Bladder Troubles. Why am I always in the Bathroom?
You may know all about cystitis. If so, you probably mean bacterial cystitis, which is the medical word for a bladder infection (urine infection). The word ‘cystitis’ really only means an irritated bladder. It does not say what caused the irritation.
Women with pelvic pain often have another type of bladder irritation called either Interstitial cystitis (IC) or Painful Bladder Syndrome (PBS). This type of cystitis is different from a urine infection. There is irritation of the bladder wall but no infection. It is another pain you can’t see at a laparoscopy.
If you have endometriosis, bladder troubles and pain on most days, then it is quite possible that you have PBS. Sometimes it is the bladder which causes most of the pain.
What problems does painful bladder syndrome cause?
The common symptoms include:
Frequency. (Needing to go to the toilet a lot)
Nocturia. (Needing to get up to the toilet at night)
Urgency. (Needing to rush to the toilet and finding it difficult to ‘hold on’)
Pain. Which gets worse as the bladder fills, and improves once the bladder empties
Pain with intercourse. Especially in positions that put pressure on the front wall of the vagina (near the bladder)
What can I do?
Dietary changes. There are many foods that can make bladder pain worse, but most women only have problems with some of these. They include:
Foods high in acid such as citrus fruit, cranberries, vitamin C, some herbal or green teas or tomatoes. A plain mint/ chamomile tea or just water is best
Foods that stimulate nerves such as caffeine, chocolate or cola drinks
Foods high in sodium or potassium such as bananas
Artificial Sweeteners including aspartamine etc
Fizzy drinks (including mineral water) Diet cola drinks are probably the worst as they contain acid, caffeine and artificial sweeteners. Cigarettes can also affect the bladder.
If you eat these foods, remember how you feel afterwards. If you feel worse, this may be a trigger food for you. You may also find trigger foods of your own.
Medications are really useful but you may need to try a few different ones with your doctor to find the right one for you:
Low dose amitriptyline from your doctor. This is a good first choice as it helps frequency, urgency, pain and the number of times you pass urine at night. It can also sleep, bloating and headaches. A dose starting at 5mg taken around 3 hours before bed and increasing slowly to between 5 and 25mg daily suits around half the women who try it. Sleepiness in the mornings usually wears off in a week or so, but start with a small dose.
Mirabegron (betmiga®) 25 or 50mg taken once a day is particularly useful for those with a painful bladder who find amitriptyline causes side effects. It won’t help other pains, but works well in most women with a painful bladder.
Other options include tolterodine 1-2mg daily, oxybutinin 5-15mg daily.
Hydroxyzine 10-50mg at night is often helpful but not available in Australia. It also helps women with allergies.
Pentosan polysulphate sodium (Elmiron®) 100mg three times daily. It is expensive and may take up to six months to work.
Bladder First Aid
If there are times when your pain or urgency comes on suddenly, you may be able to help it quickly by:
- Drinking 500ml of water mixed with 1 teaspoon of bicarbonate of soda, or a sachet of Ural ® or Citravescent ®
- Then drink 250ml water every 20 min for the next few hours
Content provided by Dr Susan Evans, Gynaecologist, Laparoscopic Surgeon, & Specialist Pain Medicine Physician (https://www.drsusanevans.com.au/). Permission has been granted to publish this content on www.theendolifestyle.com.