Thursday 30 April 2015

Interstitial Cystitis/Painful Bladder Syndrome

Interstitial cystitis (IC), one of the chronic pelvic pain disorders, is a condition resulting in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms of IC vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and surrounding pelvic area.

Symptoms may include an urgent need to urinate (urgency), frequent need to urinate (frequency), or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women's symptoms often get worse during menstruation. In IC, the bladder wall may be irritated and become scarred or stiff. Glomerulations (pinpoint bleeding caused by recurrent irritation) may appear on the bladder wall. Some people with IC find that their bladders cannot hold much urine, which increases the frequency of urination. Frequency, however, is not always specifically related to bladder size; many people with severe frequency have normal bladder capacity. People with severe cases of IC may urinate as many as 60 times a day.
Also, people with IC often experience pain during sexual intercourse. IC is far more common in women than in men. Of the more than 700,000 Americans estimated to have IC, 90 percent are women.

What Causes IC?

Some of the symptoms of IC resemble those of bacterial infection, but medical tests reveal no organisms in the urine of patients with IC. Furthermore, patients with IC do not respond to antibiotic therapy. Researchers are working to understand the causes of IC and to find effective treatments.
One theory being studied is that IC is an autoimmune response following a bladder infection. Another theory is that a bacterium may be present in bladder cells but not detectable through routine urine tests. Some scientists have suggested that certain substances in urine may be irritating to people with IC, but no substance unique to people with IC has as yet been isolated. Researchers are beginning to explore the possibility that heredity may play a part in some forms of IC. In a few cases, IC has affected a mother and a daughter or two sisters, but it does not commonly run in families. No gene has yet been implicated as a cause.

Are There Different Types of IC?

Because IC varies so much in symptoms and severity, most researchers believe that it is not one, but several, diseases. In the past, cases were mainly categorized as ulcerative IC or nonulcerative IC, based on whether ulcers had formed on the bladder wall. But many researchers and clinicians have questioned the usefulness of this classification, since the vast majority of cases do not involve ulcers, and their presence or absence does not influence treatment options as much as other factors do.
Factors that influence treatment options include whether bladder capacity under anesthesia is great or small, and whether mast cells are present in the tissue of the bladder wall, which may be a sign of an allergic or autoimmune reaction. In some cases, the success or failure of a treatment helps characterize the type of IC. For example, some cases respond to changes in diet while others do not.

How Is IC diagnosed?

Because symptoms are similar to those of other disorders of the urinary system and because there is no definitive test to identify IC, doctors must rule out other conditions before considering a diagnosis of IC. Among these disorders are urinary tract or vaginal infections, bladder cancer, bladder inflammation or infection caused by radiation to the pelvic area, eosinophilic and tuberculous cystitis, kidney stones,endometriosis, neurological disorders, sexually transmitted diseases, low-count bacteria in the urine, and, in men, chronic bacterial and nonbacterial prostatitis.
The diagnosis of IC in the general population is based on presence of urgency, frequency, or pelvic/bladder pain and cystoscopic evidence (under anesthesia) of bladder wall inflammation, including Hunner's ulcers or glomerulations (present in 90 percent of patients with IC).
Diagnostic tests that help identify other conditions include urinalysis, urine culture, cystoscopy, biopsy of the bladder wall, distention of the bladder under anesthesia, urine cytology, and, in men, laboratory examination of prostate secretions.

Urinalysis and Urine Culture

These tests can detect and identify the most common organisms that infect the urine and that may cause symptoms similar to IC. There are, however, organisms such as Chlamydia that cannot be detected with these tests, so a negative culture does not rule out all types of infection. A urine sample is obtained either by catheterization or by the "clean catch" method. For a clean catch, the patient washes the genital area before collecting urine "midstream" in a sterile container. White and red blood cells and bacteria in the urine may indicate an infection of the urinary tract, which can be treated with an antibiotic. If urine is sterile for weeks or months while symptoms persist, the doctor may consider a diagnosis of IC.

