Is there an appropriate strategy for treating co-morbid irritable bowel syndrome and bladder pain syndrome?

Introduction: Many clinicians have suggested that a history of bladder and bowel dysfunction (BBD) in childhood predisposes to the development of interstitial cystitis/bladder pain syndrome (IC/BPS) or irritable bowel syndrome (IBS) in adulthood. We hypothesized that BBD symptoms in childhood would predict the IBS-associated phenotype in adult IC/BPS patients.Methods: Consecutive female patients (n=190) with a diagnosis of IC/BPS were administered a modified form of a clinical BBD questionnaire (BBDQ) to capture childhood BBD-like symptoms, as well as Interstitial Cystitis Symptoms Index (ICSI), Interstitial Cystitis Problem Index (ICPI), Pelvic Pain and Urgency/ Frequency (PUF) questionnaires and UPOINT categorization. Patients were stratified to IBS-positive or IBS-negative according to clinical assessment of IBS-like symptoms.Results: The 127 patients (67%) identified with IBS-like symptoms recalled significantly higher BBDQ scores than the 63 patients (33%) who were IBS-negative (2.8 vs. 2.3; p=0.05). The IBS-positive patients also reported a higher number of UPOINT domains than their non-IBS counterparts (3.8 vs. 2.9; p=0.0001), while their PUF total scores were significantly higher (13.6 vs. 12.3; p=0.04). IBSpositive patients more often recalled that in childhood they did not have a daily bowel movement (BM) (p=0.04) and had “to push for a BM” (p=0.009). In childhood, they “urinated only once or twice per day” (p=0.03) and recalled “painful urination” more than those without IBS (p=0.03). There were no significant differences between the groups in answers to the other five questions of the BBDQ.Conclusions: Our symptom recollection survey was able to predict the IBS phenotype of IC/BPS based on a childhood BBDQ. Further prospective studies are needed to further evaluate these novel findings.

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Peripheral, Central, and Cross Sensitization in Endometriosis-Associated Pain and Comorbid Pain Syndromes

Frontiers in Reproductive Health ◽

10.3389/frph.2021.729642 ◽

2021 ◽

Vol 3 ◽

Author(s):

Helen C. McNamara ◽

Helena C. Frawley ◽

Jacqueline F. Donoghue ◽

Emma Readman ◽

Martin Healey ◽

...

Keyword(s):

Irritable Bowel Syndrome ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Peripheral Sensitization ◽

Organ Function ◽

Local Effects ◽

Pain Mechanisms ◽

Bladder Pain ◽

Pain Syndromes ◽

Irritable Bowel

Endometriosis-associated pain and the mechanisms responsible for its initiation and persistence are complex and difficult to treat. Endometriosis-associated pain is experienced as dysmenorrhea, cyclical pain related to organ function including dysuria, dyschezia and dyspareunia, and persistent pelvic pain. Pain symptomatology correlates poorly with the extent of macroscopic disease. In addition to the local effects of disease, endometriosis-associated pain develops as a product of peripheral sensitization, central sensitization and cross sensitization. Endometriosis-associated pain is further contributed to by comorbid pain conditions, such as bladder pain syndrome, irritable bowel syndrome, abdomino-pelvic myalgia and vulvodynia. This article will review endometriosis-associated pain, its mechanisms, and its comorbid pain syndromes with a view to aiding the clinician in navigating the literature and terminology of pain and pain syndromes. Limitations of our current understanding of endometriosis-associated pain will be acknowledged. Where possible, commonalities in pain mechanisms between endometriosis-associated pain and comorbid pain syndromes will be highlighted.

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Optimising the management of bladder pain syndrome

Journal of Clinical Urology ◽

10.1177/2051415820954738 ◽

2020 ◽

pp. 205141582095473

Author(s):

Waleed Al-Singary ◽

Reena Patel ◽

Ujjal Sarkar ◽

Hiten RH Patel

Keyword(s):

Pain Control ◽

Symptomatic Relief ◽

Pain Syndrome ◽

Skin Lesions ◽

Bladder Pain Syndrome ◽

Pain Clinic ◽

Level Of Evidence ◽

Bladder Pain ◽

Irritable Bowel ◽

Good Pain Control

Objective: Clinicians have shown variable practice in the diagnosis and management of bladder pain syndrome (BPS). This study assessed pain localisation sites, common co-morbidities, investigations and treatment patterns in clinical practice. Patients and methods: We performed a retrospective analysis of 412 patients attending our pelvic pain clinic between 2004 and 2016. Frequency counts were used to summarise findings. Results: Pain in women ( N=388) was localised to the lower abdomen (92.0%), lower back (71.1%) and vagina (60.8%). Men ( N=24) typically presented with testicular pain with painful ejaculation (70.8%). Nearly all (95.4%) patients reported sexual dysfunction. Visceral neuropathic pain and autoimmune co-morbidities, such as irritable bowel syndrome, chronic headaches or migraines and skin lesions, were more prevalent in our cohort than in the general population. All patients had urine culture and sensitivities and flexible cystoscopy. Laparoscopy, urodynamic studies and bladder biopsies were mostly normal, but were essential in excluding other pathologies. Good pain control was achieved on amitriptyline (83.0%). Hydro-distension and benign bladder ulcer cauterisation provided temporary symptomatic relief. Conclusion: This study demonstrates that patient expectation management and education is essential in BPS, with most achieving good pain control with conservative measures and amitriptyline. Those receiving intravesical treatments will most likely require subsequent revisions. Level of evidence: Not applicable for this single-centre audit.

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Partners in Crime: NGF and BDNF in Visceral Dysfunction

Current Neuropharmacology ◽

10.2174/1570159x17666190617095844 ◽

2019 ◽

Vol 17 (11) ◽

pp. 1021-1038 ◽

Cited By ~ 4

Author(s):

Ana Coelho ◽

Raquel Oliveira ◽

Tiago Antunes-Lopes ◽

Célia Duarte Cruz

Keyword(s):

Chronic Pelvic Pain Syndrome ◽

Pain Syndrome ◽

Bladder Pain Syndrome ◽

Pelvic Pain Syndrome ◽

Bladder Tissue ◽

Bladder Pain ◽

Clinical Biomarkers ◽

The Subject ◽

Irritable Bowel ◽

Urodynamic Parameters

:Neurotrophins (NTs), particularly Nerve Growth Factor (NGF) and Brain-Derived Neurotrophic Factor (BDNF), have attracted increasing attention in the context of visceral function for some years. Here, we examined the current literature and presented a thorough review of the subject.:After initial studies linking of NGF to cystitis, it is now well-established that this neurotrophin (NT) is a key modulator of bladder pathologies, including Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS. NGF is upregulated in bladder tissue and its blockade results in major improvements on urodynamic parameters and pain. Further studies expanded showed that NGF is also an intervenient in other visceral dysfunctions such as endometriosis and Irritable Bowel Syndrome (IBS).:More recently, BDNF was also shown to play an important role in the same visceral dysfunctions, suggesting that both NTs are determinant factors in visceral pathophysiological mechanisms. Manipulation of NGF and BDNF improves visceral function and reduce pain, suggesting that clinical modulation of these NTs may be important; however, much is still to be investigated before this step is taken.:Another active area of research is centered on urinary NGF and BDNF. Several studies show that both NTs can be found in the urine of patients with visceral dysfunction in much higher concentration than in healthy individuals, suggesting that they could be used as potential biomarkers. However, there are still technical difficulties to be overcome, including the lack of a large multicentre placebo-controlled studies to prove the relevance of urinary NTs as clinical biomarkers.

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