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Interstitial Cystitis

Interstitial Cystitis (IC) is a chronic bladder condition resulting in recurring discomfort and pain in the Bladder or surrounding Pelvic region. This can cause Bladder Pain Syndrome (BPS) that can lead to unrelenting pain, frequent trips to the bathroom day and night, and curtailed activities due to extreme urinary frequency.

What Is Interstitial Cystitis?

Interstitial Cystitis has been called many names, such as Painful Bladder Syndrome, Urethral Syndrome, Trigonitis, and Bladder Pain Syndrome. Some characterize it into Hunner Lesion Interstitial Cystitis, which is described as having irritating lesions on the bladder wall seen with cystoscopy (scope looking into the bladder) or Non-Hunner Lesion Interstitial Cystitis, in which no such lesions on cystoscopy. The cause or etiology of the disease is not known or not clearly recognized.

IC or BPS predominantly affects women with an average age of onset of 40 years or older. It does affect men, but it’s less common, and very rarely would affect children. Prevalence in the United States ranges from 1 to 5 out of every 100,000 people and maybe up to 12% of women having early symptoms of IC.

Symptoms of Interstitial Cystitis

Symptoms of IC have features of inflammation and irritation. These can possibly be autoimmune-related, or nerve-related.

  • Pain in the pelvis area between the Vagina and Anus in women or between the Scrotum and Anus “Perineum” in men.
  • Chronic pelvic pain.
  • Persistent need to urinate.
  • Frequent urination, often small amounts throughout the day and night.
  • Pain or discomfort while the Bladder fills and relief after urinating.
  • Pain during sexual intercourse.
  • Chronic pain

Hip Pain

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Common Causes of Bladder Pain Syndrome

The exact cause of Interstitial Cystitis is unknown, but people with IC may have a defect in the protective lining of the Bladder called the Epithelium, or the lining can be irritated or too thin.

  • The Epithelium may leak to allow the urine to irritate the Bladder wall.
  • There is the possibility of an autoimmune reaction, genetic component, undiagnosed infection or allergic response.
  • Epithelial leak.
  • Can cause a potassium leakage from the cells of the Bladder wall into the uterine.
  • This can generate symptoms of frequency, urgency, pain or incontinence or just the cells allow for the Bladder to get past the Epithelial wall causing further irritation to the deeper lining of the Bladder.
  • Autoimmune reaction – This can be a reaction where the body attacks the Bladder Epithelial cells, causing inflammation and irritation.
  • Allergies and infections.
  • Allergies to something in food or urine could cause the release of Histamine other chemicals that create inflammation as well.
  • Infections can also cause irritation and pain and inflammation, but typically Interstitial Cystitis is characterized by no bacteria grown out in culture from urine sample.
  • At the Centeno Schultz clinic we have found Lumbosacral nerve irritation can be a major cause for IC. Pudendal nerve irritation can be a cause as well.

Common Treatment for Bladder Pain Syndrome

Treatment options for Interstitial Cystitis range from conservative lifestyle changes to medications, therapy, injections, and surgeries.

  • Changes to lifestyle.
  • Sometimes a food elimination can be helpful. Foods you are sometimes told to avoid would be tomatoes, soybeans, spices like pepper, curry, hot pepper, green horseradish paste, etc., high potassium foods, citrus foods, and foods with a strong acid taste like caffeine, carbonic acid and citric acid.
  • Stress management techniques are also often tried.
  • There are some medications that may be given for pain. Common medications include oral Amitriptyline, Cimetidine, Hydroxyzine.
  • Injection-based agents into the Bladder including DMSO, Heparin, Lidocaine or PPS. The oral meds may affect decreasing inflammation and Histamine release. Amitriptyline also can have some properties that help nerve-related pain.
  • Therapy. Pelvic floor physical therapy can help relax tight, tender muscles, build strength in the pelvic muscles and work on connective tissue in the pelvis, lower abdomen, thighs, groin and buttocks.
  • Injection-based therapies can include Botox injections to relax the muscles as well.
  • Trigger point injections can help relax muscles.
  • Nerve blocks such as to the Pudendal nerve that can be irritated and that controls Bladder pain.
  • Neuromodulation with a stimulator that can be surgically implanted is another last line treatment option.
  • Very rarely, Bladder surgery may be required.

Who Is At Risk of Getting This Condition?

Women are at a higher risk to develop this condition, though men can still get it.

  • Older in age, over 40
  • People that had been diagnosed with Depression have an increased risk for IC.
  • People that have more chronic pain conditions, inflammatory disorders, mood disorders, anxiety, and hypothyroidism can be at increased risk for Interstitial Cystitis as well.

When To See a Doctor

You should visit your primary doctor if you are experiencing Bladder pain, urinary urgency, and frequency. It may be time to see a specialist if this has been going on chronically for more than 3 months, is getting worse, causing more day and nighttime urination, and affecting your activity and mood.

Examination and Diagnosis

Doctors will typically take a detailed history, do a physical examination and try to rule out other underlying problems that could lead to similar symptoms. Potentially, more invasive diagnostic measures such as a Cystoscopy, which is a procedure performed under anesthesia where a scope is placed through the Urethra into the Bladder to distend the Bladder, look for ulcers and take measurements, can be used. Here at the Centeno-Schultz Clinic, we would do a detailed neuromuscular evaluation as the diagnosis could potentially be caused by irritated nerves coming from low back problems, Sacral nerve root irritation, or Pudendal nerve root irritation, which can be treated. This may entail obtaining a low back or Sacral MRI as well.

Further Complications if Left Untreated

Patients can have persistent symptoms affecting the quality of life, and increased risk for Depression. You can have continued stiffening of the bladder wall, problems with sleeping, painful and lack of interest in sexual intercourse.

What Can You Do To Prevent Recurrence?

Interstitial Cystitis typically has no known cause and so treatments will vary from person to person. Different treatments can be effective for different patients. At the Centeno-Schultz Clinic, we look for underlying causes of Lumbosacral nerve root irritation that can be treated with our procedures. For instance, if there is an L5-S1 Disc bulge causing irritation to the lower Lumbosacral nerve roots, this can cause symptoms of Interstitial Cystitis. Doing an Epidural using the patient’s own growth factors from their blood platelets has been shown to be effective in reducing pain, improving nerve function, and decreasing or getting rid of the symptoms of Interstitial Cystitis. If that type of treatment is successful, it can prevent reoccurrence by doing maintenance exercise and therapy to protect the low back and avoid any potentially exacerbating activities. Some people may need some periodic treatments several years apart over the course of their life.

Conclusion

Interstitial Cystitis is a Painful Bladder Syndrome characterized by urinary frequency, hard to empty Bladder, painful urination, and pelvic pain that does not have an easily identifiable cause. At the Centeno-Schultz Clinic, we look for an underlying neuromuscular cause that could be treated with our regenerative and reparative injection-type techniques. Otherwise, there are medicines, stress reduction techniques, therapy, and other treatments that can be used to help manage the symptoms of IC/Painful Bladder Syndrome. If you or anyone you know is dealing with this issue and want to see if it could potentially be coming from nerve root irritation, contact the Centeno-Schultz Clinic for a full evaluation to see if a Candidate for any of our therapies.

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Our Doctors Who Treat Interstitial Cystitis

Christopher J. Centeno, MD

Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.

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Jason Markle, D.O.

Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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