It is often not uncommon to find out people who are suffering from severe symptoms of urine passage which includes severe pain. Pain is what defines their problem, pain while holding too much urine, pain while expelling urine and pain following passage of urination. Of past few decades, the understanding of such problems has evolved from being pain alone to a pain syndrome or Painful Bladder Syndrome. Despite several and exhaustive research studies, the data is still hypothetical and not exact. But the suffering it sometimes brings about can only be extrapolated to be very adverse as to cost ones job and a cause of Depression and active life.
The causes can be hindered defense mechanism of the bladder mucosa which contains the urine and hence exposing the bladder nerves to otherwise innocuous chemicals of urine.
Others subject it to altered ionic transitions in the bladder mucosa
Yet other studies call it a very ill-defined long-term rare infection with no other harm. But after all, it is closest to a pain syndrome and treatment thankfully now is available and upgraded. But before we start treatment we must rule out any organic urinary bladder pathologies such as bladder cancer, Tuberculosis, blockade of urinary passage, any malignancy of genital organs and neurogenic problems amongst others. The treatment starts with Reassurance, medication, lifestyle modification, and pain relief. Very few medications stand the scrutiny of being definitely successful in modifying the course of a disease.The medications include Glycosasaminoglycan like substances which have proven to be helpful in pacifying disease a little. These medications can be supplemented with drugs like Amitryptiline and other neuromodulators that can aid pain relief. Also, a part of treatment may be bladder relaxants such as Anticholinergics and Potassium Channel Openers such as Mirabegron the latest addition to the armamentarium. Also the treatment of the disease is a stepwise management which is oral medications followed by Intrabladder instillation of drugs which may yield in to support the bladder mucosal defences such as anticoagulants like multifactor inhibitors, Sodium Bicarbonate, low dose steroids and short-acting local anaesthesia agents; and a mixture of all these drugs on a weekly basis .Some centers still trust DMSO which is a rubber industry product. Latest to enter the catalogue is Intravesical Anti Wrinkle Injection which can be applied cystoscopically in the affected patients along with hydrodistension. If relieving the patients can have a repeat dosage after 6 or so months.
But the treatment runs a light risk of retention of urine which has to be weighed against the benefits of salutary effects of the medication. Treatment on the horizon is Transcutaneous Nerve Stimulation ( Posterior Tibial ) TENS, Sacral Nerve neuromodulation ( SNS).
Also, surgery such as Cystectomy or complete bladder removal may be needed for very desperate and motivated patients