Cystoscopy Under Anesthesia with Bladder Distention

During cystoscopy, the doctor uses a cystoscope--an instrument made of a hollow tube about the diameter of a drinking straw with several lenses and a light--to see inside the bladder and urethra. The doctor will also distend or stretch the bladder to its capacity by filling it with a liquid or gas. Because bladder distention is painful in patients with IC, they must be given some form of anesthesia for the procedure. These tests can detect bladder wall inflammation; a thick, stiff bladder wall; and Hunner's ulcers. Glomerulations are usually seen only after the bladder has been stretched to capacity.
The doctor may also test the patient's maximum bladder capacity--the maximum amount of liquid or gas the bladder can hold. This must be done under anesthesia since the bladder capacity is limited by either pain or a severe urge to urinate. A small bladder capacity under anesthesia helps support the diagnosis of IC.


A biopsy is a tissue sample that is then examined under a microscope. Samples of the bladder and urethra may be removed during a cystoscopy and later examined with a microscope. A biopsy helps rule out bladder cancer.

What Are theTreatments for IC?

Scientists have not yet found a cure for IC, nor can they predict who will respond best to which treatment. Symptoms may disappear without explanation or coincide with an event such as a change in diet or treatment. Even when symptoms disappear, they may return after days, weeks, months, or years. Scientists do not know why. Because the causes of IC are unknown, current treatments are aimed at relieving symptoms. Most people are helped for variable periods by one or a combination of treatments. As researchers learn more about IC, the list of potential treatments will change, so patients should discuss their options with a doctor.

Bladder Distention

Because many patients have noted an improvement in symptoms after a bladder distention done to diagnose IC, the procedure is often thought of as one of the first treatment attempts. Researchers are not sure why distention helps, but some believe that it may increase capacity and interfere with pain signals transmitted by nerves in the bladder. Symptoms may temporarily worsen 24 to 48 hours after distention, but should return to predistention levels or improve after 2 to 4 weeks.

Bladder Instillation

During a bladder instillation, also called a bladder wash or bath, the bladder is filled with a solution that is held for varying periods of time, averaging 10 to 15 minutes, before being emptied. The only drug approved by the U.S. Food and Drug Administration (FDA) for bladder instillation is Dimethyl Sulfoxide (DMSO, RIMSO-50). DMSO treatment involves guiding a narrow tube called a catheter up the urethra into the bladder. A measured amount of DMSO is passed through the catheter into the bladder, where it is retained for about 15 minutes before being expelled. Treatments are given every week or two for 6 to 8 weeks and repeated as needed. Most people who respond to DMSO notice improvement 3 or 4 weeks after the first 6- to 8-week cycle of treatments. Highly motivated patients who are willing to catheterize themselves may, after consultation with their doctor, be able to have DMSO treatments at home. Self-administration is less expensive and more convenient than going to the doctor's office.
Doctors think DMSO works in several ways. Because it passes into the bladder wall, it may reach tissue more effectively to reduce inflammation and block pain. It may also prevent muscle contractions that cause pain, frequency, and urgency.
A bothersome but relatively insignificant side effect of DMSO treatments is a garlic-like taste and odor on the breath and skin that may last up to 72 hours after treatment. Long-term treatment has caused cataracts in animal studies, but this side effect has not appeared in humans. Blood tests, including a complete blood count and kidney and liver function tests, should be done about every 6 months.

Oral Drugs

Pentosan polysulfate sodium, the first oral drug developed for IC, was approved by the FDA in 1996. In clinical trials. This drug improved symptoms in 38 percent of patients treated. Doctors do not know exactly how it works, but one theory is that it may repair defects that might have developed in the lining of the bladder.
The FDA-recommended dosage is 100 mg, three times a day. Patients may not feel relief from IC pain for the first 2 to 4 months. A decrease in urinary frequency may take up to 6 months. Patients are urged to continue with therapy for at least 6 months to give it an adequate chance to relieve symptoms.
Side effects are limited primarily to minor gastrointestinal discomfort. A small minority of patients experienced some hair loss, but hair grew back when they stopped taking the drug. This drug may affect liver function, which should therefore be monitored by the doctor.

Other Oral Medications

Aspirin and ibuprofen are easy to obtain and may be a first line of defense against mild discomfort. Doctors may recommend other drugs to relieve pain.
Some patients have experienced improvement in their urinary symptoms by taking antidepressants or antihistamines. Antidepressants help reduce pain and may also help patients deal with the psychological stress that accompanies living with chronic pain. In patients with severe pain, narcotic analgesics such as acetaminophen with codeine or longer acting narcotics may be necessary.

