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Having constant pain in bladder. No relief from fiorcett. Any suggestion for relief?

Mar 2013
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Practicing since : 1998
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What do you recommend to stop the constant pain in bladder ? I have Ic, diagnosed about 8 years ago. use bladder installations meds, twice a day. interstem didn't help , urelle seems to help a lot but insurance won't pay for it and its $400.00 for 90 pills. Take fiorcett for the pain, usually helps a lot , but not now. I've had a lot of stress in my life, and assume I am having a flare up, not sure how to get some relief, can you suggest anything.?
Posted Thu, 21 Mar 2013 in Urinary and Bladder Problems
Answered by Dr. Aarti Abraham 37 minutes later
Thanks for your query.
It appears as though you have tried every medical treatment in the book.

Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding area. In recent years, scientists have started to use the terms bladder pain syndrome (BPS) or painful bladder syndrome (PBS) to describe cases with painful urinary symptoms that may not XXXXXXX the strictest definition .
Medical research has yet to find a specific cure for IC.
the promising ones such as Interstim and bladder instillation have already failed to work for you.
You might try Urelle again as that helped, though sadly the finances will be a factor.
Elmiron might be tried too.
No scientific evidence links diet to IC/PBS, but many patients find that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation. Some people also note that their symptoms worsen after eating or drinking products containing artificial sweeteners.
Many people feel smoking makes their symptoms worse.
Many patients feel that gentle stretching exercises help .
People who have found adequate relief from pain may be able to reduce frequency by using bladder training techniques. Methods vary, but basically patients decide to void—empty their bladder—at designated times and use relaxation techniques and distractions to keep to the schedule. Gradually, they try to lengthen the time between scheduled voids. A diary in which to record voiding times is helpful in keeping track of progress.

New evidence indicates that certain types of physical therapy, when administered by an experienced physical therapist, may improve symptoms.

Surgery should be considered only if all available treatments have failed and the pain is disabling. Many approaches and techniques are used, each of which has advantages and complications that should be discussed with a surgeon.

Two procedures—fulguration and resection of ulcers—can be done with instruments inserted through the urethra. Fulguration involves burning Hunner’s ulcers with electricity or a laser. When the area heals, the dead tissue and the ulcer fall off, leaving new, healthy tissue behind. Resection involves cutting around and removing the ulcers. Both treatments are done under anesthesia and use special instruments inserted into the bladder through a cystoscope. Laser surgery in the urinary tract should be reserved for people with Hunner’s ulcers and should be done only by doctors with the special training and expertise needed to perform the procedure.
Another surgical treatment is augmentation, which makes the bladder larger. In most of these procedures, scarred, ulcerated, and inflamed sections of the patient’s bladder are removed, leaving only the base of the bladder and healthy tissue. A piece of the patient’s colon—also called large intestine—is then removed, reshaped, and attached to what remains of the bladder. After the incisions heal, the patient may void less frequently. The effect on pain varies greatly; IC/PBS can sometimes recur on the segment of colon used to enlarge the bladder.
Even in carefully selected patients—those with small, contracted bladders—pain, frequency, and urgency may remain or return after surgery, and they may have additional problems with infections in the new bladder and difficulty absorbing nutrients from the shortened colon. Some patients become incontinent, while others cannot void at all and must insert a catheter into the urethra to empty the bladder.
Bladder removal, called a cystectomy, is another, infrequently used surgical option. Once the bladder has been removed, different methods can be used to reroute the urine. In most cases, ureters are attached to a piece of colon that opens onto the skin of the abdomen. This procedure is called a urostomy and the opening is called a stoma. Urine empties through the stoma into a bag outside the body. Some urologists are using a second technique that also requires a stoma but allows urine to be stored in a pouch inside the abdomen. At intervals throughout the day, the patient puts a catheter into the stoma and empties the pouch. Patients with either type of urostomy must be very careful to keep the area in and around the stoma clean to prevent infection. Serious potential complications may include kidney infection and small bowel obstruction.
A third method to reroute urine involves making a new bladder from a piece of the patient’s colon and attaching it to the urethra. After healing, the patient may be able to empty the newly formed bladder by voiding at scheduled times or by inserting a catheter into the urethra. Only a few surgeons have the special training and expertise needed to perform this procedure.
Even after total bladder removal, some patients still experience variable IC/PBS symptoms in the form of phantom pain. Therefore, the decision to undergo a cystectomy should be made only after testing all alternative methods and seriously considering the potential outcome.
Removing the bladder is not always done in patients with severe disease. Some urologists recommend rerouting urine to a piece of bowel connected to the abdominal wall. Urine is then collected in an external bag that is emptied periodically.

If you can tide over the flare with Urelle , fine, otherwise for the long run, consider surgical options with your doctor.

Stress relaxation, yoga and lifestyle modifications also help.

Take care and feel free to ask for further clarifications.
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