndrome often flares with cycles, and tends to gradually worsen over the course of one’s life. Symptoms can also include vaginal irritation, burning and painful intercourse.
IC develops when the natural mucus barrier protection in the bladder lining starts to break down. This allows the normal high levels of potassium in urine to diffuse into the nerves and muscle fibers in the bladder wall and surrounding tissues. The potassium damages the nerve and muscle cells, causing pain and poor function. The bladder begins to feel more urgency and decreased capacity. Treatment is aimed at improving the mucus barrier and decreasing the concentration of potassium. The nerve and muscle tissues can then regain strength and function.
Since there is a relationship with the body’s allergic response, flare-ups can also occur during the allergy seasons. Traditional testing such as cystoscopy and even laparoscopy is not effective in finding the problem. Researchers have discovered a new test that is very accurate in determining when IC is present. The test is offered to patients who have a high score on a bladder symptom/ pelvic pain questionnaire that was developed by experts on the condition. Because much of what is known about IC is new information, the disorder is frequently misdiagnosed as endometriosis, chronic UTI/Cystitis, vulvodynia, chronic yeast infection and a number of other diseases. Many other patients with IC are left without any specific diagnosis or treatment. Without proper care, the process worsens, and symptoms increase. Later stages of the disorder are more difficult to reverse and damage can become permanent. With a careful evaluation, simple testing and brand-new treatment programs, up to 80% of people that suffer from IC can get significant improvement and lead normal lives.