Transcutaneous Electrical Nerve Stimulation

With transcutaneous electrical nerve stimulation (TENS), mild electric pulses enter the body for minutes to hours two or more times a day either through wires placed on the lower back or just above the pubic area, between the navel and the pubic hair, or through special devices inserted into the vagina in women or into the rectum in men. Although scientists do not know exactly how TENS works, it has been suggested that the electric pulses may increase blood flow to the bladder, strengthen pelvic muscles that help control the bladder, or trigger the release of substances that block pain.
TENS is relatively inexpensive and allows the patient to take an active part in treatment. Within some guidelines, the patient decides when, how long, and at what intensity TENS will be used. It has been most helpful in relieving pain and decreasing frequency in patients with Hunner's ulcers. Smokers do not respond as well as nonsmokers. If TENS is going to help, improvement is usually apparent in 3 to 4 months.


Patients find that certain foods may contribute to bladder irritation and inflammation. Refer to the list of dietary bladder irritants below. Some patients note that their symptoms worsen after consuming these products. Patients may try eliminating various products from their diet and reintroducing them one at a time to determine which affect symptoms. It is important, however, to maintain a varied, well-balanced diet. Click here to download IC Smart Diet.


Many patients feel that smoking makes their symptoms worse. Because smoking is the major known cause of bladder cancer, one of the best things smokers can do for their bladder is to quit.


Many patients feel that gentle stretching exercises help relieve IC symptoms.

Bladder Training

People who have found adequate relief from pain may be able to reduce frequency by using bladder training techniques. Methods vary, but basically patients decide to void (that is, empty their bladder) at designated times and use relaxation techniques and distractions to keep to the schedule. Gradually, patients try to lengthen the time between scheduled voids. A diary that records voiding times is usually helpful in keeping track of progress.


Many approaches and techniques are used, each of which has its own advantages and complications that should be discussed with a surgeon. Surgery should be considered only if all available treatments have failed and the pain is disabling. Most doctors are reluctant to operate because the outcome is unpredictable since some people still have symptoms after surgery.
Those considering surgery should discuss the potential risks and benefits, side effects, and long- and short-term complications with a surgeon and with their family, as well as with people who have already had the procedure. Surgery requires anesthesia, hospitalization, and weeks or months of recovery, and as the complexity of the procedure increases, so do the chances for complications and failure.
Two procedures--fulguration and resection of ulcers--can be done with instruments inserted through the urethra. Fulguration involves burning Hunner's ulcers with electricity or a laser. When the area heals, the dead tissue and the ulcer fall off, leaving new, healthy tissue behind. Resection involves cutting around and removing the ulcers. Both treatments are done under anesthesia and use special instruments inserted into the bladder through a cystoscope. Laser surgery in the urinary tract should be reserved for patients with Hunner's ulcers and should be done only by doctors who have had special training and have the expertise needed to perform the procedure.
Another surgical treatment is augmentation, which makes the bladder larger. In most procedures, scarred, ulcerated, and inflamed sections of the patient's bladder are removed, leaving only the base of the bladder and healthy tissue. A piece of the patient's bowel (large intestine) is then removed, reshaped, and attached to what remains of the bladder. After the incisions heal, the patient may void less frequently. The effect on pain varies greatly; IC can sometimes recur on the segment of bowel used to enlarge the bladder.
Even in carefully selected patients--those with small, contracted bladders--pain, frequency, and urgency may remain or return after surgery, and the patient may have additional problems with infections in the new bladder and difficulty absorbing nutrients from the shortened intestine. Some patients are incontinent, while others cannot void at all and must insert a catheter into the urethra to empty the bladder.
Bladder removal, called a cystectomy, is another surgical option. Once the bladder has been removed, different methods can be used to reroute urine. In most cases, ureters are attached to a piece of bowel that opens onto the skin of the abdomen;this procedure is called a urostomy, and the opening is called a stoma. Urine empties through the stoma into a bag outside the body. Some urologists are using a second technique that also requires a stoma but allows urine to be stored in a pouch inside the abdomen. At intervals throughout the day, the patient puts a catheter into the stoma and empties the pouch. Patients with either type of urostomy must be very careful to keep the area in and around the stoma clean to prevent infection. Serious potential complications may include kidney infection and small bowel obstruction.
A third method to reroute urine involves making a new bladder from a piece of the patient's bowel and attaching it to the urethra. After healing, the patient may be able to empty the newly formed bladder by voiding at scheduled times or by inserting a catheter into the urethra. Few surgeons have the special training and expertise needed to perform this procedure.
Even after total bladder removal, some patients still experience variable IC symptoms in the form of phantom pain. Therefore, the decision to undergo a cystectomy should be undertaken only after testing all alternative methods and after seriously considering the potential outcome.
A surgical variation of TENS, called saccral nerve root stimulation, involvespermanent implantation of electrodes and a unit emitting continuous electrical pulses.


