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Men with Interstitial Cystitis / Bladder Pain Syndrome – What to do

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Men with Interstitial Cystitis / Bladder Pain Syndrome

 

man IC
About 6 weeks ago I saw a pleasant 28 year old male at the clinic , we will call him John, with Interstitial Cystitis / Bladder Pain Syndrome (IC/BPS). Admittedly, I have seen about a handful of cases of men with IC / BPS since this condition often affects women.

What is Interstitial Cystitis / Bladder Pain Syndrome (IC /BPS)?

IC / BPS is a condition with chronic inflammation of the bladder causing pain in the lower abdominal and pelvic area. Pain is accompanied with urinary urgency and frequency.

In about 5% of patients a physician would find ulcers in the inner lining of the bladder with a cystoscopy. But this is rarely the case which makes this condition very difficult to diagnose.

What should you do if you are a man with IC / BPS?

First, realize and accept that there is no perfect way of diagnosing IC/BPS. And this is the frustration for both you and your doctor. There are no biomarkers to distinguish IC/BPS from prostatitis or urethritis. In fact, the symptoms of IC /BPS and prostatitis are very similar to each other.

So here’s how I learn to distinguish IC /BPS from prostatitis in men

First of all, once an infection is ruled out, there is no lab test that can help with a diagnosis.
Figuring out the problem with  the patients clinical presentation, medical history and physical exam is all there is.

Cystoscopy with hydraulic distention of the bladder in males appears to be the technique most commonly used to diagnose IC in this population.

With IC / BPS there is constant pain below the umbilicus that comes and goes. It often flutters. This pain is accompanied by urinary urgency and frequency.

No urinary problems means no IC in men.

With prostatitis the pain is experienced in the area between the testicles and anus (perineum) and is also accompanied with urinary symptoms.

No urinary symptoms and only pain present means it is not prostatitis and likely only pelvic pain.

Sometimes there is only penis or testicular pain. But when performing a prostate exam the pain in the testicle or penis gets worse. The pain on the prostate is also pretty bad.  These patients have chronic, non-bacterial prostatitis.

Only penis pain is often diagnosed as urethritis.

Only testicular pain is often diagnosed as just that – chronic testicular pain.

Causes Interstitial Cystitis / Bladder Pain Syndrome in men
My patient John was abusing a recreational drug known in the streets as Special K.  Special K is made from Ketamine, a schedule three drug used in human anesthesia and veterinary medicine.
Special K is very short acting hallucinogen with effects lasting sixty minutes when inhaled or injected and up to two hours when ingested, the total experience lasting no more than a couple of hours.
Special K is known to damage the bladder wall and cause pain and urinary problems. (Tsai TH et al. 2009)
John’s case was interesting in that; he was an America male in his upper 20’s and Special K is most common amongst teenage Asian girls.
Ketamine is also used in humans in emergency medicine as a pain killer or for respiratory problems. There again bladder pain can be induced when Ketamine is used legally for medical purposes.

Natural Treatment Options for men with Interstitial Cystitis / Bladder Pain Syndrome

De-Stress – you know stress makes pain worse. Stress tightens muscles in the around the pelvic area and bladder making pain worse. Read and practice meditations from Jon Kabat Zynn. There’s also a phone App that helps with stress called Headspace.

Have an outlet. Guys are notorious for ‘holding things’ in. Physical exercise that includes boxing on punching bags helps to release tension.

Try Acupuncture – Collectively there has been more than 400 subjects studied for prostatitis showing efficacy with acupuncture.

The right combination of phytotherapy can reduce inflammation and reduce symptoms without side effects. Natural agents to consider include: quercetin, curcumin and rye pollen extract. By reducing inflammation naturally you can also benefit from other health problems since IC /BPS is almost never experienced alone. Most sufferers also have Irritable Bowel Syndrome (IBS), fibromyalgia or some other autoimmune disease.

Some foods can be a problem. Typically these include; tomato’s, caffeine, citrus fruits and juices and wine. I find wheat and gluten can also be a trigger for many.

The trick is to work on all of these together. Monotherapy fails with the treatment of IC / PBS. Throw the ‘kitchen sink’ at this thing for relief.

 

Reference:
Tsai TH, Cha TL, Lin CM, Tsao CW, Tang SH, Chuang FP, Wu ST, Sun GH, Yu DS, Chang SY. Ketamine-associated bladder dysfunction. Int J Urol. 2009 Oct;16(10):826-9.

Helpful Resources:
http://www.ic-network.com/
http://www.ichelp.org/

http://www.prostate.net/

 

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by Dr. Geo

4 comments… add one

  • So glad that “John” made it to your office. I think I might have referred him to you!

    Ketamine cystitis has been a passion of mine and we offer the ONLY support for patients on the web. We have a dedicated website – http://www.ketaminecystitis.com

    But I also just added ketamine cystitis to the ICN under “related conditions”

    BTW… I worked with a very serious case of KC last week. This 24 year old male had been given increasing doses of ketamine over a two year period for the treatment of headache pain. When the bladder symptoms emerged, a diagnosis of IC was made and the connection was not made until irreversible damage occurred. He’s had his ureters shortened and moved to relocate the diseased section. He has acute, intractable ulceration of the bladder wall. But the saddest of all is that he’s also been diagnosed with a brain injury, also the result of the ketamine. Research emerged in 2010 demonstrating that brain damage can and does occur with prolonged ketamine use. All because it was prescribed at a time when doctors just didn’t understand the risks. In his case, they are now exploring augmentation or cystectomy.. which is very very sad indeed.

    We need more data on the incidence of ketamine cystitis in the USA. I’d like to do that but we just don’t have any funds for research.

    Reply
    • Thank you for sharing Jill. It’s one thing when Ketamine is used as a recreational drug but when the damage is caused from it being medically prescribed, that’s more of an unfortunate scenario. In my talks worldwide to practitioners on the subject, this is a major point I raise as awareness is key here.

      Reply
  • Gene ,

    You did not mention Pelvic Floor Dysfunction, and how physical therapy can help. Try reading Heal Pelvic Pain by Amy Stein or Heal Male Pelvic Pain

    Reply
    • Hi, Thank you for your comment. Yes, Amy Stein’s book and Isa Herrera’s book Male Pelvic Pain are excellent sources. Physical therapy was beyond the scope of the particular blog post. Thank you though and very good point.

      Reply

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