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Pain, bladder capacity was large, prone to cystitis. Is one red patch enough to consider IC?

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Practicing since : 1998
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Hi, I have always been prone to cystitis, but around four months ago it began getting more frequent. I had a few rounds of antibiotics (later Idiscovered no bacteria was found, but was given antibiotics, I think, on protein being found in urine). Anyway, then became more and more frequent flares of EXTREME pain until was on average every second day. Codeine didn't work, tramadol did for a while, and now on Morpheine as and when an attack comes on. When an attack comes on it lasts about a day (hard to tell as Morpheine blocks the pain, but is usually gone by time the painkiller wears off). Whilst am having an attack I urinate many, many times (only a bit comes out and is V painful). Sometimes it feels like I am close to losing continence. Yesterday I had cytology with hydrodistilation and biopsy. The urologist said my blader capacity was large (I think 700ml), and that there was no structural abnormalities. There was, however, a red patch/area which he biopsied. I need to wait two months for follow up app. I had resigned myself to him diagnosing instertitial cystitis upon investigation, but having him find very little is a surprising let down as I am now left clueless as to the symptoms. The pain is indescribable, suicide-inducing type pain. I really want a diagnosis so I can get treatment, but I worry now that he'll decide there's 'nothing wrong'. What do you think? Is one red patch enough to consider IC? Is it possible it could be cancer?? Could normal bladders have a red patch? I'm a 32 yr old female with other medical history of PCOS, IBS, chronic anxiety and OCD and a diagnosis of genital herpes around three yrs ago (though have been unable to detect symptoms for last year). I also have on around 10-15 occasions in the past few years (not in last year) used Ketamine. Do you think it's IC? Pls help as can't cope with the pain :-( Thank you ps I also had mirena coil fitted last April. Had a really hard time with it-had bad period pains for a month, and got a psoriosis type flare up straight after, all over body (never had b4)
Posted Fri, 13 Apr 2012 in Men's Health
Answered by Dr. Rajiv goel 13 hours later

It is disturbing to hear your symptoms and how they are affecting your quality of life.

Your cystoscopy findings don't suggest interstitial cystitis (IC). Classically IC patients have small capacity bladder and whole bladder shows red patches on hydro-distension. Single red patch is unlikely IC but yes carcinoma has to be ruled out with histology.

Although your cystoscopy does not suggest IC, your symptoms are highly suggestive for the same. I usually put all such patients of mine on amytriptylline and it works well for a large majority. Please discuss regarding the same with your treating doctor.

Hope I have answered your query. Please accept my answer in case you do not have further queries.

Get well soon.

Above answer was peer-reviewed by
Follow-up: Pain, bladder capacity was large, prone to cystitis. Is one red patch enough to consider IC? 33 hours later
Hi Dr Goel,

Thank you for the answer. Hmm, so I suppose that since my symtoms conflict with the examination findings, It'll be unlikely to result in a diagnosis? Hope you don't mind answering a couple more things. . . If histology comes back ok, but symptoms persist, what would they then do? Diagnosis IC anyway? Can you get a diagnosis of IC when bladder looks like mine does (ie normal?). I can't have amytriptylline as I'm already on an SSRI (fluvoxamine), and have finally got the right dose and feeling psychologically well so I wouldn't want to tamper with my mental state even if they would prescribe it with my SSRI. What would you say the likelyhood is of it being cancer? I have to wait two weeks for histology results and may go out of my mind not knowing if it's likely/just a precaution to rule it out? (I'm a social smoker and drinker). Thank you for your help btw, I know I'm asking millions of questions but I feel v anxious about the outcome as now that it looks unlikely to be IC, I'm thinking it may be cancer :-( , Thanks, XXXXXXX
Answered by Dr. Rajiv goel 5 hours later

Thanks for the follow-up.

As already mentioned the cystoscopy does not suggest you having IC.

However, despite being a social smoker, the other possibility, bladder cancer is very minimal as your age goes against it.

Hence, you should let your mind rest at peace and treat yourself as IC patient once the histology comes as normal.

Hope I have answered your query.

Please accept my answer if you do not have any more questions.

Wishing you good health.

Above answer was peer-reviewed by
Follow-up: Pain, bladder capacity was large, prone to cystitis. Is one red patch enough to consider IC? 2 days later
Ok, thank you. that does put my mind at rest a bit. Whilst I still have one question left (will accept after this), do you think it might be a good idea to see a gynacologist incase it's a gynacological prob that I just feel is coming from my bladder?
Answered by Dr. Rajiv goel 15 minutes later

Thanks for the follow-up.

I will suggest you stick with your urologist rather than see gynecologist.

To me it seems to be a primary urological problem.

Hope I have answered your query.

Wishing you good health.

Above answer was peer-reviewed by
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