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Patient Information > Bladder
Painful Bladder Syndrome
Painful Bladder Syndrome/Interstitial Cystitis (PBS/IC) occurs mainly in women. It is poorly understood. The symptoms are bladder pain, urinary frequency, urgency and nocturia (the need to urinate frequently at night ). Treatments include diet/lifestyle approaches, oral medication, bladder instillations and in some cases surgery. There is little agreement about the best form of treatment for the condition. More than 180 different types of therapy have been used in the treatment and management of PBS/IC.
A Cochrane Systematic Review (2007 ) looked at randomized or quasi-randomized controlled trials of participants with a clinical diagnosis of PBS/IC and where part of the trial was treatment with a bladder instillation. The main outcome measures were the effect on pain and bladder capacity. Other measures included quality of life assessment, economic factors and harmful events.
The review included six types of bladder instillation: Resinferatoxin, Dimethl sulfoxide, BCG (Bacillus Calmette- Guerin), Pentosan polysulfate, Oxybutin, and alkalinisation of urine pH.
Pain during instillation and withdrawal from treatment were more common with resinferatoxin. The data on Dimethyl sulfoxide (DMSO) was limited with no clear differences from placebo. Those treated with BCG tended to report less pain and fewer general symptoms. Adverse events were more commonly reported but no more so than after a placebo instillation. Oxybutin was associated with increased bladder capacity, reduced frequency, improved quality of life scores and fewer drop-outs. Alkalinisation of urine pH did not make any clear difference.
The review concluded that the evidence for Oxybutin and BCG is promising. It concluded that there is little evidence for the other treatments included in the review. Randomized controlled trials are needed and study design should use the outcome measures that are relevant to patients. The outcome measures should be standardized.
Reference:
Dawson TE, Jamison J
Cochrane Database Syst Rev. 2007 Oct
Current evidence suggests the efficacy of dimethyl sulfoxide and amitriptyline.
A recent systematic review of pharmacologic management of painful bladder syndrome/IC concluded that BCG and Resinferatoxin did not show efficacy but that Pentosan polysulphate may be modestly beneficial for PBS/IC. They also concluded that a consensus on outcome measures is urgently needed.
Reference:
Dimitrakov J et al
Arch Intern Med 2007 Oct 8 2007
There are a number of self-help options for those with painful bladder symptoms. We would like to hear of patient's experiences with these. To read about and discuss these you can register on our message board: www.pelvicpain.org.uk
