Interstitial Cystitis, Overactive Bladder, and Mild Urinary Incontinence

What is the probability of interstitial cystitis? What is the probability of overactive bladder? What about mild urinary incontinence?

In May 2019, I was diagnosed with endometriosis by a gynecologist, with a CA125 level of 58 (the cyst was determined by the doctor to be non-malignant and would resolve with menstruation; the uterus showed mild enlargement).
Surgery was not necessary, and I was advised to monitor the situation.
In July 2019, I was diagnosed with autonomic nervous system dysfunction and anxiety disorder by a family physician.
I began taking traditional Chinese medicine for body regulation in November, and my anxiety has significantly improved since then.

Starting around July 2018, I experienced occasional urgency to urinate, particularly when changing positions while sleeping, where I would suddenly feel the urge but could not urinate.
This continued until July 2019, when the frequency of urgency increased, and I often felt a sense of fullness in my bladder, though it was not painful.
On January 23, 2020, just before the Lunar New Year, I experienced bladder pain, burning during urination, and a sensation of incomplete emptying.
I visited a general practice clinic and received a three-day course of medication, which was ineffective, so I went to a gynecologist and was prescribed antibiotics for four days (morning, noon, and night).
After this treatment, my bladder pain resolved, urination returned to normal, and I no longer felt the sensation of incomplete emptying, so I stopped taking medication and relied on drinking more water.
Currently, I am troubled by several issues: 1.
Despite my efforts to drink more water, I rarely reach the recommended 2000-2500 ml daily.
My bladder often feels full; initially, I would urinate when I felt the urge, but found the output to be minimal.
I then tried to hold it for about 2-3 hours to accumulate more urine, which is uncomfortable due to the fullness.
After urinating, I feel relief, but drinking water—especially when I am idle—intensifies the feeling of fullness.
When I do urinate after holding it, there is no discomfort, but the flow is noticeably slow.
2.
Certain movements or changes in posture can trigger sudden urges, leading me to believe I need to urinate, but I often do not.
3.
Drinking tea or coffee increases my urgency, prompting quicker trips to the restroom, so I have avoided them since November of last year.
4.
Recently, I have noticed that my urine flow has become slower and lacks the force it used to have.
5.
Due to frequent urges, I have limited my water intake; aside from the water and soup in my meals, I aim to drink about 700 ml during the day and about 150-200 ml of warm water after brushing my teeth in the morning.
After taking traditional Chinese medicine around 7 PM, I only drink a couple of sips before stopping for the night.
6.
Although I do not drink water after that, if I do not sleep deeply, I wake up around 3 AM due to bladder fullness.
7.
I wake up around 6 AM, and my urine flow feels normal, with a typical volume.
8.
The color of my urine has consistently been light yellow; if the intervals between urination are short (like one hour or half an hour), the volume is low and resembles clear water.
9.
During my most recent sexual encounter, I experienced intermittent bladder pain.
I have been prescribed diuretic traditional Chinese medicine three times (the doctor typically prescribes a seven-day course, so I have taken it 14 times in total), but no further diuretics have been prescribed since.

I would like to ask what might be wrong with my bladder.
I am particularly concerned about interstitial cystitis, as I have heard it is expensive and difficult to treat.
I am considering visiting a urologist to identify the issue, but I am hesitant due to safety concerns related to COVID-19.
I apologize for the lengthy message and appreciate your assistance.
Thank you.

S, 30~39 year old female. Ask Date: 2020/02/12

Dr. Du Mingyi reply Urology

It is likely that the condition is related to simple overactive bladder syndrome and autonomic nervous system issues, which can fluctuate.
It is recommended to relax, as this may help improve the situation.

Reply Date: 2020/02/12

More Info

Interstitial cystitis (IC), overactive bladder (OAB), and mild urinary incontinence are conditions that can significantly affect a person's quality of life, particularly in women. Understanding these conditions requires a comprehensive look at their symptoms, potential causes, and treatment options.

Interstitial Cystitis (IC) is a chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain. The symptoms can vary widely among individuals but often include a frequent need to urinate, urgency, and pain during urination. The exact cause of IC is not well understood, but it is believed to involve a combination of factors, including bladder lining dysfunction, autoimmune responses, and possibly nerve signaling issues. Diagnosis typically involves ruling out other conditions, such as urinary tract infections (UTIs) or bladder cancer, through urine tests, cystoscopy, and bladder biopsies.

Overactive Bladder (OAB) is defined by a sudden urge to urinate that may be difficult to control. It can occur with or without urinary incontinence (the involuntary leakage of urine). OAB can be caused by various factors, including bladder muscle overactivity, neurological disorders, or even certain medications. The condition can lead to frequent urination, including nighttime urination (nocturia), which can disrupt sleep and lead to fatigue and decreased quality of life.

Mild Urinary Incontinence can be a symptom of both IC and OAB. It refers to the involuntary leakage of urine that occurs when there is a sudden urge to urinate. This can be particularly distressing for individuals, leading to social embarrassment and anxiety.

In your case, the symptoms you describe—such as the feeling of bladder fullness, urgency, and discomfort—could suggest a diagnosis of IC or OAB. The fact that you experience increased urgency with certain activities or positions, as well as the discomfort during sexual activity, further supports this possibility. Additionally, your history of anxiety and autonomic nervous system dysregulation could contribute to your urinary symptoms, as stress and anxiety can exacerbate bladder issues.

Management and Treatment Options:
1. Lifestyle Modifications: Reducing caffeine and alcohol intake, which can irritate the bladder, may help alleviate symptoms. Staying well-hydrated is essential, but it’s also important to find a balance that prevents excessive urgency.

2. Bladder Training: This involves gradually increasing the time between urination to help train the bladder to hold more urine and reduce urgency.

3. Medications: Anticholinergic medications are commonly prescribed for OAB to help reduce urgency and frequency. For IC, medications like pentosan polysulfate sodium (Elmiron) may be used to help restore the bladder lining.

4. Physical Therapy: Pelvic floor physical therapy can be beneficial for individuals with bladder pain or discomfort, as it addresses muscle tension and dysfunction in the pelvic region.

5. Alternative Therapies: Some patients find relief through acupuncture, dietary changes, or herbal supplements, although these should be discussed with a healthcare provider.

6. Cystoscopy and Biopsy: If symptoms persist, a urologist may recommend cystoscopy to visually inspect the bladder and possibly perform a biopsy to rule out other conditions.

Given your symptoms and concerns, it would be advisable to consult a urologist, especially since you have been experiencing these issues for an extended period. They can provide a thorough evaluation and tailor a treatment plan specific to your needs. While the ongoing pandemic may cause hesitation in seeking care, many healthcare facilities have implemented safety protocols to minimize the risk of infection.

In conclusion, while your concerns about interstitial cystitis are valid, a comprehensive evaluation by a specialist will provide clarity and help determine the best course of action for managing your symptoms effectively.

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