Interstitial Cystitis and Overactive Bladder-An Overview

I have practiced Urology for over twenty-five years and I must say that I have been in some very emotional situations for a variety of reasons. The most common and emotional issue however is the female with debilitating urinary frequency and urgency. The patients that come immediately to mind are teachers. Teachers are a very conscientious bunch and it is my understanding that principals don’t often understand the dramatic effect that an overactive bladder has on a teacher. A teacher that can’t leave the classroom unless there is someone there to supervise the children. So, imagine the teacher who is voiding ten times a day during work and at each time they are having to explain and apologize for their problem. Day in and day out, taking medicines that may not be helping and having troublesome side effects to boot…it is very frustrating. In my office on many occasions I have had teachers break down and cry. ” I can’t live this way anymore.” I get it and I believe that with the medicines available today, the options of the InterStim device and our experience and interest in this order, that “help on the way” and the problem improved. Overactive bladder, stress incontinence, and interstitial cystitis are urological conditions the physicians at the Northeast Georgia Urological Associates are not only good at but have an interest of being of help in this very varied, frustrating and emotional time for our patients. John McHugh M.D.

This may surprise you. The most common cause of bladder irritative symptoms of frequency, urgency and getting up at night to urinate seen by the family physician is a bladder infection (UTI). The most common diagnosis of the urologist who sees a patient with similar symptoms is Overactive Bladder (OAB) or Interstitial Cystitis (IC). If a patient has all the symptoms of a bladder infection but does not have an infection, then the treatment pathway is not antibiotics. A different approach is taken that takes into consideration:

Hormone depletion of the vaginal mucosa around the urethra
The effect that certain foods in one’s diet has on the bladder
Consideration of factors that are important to IC only
Consideration of medications such as anti-cholinerigics
Neurostimulators or Urgent PC- we offer both.

Symptoms/Treatment of Bladder Disorders

Urgency, frequency and getting up at night-Medications
Urgency associated with incontinence-Medications/Slings
Stress urinary incontinence-Mid urethral Slings
Urgency, frequency refractory to medication-Medtronic InterStim
Intrinsic Sphincter Dysfunction-Bulking agents

Although surprising to some, patients seen by the physicians at Northeast Georgia Urological Associates who are female approaches 50%. Most people think of urologists as a doctor that only treats males. Females are troubled by many disease processes similar to males such as kidney stones, bladder infections, renal and bladder malignancies, and hematuria. Although men suffer from IC and OAB symptoms also, these conditions are much more common in the female.

However, when it comes to urinary incontinence and debilitating bladder disorders females are more likely to be affected by these maladies than the male. The diagnosis and treatment of these issues can be frustrating to both the urologist and the patient. The management of Overactive Bladder and Interstitial Cystitis (IC) can be particularly tricky and difficult. On the paragraphs that follow and hopefully during your office visit, we hope to explain the nuances of these issues and make a commitment to you that we have both the interest in these female problems and the experience to help.

Interstitial Cystitis Association Home Page

First Things First: Do you have a bladder infection or not?

The reason female voiding dysfunction is difficult is that all the symptoms that are irritative in nature (urgency, frequency, burning to void, and getting up at night) occur with a bladder infection as well. The first response by doctors to the above symptoms is to prescribe an antibiotic. If the symptoms are not from a bladder infection but from IC or overactive bladder (OAB), then the symptoms will not improve. What often happens is that the patient then gets a vaginal infection from the antibiotics which complicates the diagnostic and therapeutic picture.

A bladder infection will have white cells in the urine
A bladder infection will have a positive urine culture
A yeast infection will burn to void and when not voiding
A bladder infection burns only when you urinate
Sometimes you have to treat a bladder and vaginal infection
If no vaginal infection, anti-yeast medicines won’t help
If no bladder infection, antibiotics won’t help
Overactive bladder and IC symptoms are not because of infection

The issue of atrophic vaginitis and senile urethritis

After menopause, the tissues of vaginal mucosa change
The tissues are less moist, less vascularized, and becomes thin
This causes painful intercourse
This promotes bladder infections
As the mucosa thins it is easier for bacteria to enter the urethra
Senile urethritis because of lack of hormone mimics a UTI
Using hormone cream can replinish these abnormalities
Lack of hormone mimics OAB, IC and UTI

Everything but OAB and IC has been ruled out

We have evaluated or treated any potential vaginal hormonal issue
We have ruled out an infection
We don’t have a yeast infection or vaginitis
Another doctor tried antibiotics and it hasn’t helped
Its time to think OAB and IC!

OAB or IC symptoms in the presence of blood in the urine

If a female has these symptoms and there is blood in the urine there is the possibility of a small ureteral stone near the bladder exists
The blood must be proved to be benign with CT Scan and cystoscopy (A bladder tumor could cause voiding symptoms and blood in the urine.)

Now to the issues of your bladder unrelated to an infection and requires treatment modalities that don’t utilize antibiotics and require the expertise of someone in tune with what you are experiencing. You know who you are. We at the Northeast Georgia Urological Associates understand the frustration of bladder disorders and want to help. Christie Woodruff, our nurse practitioner, has a particular interest in these disorders in females. She, along with the over thirty years of experience of the NGUA physicians treating these type of conditions, is anxiously awaiting beginning the process of “making things better.”