Cystoscopy is performed to exclude other bladder pathology including carcinoma in situ and other malignancy. In the office, cystoscopy under local anesthesia is usually normal in IC. However, cystoscopy and hydrodistention under anesthesia have more of a therapeutic than diagnostic role, because the presence of glomerulations is not specific and their absence does not exclude the diagnosis of IC. A full cystoscopic examination of the bladder is performed first. We use water as a cystoscopic irrigant. Water is infused at a pressure of 80 cm of water weight into the bladder until filling stops. Diminished bladder capacity under anesthesia can be seen in patients with advanced forms of IC. The bladder is distended for 2 to 5 minutes before all irrigant is released from the bladder. Terminal bloody efflux of irrigant suggests the diagnosis of IC. The bladder is then reexamined cystoscopically. The appearance of glomerulation (petechiae) and/or Hunner's ulcers, which appear as fissures or cracks in the epithelium, are consistent with IC. The appearance of Hunner's ulcers is not common in IC (11%), although it has been suggested that its presence is a more specific sign than glomerula-tion.34 The diagnostic specificity of appearance of post-distention glomerulation is in question, because it is seen in some normal controls after hydrodistention. Hunner's ulcers are significantly associated with reduced anesthetic bladder capacity, pain, urgency, and frequency, whereas glomerulations are not.

Hydrodistention has a therapeutic role, because it can relieve the IC symptoms in 30% to 50% of patients.35 A dramatic reduction in pain, frequency, and urgency can occur after hydrodistention in these patients. It was found that the mechanism underlying this reduction may be attributed to a placebo effect or it may deplete substance P from C nerve fibers. However, in one of the studies, a normalization of urine growth factor abnormalities and APF was seen after hydrodistention.36

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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