Pain in IC Overview
* The pain of IC has often been compared to the pain of childbirth. It is intense, and at times, unremitting. It can be felt as a burning or stabbing pain in the bladder, or dull pressure in the entire pelvic region. There may be painful bladder spasms and a pain cascade that starts in the bladder and moves to other areas. At times the entire body is involved in this cascade leading to the expression, “even my skin hurts”.
* When in intense pain, the body descends into a primitive mode involving the limbic system. Strong emotions come to the forefront and the thinking part of the brain recedes. Depression and perhaps even thoughts of suicide may result. Getting and keeping intense pain under control is essential.
* Understanding the various mechanisms that cause pain in IC is the key to determining what triggers pain in an individual. Pain definitely varies from person to person and even within the same individual at different times. There are multiple triggers that cause pain and multiple mechanisms of pain. Some triggers may cause a slight burning pain, while others may start a spasmodic attack leading to intense pain and involving the entire body.
* The glycosaminoglycan (GAG) layer of the bladder is damaged in IC and allows normally innocuous substances to penetrate deeper layers of the bladder (connective tissue, muscle). These substances trigger nerve endings that are close to mast cells (immune system). Nerve endings send out pain messages through the use of substance P and trigger mast cells to release their toxic elements (degranulate). The contents of mast cells cause additional pain, inflammation, muscle spasms and trigger more nerve endings. A vicious cycle ensues in which pain intensifies and additional nerve endings and mast cells are created.
* There are various agents that can trigger either nerve endings in the bladder, mast cells or both. These agents are estrogen, allergens, food substances, urine, specific neurotransmitters (nerve messengers), certain amino acid (protein components), bacteria, yeast, certain drugs, cold, pressure, some vitamins, mechanical jarring, mold, stress, environmental toxins and sex.
* If left untreated, the pain response can become heightened requiring fewer stimuli to achieve the same level of pain. It is as if the nervous system becomes “rewired” to the state of pain as the norm. This is called “plasticity”. However, once the pain cycle is broken, the heightened pain awareness can be reprogrammed back to a more normal level.
* Breaking the pain cycle is a vital element of improving IC and preventing multiple inflammatory disorders that can arise from IC.