These may aggravate Bladder Control Problems

All alcoholic beverages
Apples, apple juice
BBQ Sauce
Carbonated drinks
Cheese (except American, cottage, ricotta, cream)
Chicken livers
Chilies/spicy foods
Citrus fruits
Coffee (except no-acid type)
Cocktail Sauce
Corned beef
Cranberry juice and sauce
Grapefruit, grapefruit juice
Grapes, grape juice
Green Pepper
Hot Sauce
Lemons, lemon juice
Lima beans
Limes, lime juice
Artificial sweetners
Nuts (almonds, peanuts and pine nuts are tolerable)
Oranges, orange juice
Pickles (vinegar)
Pickled herring
Pineapple and pineapple juice
Pizza with tomato sauce
Red pepper
Rye bread
Salad dressing
Soda pop
Sour cream
Soy sauce
Spaghetti sauce
Steak Sauce
Sweet/Sour sauce
Tomatoes (except low-acid types)
Tomato juice, sauce and soup
Vitamins buffered with aspartate
Vitamin C and B complex

Thursday 23 April 2015

Vaginal Yeast Infections

What is a vaginal yeast infection?
A vaginal yeast infection is irritation of the vagina and the area around it. Yeast is a type of fungus. In about 90% of cases yeast infections are caused by overgrowth of the fungus called Candida       Albicans. Small amounts of yeast are always in the vagina but when there is an overgrowth of yeast, you can get an infection. Yeast infections are very common. About 75 percent of women have one during their lives. And almost half of women have two or more vaginal yeast infections. If you are prone to yeast infections or have had four or more infections in one year you may have Recurrent Vulvovaginal Candidiasis. Women with recurrent vaginal yeast infections are more likely to suffer depression, have low self-esteem and to perceive their lives as stressful affecting sexual and emotional relationships. Please ask one of our doctors about more information if you are experiencing these symptoms. 

What are the signs of a vaginal yeast infection?
The most common symptom of a yeast infection is extreme itchiness in and around the vagina. Other symptoms include: burning, redness, swelling of the vagina and the vulva, pain when passing urine, pain during sex, soreness, a thick white vaginal discharge that looks like cottage cheese and does not have a bad smell, and a rash on the vagina. You may only have a few of these symptoms. They may be mild or severe.  

Should I call my doctor if I think I have a yeast infection?
Yes, you need to see the doctor to find out for sure if you have a yeast infection. The signs of a yeast infection are much like those of sexually transmitted diseases (STD), such as Chlamydia, Trichomonas, Herpes or Gonorrhea. In addition, skin changes such as vaginal eczema, vaginal warts, ulcers, a reaction to spermicidal condoms and even cancer may be underlying and would result in serious consequences if treated with antifungal medication. So, it’s hard to be sure you have a yeast infection and not something more serious. If you recognize your symptoms and you’ve had vaginal yeast infections before, talk to your doctor about acquiring over-the-counter medicines.

How is a vaginal yeast infection diagnosed?
Your doctor will do a pelvic exam to look for swelling and discharge, probing the affected region with a cotton bud to see what areas are sore. Your doctor may also use a swab to take a fluid sample from your vagina. A lab test, known as a fungal culture, will show if yeast is causing the problem.

What will my doctor be looking for during a physical exam?
To determine the manifestations of vaginitis in the affected area, a physical exam may be necessary. Your doctor will ask you about the nature, quantity and color of the discharge. Looking at physical symptoms, your doctor may ask, does the area feel like it’s itching, burning, or do you have dyspareunia (pain during intercourse). If the patient notes having an active sex life, a history into your past and recent sexual history will help your doctor reach the correct diagnosis.

