When you gotta go a lot, it may be this

Q: I am constantly running to the bathroom. In addition, it hurts and burns when I urinate. My doctor says I don’t have a bladder infection; instead, he says I have interstitial cystitis. What is really going on in my abdomen, and what will help?

A: Normally, we are not aware of our bladder until it becomes distended and we feel the urge to void. With interstitial cystitis, urine collecting in the bladder causes irritation, urgency and pain, probably because the internal walls of the bladder are damaged.

Urine seeps through the wall’s normal coating, and certain fibers in the bladder wall are activated. This ultimately causes a secretion of inflammation-producing substances — histamines, leukotrienes and prostaglandins.

As a further insult, the nerves in the bladders of women with interstitial cystitis, or IC, are easily stimulated and therefore more likely to “feel” pain.

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This disorder is quite common — and getting more so. In fact, researchers have yet to nail down a cause for IC, which affects about 700,000 people in America, 90 percent of them female. Most sufferers are diagnosed between the ages of 42 and 46, but often notice symptoms five to seven years before they receive appropriate treatment.

Tests
There is no test for IC. Urinalysis appears normal, a urine culture is negative, and there is no definitive blood test. Your medical history is important for diagnosis, so be specific in relating your symptoms to the doctor.

Women with IC void an average of 16.5 times a day, compared with a normal 6.5 times. Alcohol, spicy foods, artificial sweeteners and smoking can exacerbate symptoms.

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Your doctor will first rule out the possibility of kidney infections, vaginal infections and endometriosis; perform a pelvic ultrasound and also check for kidney stones with a special X-ray called an IVP.

If these tests are negative, you should see a urologist for cystoscopy, a procedure in which a thin scope is inserted through the urethra for a magnified view of the bladder’s internal walls. A biopsy of the bladder wall can be done at this time. Fluid is then pushed into the bladder to fill it to capacity.

Interestingly, this hydrodistention often helps improve the symptoms of IC within two to four weeks. So although the test is done for diagnostic purposes, it can also be therapeutic.

Another diagnostic test is called the PST. Potassium chloride is put into the bladder. Patients with a normal bladder surface do not react to this, whereas those with IC have significant discomfort.

Treatments
There are several treatments. An oral medication, pentosan polysulfate sodium (PPS, or Elmiron), contains a substance similar to a naturally occurring sealer on the bladder’s surface. This medication may replenish the defective layer and prevent inflammatory processes. It is usually taken as a 100-mg capsule three times a day, but can take up to six months to achieve significant pain relief.

In an older therapy, dimethylsulfoxide (DMSO) is administered directly into the bladder. This is an anti-inflammatory analgesic with muscle-relaxing properties that seems to decrease nerve sensitivity and increase bladder capacity.

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The DMSO is passed through a catheter into the bladder, where it is retained for 15 minutes before being expelled. Treatment is either weekly or biweekly for six to eight weeks. If improvement occurs, it usually does so within four weeks.

Other treatment options include analgesics, antidepressants (particularly amitriptyline and other tricyclics), antihistamines, antispasmatics and even the anti-epileptic drug Neurontin. Some studies show that instillation of solutions containing heparin sulfate into the bladder can help relieve symptoms. In very severe cases, doctors resort to cauterizing a portion of the bladder’s surface or even surgically removing the bladder.

Dr. Reichman’s Bottom Line: If you are constantly running to the bathroom with painful urination and it’s not an infection, see a specialist for a urinary work-up. IC is a common problem and the right therapy can ease your pain.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of HarperCollins.

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.

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