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Tratamiento Integrado Del Dolor

Condiciones

Cistitis intersticial

Interstitial Cystitis Also known as bladder pain syndrome, is the term used to refer to a chronic inflammatory condition affecting the muscular and submucosal layers of the bladder. The cause of interstitial cystitis is not known and this condition is considered a diagnosis of exclusion.

Cistitis intersticial

The condition is associated with urinary frequency, urinary urgency, sterile urine culture and nocturia or waking up to urinate at night.

People suffering from interstitial cystitis may experience symptoms that will overlap with other urinary bladder related disorders such as UTI or urinary tract infection, arthritis, prostatitis, urethral syndrome and overactive bladder.

Patients of interstitial cystitis can be compared to those suffering from cancer pain, those on kidney dialysis or rheumatoid arthritis as far as the quality of life is concerned.

Signos y síntomas

Symptoms associated with interstitial cystitis will be misdiagnosed in most cases because they mimic urinary tract infection.

Though this is the case, interstitial cystitis has not been found to be caused by bacterial infection treatment through antibiotics will be ineffective. Initially, the symptoms of interstitial cystitis might be attributed to uterine fibroids and endometriosis in women or epididymitis or prostatitis in men.

The most common symptoms described by people suffering from interstitial cystitis is the waking up at night to urinate, pain during sexual intercourse, urinary frequency and suprapubic pain.

From a general perspective, the symptoms of interstitial cystitis may include pain during urination; a pain described as a burning sensation in the urethra, pelvic pain which is worsened by certain drinks or foods, pressure in the pelvis or bladder, and urinary urgency

Other symptoms that are frequently described by interstitial cystitis patients include urinary hesitancy which is a situation where the patient has to wait for the urinary stream to start as a result of tension and the dysfunction of the pelvic floor, difficulty ad discomfort during working, driving and travelling.

The pelvic pain experienced by interstitial cystitis patients is worse when the bladder is full and is relieved by urination.

During cystoscopy about 10% of interstitial cystitis patients are discovered to have Hunner’s ulcers. People with interstitial cystitis might experience the discomfort in the urethra only and in some nights, they might struggle with pain affecting the entire pelvis region.

The pain associate with this condition will fall into one of the two categories; significant suprapubic pain characterized by little urinary frequency or the lesser amount of suprapubic pain with increased frequency.

Causas

The causes of interstitial cystitis are not known. There are a number of proposed explanations including the nerve theory, the autoimmune theory, leaky lining theory, theory of production of a toxic substance in the urine, mast cell theory, and the infection theory.

There are other suggested causes such as allergic reactions, neurologic issues, stress-psychological and genetic compositions. Recent studies have indicated that interstitial cystitis patients’ urine might contain a substance that inhibits cell growth in the bladder epithelium.

Clinical tests have indicated that mast cells might have something to do with the development of interstitial cystitis because they can release histamine and cause swelling, scarring slow healing and cause pain.

Studies have also indicated that there is a proliferation of nerve fibers in the bladder of interstitial cystitis patients, which are absent in the bladders of people who are not suffering from interstitial cystitis.

Diagnóstico

The diagnosis of interstitial cystitis is regarded as an exclusion procedure and can also involve the clinical assessment of the symptoms described.

It is recommended that medical practitioners start with the patient’s history followed by a physical examination then laboratory tests for the assessment and documentation of the interstitial cystitis and other potential conditions.

In cases that are considered complex, cystoscopy with hydrodistention maybe employed.

Researchers have discouraged the use of this test indicating that the examination of the wall of the bladder after stretching is not specific to interstitial cystitis and the process can result in petechial hemorrhages which are small glomerulations found in interstitial cystitis.

This leaves the best diagnostic procedure as the exclusion method and the assessment of the clinical symptoms.

Servicios

Tratamiento

Existen directrices recomendadas para el tratamiento de la cistitis intersticial. Estas directrices van desde el tratamiento conservador hasta las intervenciones invasivas. Estas son las pautas recomendadas:

Tratamientos de primera línea

Esto implica la educación del paciente, la modificación de la dieta y el control del estrés.

Tratamiento de segunda línea

Éste implica medicación oral como cimetidina, hidroxizina, pentosan, amitriptilina y polisulfato, fisioterapia, instalación en la vejiga (lidocaína, heparina o DMSO)

Tratamientos de tercera línea

Esta línea de tratamiento implica el manejo de las úlceras de Hunner que puede ser mediante fulguración, inyección de triamcinolona o láser. También implica la hidrodistensión de corta duración y a baja presión.

Tratamiento de cuarta línea

Esta línea implica simplemente una modulación neural como el nervio pudendo o el sacro

Tratamiento de quinta línea

Esta línea incluye la toxina botulínica A y la ciclosporina A.

Tratamiento de sexta línea

Este es el tratamiento final e implica una intervención quirúrgica que puede incluir aumento, cistectomía y derivación urinaria.

The guidelines also have a list of discontinued treatment options such as high pressure long duration hydrodistension, systematic glucocorticoids, intravesical bacillus, Calmette Guerin, and long-term oral antibiotics.

Any individual experiencing any of the motioned symptoms should seek medical attention for proper diagnosis and treatment to eliminate the symptoms and relieve the pain and discomfort that might negatively affect the patient’s quality of life.

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