Why did I get a yeast infection?
Many things can raise your risk of a vaginal yeast infection, such as: stress, lack of sleep, illness, poor eating habits, including eating extreme amounts of sugary foods, pregnancy, having your period, taking certain medicines, including birth control pills, antibiotics, and steroids. In addition, poor hygiene, lack of air flow to the region, not changing your underpants often enough, not changing out of sweaty clothes, damp clothing or underpants, not washing after sex, washing incorrectly can all cause yeast infection.
Some chronic sufferers may be especially vulnerable to yeast infections by virtue of vaginal immune system instability. Some exogenous factors may include diabetes, antibiotic use, systemic corticosteroids, or an infection correlated with human immunodeficiency virus.

How can I avoid getting another yeast infection?
To help prevent vaginal yeast infections avoid: douches, scented hygiene products like bubble bath, sprays, pads, and tampons. Change tampons and pads often during your period, avoid tight underwear or clothes made of synthetic fibers, wear cotton underwear and panty-hose with a cotton crotch, change out of wet swimsuits and exercise clothes as soon as you can, avoid hot tubs and very hot bath. If you keep getting yeast infections, be sure and talk with your doctor to avoid exaggerated symptoms.

What should I do if I get repeat yeast infections?
Call us, a diagnosis may need to be re-established. About 5 percent of women get four or more vaginal yeast infections in one year. This is called recurrent vulvovaginal candidiasis (RVVC). RVVC is more common in women with diabetes or weak immune systems. Doctors most often treat this problem with antifungal medicine for up to 6 months. However, this may not be the treatment plan for you. Many candidates who fail initial therapy have been successful using a combination of suppositories/oral medications and topical creams.

What are common therapy regimes used to treat yeast infections?
Over the counter medications:
Gyne-Lotrimin or Mycelex (clotrimazole)
Gynezol or Femstat (butoconazole)
Monistat (miconazole nitrate)
Vagistat (tioconazole)
Terazol (terconazole)

Prescription oral medications:
Fluconazole (Diflucan)
Itraconazole (Sporanox)

Other treatment options may include:
Boric acid suppositories
Tea tree oil

What are common home- therapies used to treat yeast infections?
Dietary changes can be particularly beneficial in preventing yeast flora from growing. Refined sugar, alcohol, and carbohydrates all feed yeast, thus allowing the food for an infection to thrive. Using natural sweeteners like honey, date syrup or agave syrup in small quantities may be a good way to combat sugar cravings.  Many women have found cutting out caffeine can also be effective, as blood sugar levels are kept more constant. Because protein balances blood sugar levels, fish, eggs, white meat and beans should be eaten sparingly.
There are some products which may help. These include: Antifungals (walnut, olive leaf, garlic, grapefruit seeds), Probiotics (Acidophilus) and Enzymatic Products. Vegetables such as: asparagus, avocado, broccoli, brussels sprouts, eggplant, kale, cabbage, cauliflower, celery, cucumber, onions, peppers, radish, spinach, Swiss chard, tomatoes, turnip may be beneficial. In addition, look for fruit and herbal teas known for their high antioxidant properties. Avoid wine, beer, and hard liquor. These will all make candida worse. Exercise Every Day. Drink Lots of Water. Stress-Less, get more sleep, do yoga, breathing and meditation.
Remember, hydration is the key to minimizing all symptoms and will bring about a faster recovery.

Lastly, some hygiene dos and don’ts.
Your vagina is self-cleaning but it is vitally important that you shower daily. Do not use harsh (non-pH balanced soaps) internally, and if a mild soap is used, wash it out completely. Change your clothes daily. Don’t wear clothes that are too tight or that are made with irritating materials; cotton is preferred. Avoid wearing soiled or sweaty underwear. Try to sleep without underwear and keep your vaginal area at all times. Always wipe/wash from front to back after using the toilet. Fold and wet toilet paper with water and wipe front to back until clean after bowel movements. And lastly, if you are sexually active, remember to wash after sex and to ask your partner about their sexual past before genital contact.
This guide will help you avoid exaggerated or prolonged symptoms of vaginitis and fight against disease for long term vaginal health.