If simple treatments don’t help, your doctor may suggest seeing a urologist, gynaecologist or pain specialist for further tests or treatments.
Depending on your particular symptoms, these tests might include:
- An ultrasound of your bladder and pelvis
- A Cystoscopy which allows your doctor to see inside the bladder
- Urodynamics which investigates how the bladder functions when it fills and empties. This is usually only necessary if simple treatments haven’t worked for you or you have other bladder problems as well as pain.
- An MRI scan. This is only necessary when looking for rare types of pain such as a urethral diverticulum (pocket in the urethra).
Blood tests are not usually necessary.
How is a cystoscopy done and what can it show?
At a cystoscopy, a small telescope is inserted through the urethra (opening where urine comes out) up into the bladder. A cystoscopy can show some types of pain, such as stones or growths, but may still be normal in Painful Bladder Syndrome.
A cystoscopy can be done while you are awake, or asleep under general anaesthesia.
If done while you are awake, it is called a flexible cystoscopy. Your doctor will use a local anaesthetic gel to numb the urethra.
If done while you are asleep, it is called a rigid cystoscopy. In this situation the cystoscopy may be combined with a bladder stretch procedure (hydrodistension) or with a small sample of the bladder wall removed (biopsy). It can also show how much urine your bladder can hold. This may be less than usual in people with Bladder Pain Syndrome. Sometimes a cystoscopy done while you are asleep shows small bleeding points in the wall of the bladder called glomerulations, or ulcers in the bladder wall.
What if the cystoscopy is normal?
This can happen. It doesn’t mean that your pain is not real. There are many pains that can’t be seen. Bladder pain is diagnosed on your symptoms, not what his found at a cystoscopy. You will have the same chance of responding to treatments as anyone else with pain.
Depending on your particular symptoms, your doctor may recommend:
- Less common medications for bladder pain
- Cystoscopy and hydrodistension (bladder stretch) under anaesthesia with diathermy (cautery) of any ulcers found
- Pelvic Physiotherapy. This is particularly useful where there is spasm or tensing of the muscles around the bladder, making the bladder pain worse. This can happen without you realising the muscles are tight. There is information on the management of pelvic muscle pain on other pages on this site.
- A bladder installation (intravesical treatment). Soothing medicine is inserted into the inflamed painful bladder through a small catheter inserted through the urethra into the bladder. This can be done in the doctor’s office or treatment centre. If you find it helpful, you doctor may teach you how to do this at home. A common plan for installation might include installation once a week for 6 weeks, with top-up treatments when your problems return.
- Other treatments depending on your personal situation
Over time, your bladder pain may change and need different treatments. You can expect that there will be times when the pain is easier to manage than others. It may even go away altogether for months or years at a time – then come back at a time when you are stressed or run-down. Treatments are always improving and evolving. Even if a particular treatment hasn’t worked for you in the past, there may be newer treatments that suit you well.
It is important to work together with your doctors to find the treatments that suit you best.