Intra-Vesical Bladder Instillation Therapy for Bladder Pain Syndrome

Intra-vesical bladder instillation therapy for Bladder Pain Syndrome.

What is Bladder Pain Syndrome?

Bladder Pain Syndrome (BPS) is a long term (chronic) condition associated with inflammation of the bladder wall. It affects more women than men across all age groups and ethnicities. It can cause:  Lower abdominal pain.  Urinary frequency – passing urine more than 8 times a day.  Urinary urgency.  Pain and burning when passing urine.  Reduced bladder capacity.

Research suggests that causes of the condition include:  Non-bacterial infections in the bladder.  Damage to the lining cells of the bladder.  Irritants in urine.  Nerve disorders and/or auto immune diseases.

The management of BPS can be very challenging for both the patient and the Urogynaecology team. However, effective treatments for BPS are available. One of these treatments is intra-vesical bladder instillations. Intra-vesical therapy is becoming one of the most effective treatments for BPS in the UK.

What is an intra-vesical bladder instillation?

This is a medicine in liquid form that is administered into the bladder via a catheter. There are several different types of solution that can be inserted into your bladder; they can provide temporary relief from bladder symptoms, but with repeated instillations, longer term benefits can be seen.

How does it work?

One of the most popular theories in the aetiology of BPS is a defect or damage to the GAG layer (glycosaminoglycan), which is the protective layer of the inside of the bladder. The aim of the instillation is to replace or replenish this GAG layer. This repairs the protective layer and reduces the permeability of the lining of the bladder to potassium ions, believed to cause BPS bladder pain, urgency and frequency.

How is the treatment given?

At your initial appointment you will be asked to provide a brief past medical history and to complete a Kings Health questionnaire (KHQ), to allow us to gain knowledge of your baseline symptoms and pain score. You will be asked to pass urine prior to treatment. A Nurse will pass a thin tube called a catheter through your urethra (the tube that urine travels through from your bladder to leave your body) into your bladder. The catheter will be lubricated with a local anaesthetic gel to help reduce discomfort.

Any remaining urine will be drained away from the bladder. The solution will then be administered through the catheter and into the bladder. The catheter will then be removed. You will need to keep the solution in your bladder for a minimum of half an hour and a maximum of 4 hours. You should therefore try not to pass urine for at least half an hour after the instillation is performed; if you are unable to tolerate this, the treatment may not work as effectively as it should. You can go home straight after the instillation. Try not to drink a lot of fluid prior to your instillation – this will enable you to hold the solution for longer, which in turn will improve effectiveness.

How many treatments will I have?

You will be given an instillation every week for 4 weeks, then 2 further treatments fortnightly, then a further 2 treatments 3 weekly. After your 8th instillation your pain, frequency and urgency symptoms will be reviewed and you will be asked to complete a 2nd KHQ. Once your symptoms are under control, the treatment regime is tailored to the specific need of each patient ranging from once every 3 weeks to every 2-3 months. Not all patients need to go onto a maintenance protocol and some BPS patients can have a relatively prolonged remission with this therapy. If your symptoms have not been significantly improved with the initial course, an appointment will be made to see your consultant to discuss other treatment options.

Are there any side effects?

There are no specific side effects noted for these instillations, however the catheterisation can cause minor discomfort and there is small chance of developing a urinary tract infection.

Why a bladder instillation?

The advantages of instillations are the following:  High concentration of drug at target location.  Fast symptom relief.  High response rate.  Minimum side effects.  Outpatient treatment.

Are there any alternatives?

There may be other treatment options – this depends on your individual circumstances. Alternatives may include oral (taken by mouth) medicines, including anti-inflammatory medicines, antispasmodics, antihistamines and muscle relaxants. These medicines have been found to be effective in controlling some symptoms of BPS. Your consultant will discuss these with you in more detail if they are appropriate, however you may have already tried some of these without success.

Useful sources of information.

The Cystitis and Overactive bladder Foundation UK, is a charity that provides information and support to sufferers of bladder problems. www.cobfoundation.org

The Bladder and Bowel Foundation is the UK wide charity for people with bladder and bowel control problems. It provides information and support services. www.Bladderandbowelfoundation.org