Adult and Pediatric Urology
OUr urologists follow a standard approach to patients with interstitial cystitis or chronic pelvic pain syndrome (IC/CPPS). IC/CPPS is called a diagnosis of exclusion, which means that we must rule out other potential causes of the symptoms before we can conclude that a patient has IC/CPPS. Our approach ensures that we do not overlook other causes for the symptoms and emphasizes less invasive treatments and non-pharmacological treatments as the first line of treatment. We also are willing to utilize long-term drug therapy in patients with more severe chronic pain. We believe that our approach to treating these problems in men and women improves the chances of long-term improvement or resolution of their symptoms with the least risk of sede effects or error in diagnosis.
The first step in the evaluation of patients with chronic pelvic pain is reaching a correct diagnosis. This mostly involves ruling out other conditions that might cause pelvic, bladder or genital pain, including infection, urinary stone disease, bladder cancer, endometriosis, problems with the uterus or ovaries in women, prostate problems in men, or other conditions. The correct diagnosis can require several different types of tests, including urine culture, cytology, CT scan, cystoscopy, prostate ultrasound, and other tests. Conditions identified during the testing are treated to see if the pain and other symptoms will go away. Men who have not received antibiotics before are usually treated with 6 weeks of antibiotics for possible prostate infection. After a thorough evaluation has been completed a patient may be given the diagnosis of IC/CPPS, and treatment of this chronic pain condition is started. Click here to read more about testing for IC/CPPS.
Another part of the first step of our approach to IC/CPPS is control of severe pain. This initially includes the use of short-acting narcotics if necessary because control of pain allows patients to evaluate their symptoms, continue to work and perform other important daily activities, and break the cycle of severe pain.
The second step of treatment of IC/CPPS involves the use of non-medical treatment options for pain and symptom control. These can include dietary changes, over-the-counter anti-inflammatory medications such as Tylenol or Advil, use of natural products such as quercitin or saw palmetto extract, stress relief, and pelvic floor therapy. Safe medical therapy may also be offered to help with urinary symptoms such as frequent urination or burning with urination. Patients are usually seen monthly during the first few months for assessment of their symptoms to see if the treatments are working. Click here to read more about pelvic floor therapy and pelvic floor dysfunction (PFD).
Patients who have severe pain or pain that does not respond to other treatments may consider medical or surgical treatments. Many patients can get good long-term pain relief from medical therapy, which may include the use of anti-depressant medication for pain control, Elmiron to treat the bladder changes of IC, and anti-histamines to control bladder inflammation. Patients with IC may get faster relief of pain from direct instillation of medication into the bladder. Some patients will get pain control from medications for neuropathy such as gabapentin or Lyrica. Many patients can get temporary relief from bladder distention, and others will get relief from instillation of medication (i.e. clorpactin, capsaicin) into the bladder under anesthesia.
Many patients will also get good pain control from the use of long-acting narcotics such as oral morphine or methadone. We believe that narcotics should be used only when necessary, but we also believe that chronic pain has a severe impact on physical and mental health, and severely affects quality of life. Narcotics can be a very important part of the treatment plan if they allow men and women to resume activities that are important to them, such as work, exercise, and sexual relations. Patients who do not respond adequately to initial treatments may be offered other advanced treatments, including sacral nerve root stimulation or Botox injections into the bladder, and men may be offered minimally-invasive prostate treatments.
Our doctors are willing to committ the time to help each patient find the treatment plan that works best for him or her, and will also refer patients who do not respond to initial treatments to specialists at Stanford Medical Center for a second opinion and consideration of investigational treatment options.