Interstitial Cystitis/Bladder Pain Syndrome (ISC/BPS)

Our department deploys a dedicated team for patients with Interstitial Cystitis/Painful Bladder Syndrome within the Female Lower Urinary Tract Symptom (LUTS) Clinic. We try to provide a holistic approach where we address also gynaecological, metabolic, psychological and general quality-of life issues. Our main target is to reduce or eliminate the bladder-related pain in a quick and effective way.

This is a condition defined by long lasting pain or pressure or discomfort, which is perceived to be related to the bladder and accompanied by persistent urgency and/or frequency.
In other words, this kind of bladder condition is characterized by bladder-related pain which can be intermittent or permanent and shows also functional disorders like painful urge/ urge-incontinence or disturbing frequency, also overnight.

It is estimated that 2.7 to 6.5% of the female population in the US suffer from the condition, but only around 9.5% receive the correct diagnosis. This is partially due to the complexity of this syndrome, as it has numerous ramifications in emotional, sexual, social disorders. (e.g. depression, partner-problems, job-loss) and shares common symptoms and findings with other diseases, such as bacterial bladder-inflammation (bacterial cystitis), gynaecological conditions (e.g. endometriosis) or, in rare cases, bladder-cancer. There is also a significant number of ICS-patients who also suffer from IBS (irritative bowel syndrome), autoimmune diseases or fibromyalgia.

We explore the medical history, medication, psychological status, social setting, all of which can deliver important details regarding ISC.

We ask our patients to fill out a fluid chart and a symptom score in order to evaluate the bladder function and the pain/discomfort level.

A urine test checks potential bacterial inflammation and/or the presence of blood in the urine. Under certain circumstances blood tests follow en suite. Urine-flow test and bladder Ultrasound give us further information about the bladder function. A cystoscopy is an investigation with an endoscopic camera which is carefully inserted into the bladder under local anaesthesia in order to rule out bladder stones, specific inflammations or bladder-tumours.

All our patients receive counselling with regards to life-habits: sleep hygiene, avoidance of carbonated or alcoholic beverages, and of certain foods, such as bananas, tomatoes, spicy dishes, sweeteners or large amounts of Vitamin C. According to our findings we can offer a large array of pharmaceuticals, physio-therapies,
bladder-distension under general anaesthesia with fulguration of bladder-ulcers, Botox injections in the bladder wall.

Patients who require specific neuro-urological treatment with nerve-stimulation via electrodes will be referred to our partner-clinics in London.

In the case of bacterial inflammation we can also deploy non-antibiotic substances such as D-Mannose or Hipprex.

One important therapy module which I would like to emphasize here is the Bladder-Instillation Therapy with Hyaluronate, a substance which mimics the bladder mucus.

This therapy was devised in the early 1990s under the pretext to find a substance that can help to avoid the attachment of bacteria at the bladder wall.

The so-called GAG-layer was found, a mucus-like substance which clads the bladder from inside, and indeed hinders adherence of bacteria.

In the following years it was shown that women with recurrent bladder inflammations and with ISC often have a GAG-deficiency.

Several substances have been found which can replace the deficient GAG-layer and the application via catheter provides a highly efficient therapy without distribution over the bloodstream.

In other words, the therapeutic substance is instilled into the bladder with a little catheter (which will be removed immediately after the application) and does not need to travel through the whole gastro-intestinal – and bloodstream-system in order to reach finally the organ of interest which is the bladder.