Bladder Pain

Bladder pain is mostly a dull ache and is usually localized to the suprapubic region. The most common causes of pain are bladder distention by obstruction and cystitis. Bladder distention accompanied by acute or chronic inflammation is manifested as severe suprapubic spasmodic pain, urinary frequency, and dysuria. Treatment of the cause of inflammation (e.g., obstruction, stone, enlarged prostate, vesicoureteral reflux) is the treatment of choice for pain. Untreated cystitis may result in upper urinary tract infection. Pregnancy, diabetes mellitus, and immune deficiency are additional risk factors.

Interstitial cystitis is a condition with unknown cause that frequently poses a challenge to physicians. The pathologic features of interstitial cystitis are nonspecific chronic inflammatory infiltrates, edema, and vasodilatation. Suprapubic pain is due to bladder spasm or uncoordinated detrusor muscle contraction. Suprapubic pain and the frequency of micturition may become so incapacitating that cystectomy may be required in extreme cases. Options for pain control include bladder denervation (rhizotomy), transurethral electrocautery, cystolysis, presacral nerve blocks, and neurolytic blocks. Medical management includes antihistamines, corticosteroids, anticholinergics, and calcium channel blockers.^{[237] [238]}