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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35471
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I have a small bladder and go the loo a lot at night also

Customer Question

Hi I have a small bladder and go the loo a lot at night also get a lot of stomach pain from it and get pain from my fribromyalgia. so not sleep at night only getting 2 hrs sleep if that. can you help me with this please.
Submitted: 4 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 4 years ago.

Greetings Lucy.

I am sorry about your significant symptoms.

Fibromyalgia too can cause sleep disturbances apart from increased frequency of urination due to small bladder. The treatment of fibromyalgia is comprehensive and a single guideline for an individual is difficult to make. The treatment has to be individually tailored;

1) Aerobic exercise; low-impact aerobics, walking, water aerobics, stationary bicycle.

2) Heat, massage, and other treatments like sauna, hot baths and showers, hot mud, and massage.

3) Trigger-point injections,

4) Acupuncture,

5) Chiropractic manipulation,

6) Myofascial release

7) Neural pulse stimulation (CNP) device

8) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT)

9) Relaxation training and biofeedback

10) Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen

11) Opioid analgesics (hydrocodone, oxycodone, fentanyl, morphine),

12) Anxiolytics/hypnotics

13) Estrogen receptor modulator raloxifene

14) St. John's wort, ginseng, valerian, botanical oil, melatonin, magnesium, dehydroepiandrosterone

A combination of above is tried for an individual to relieve the symptoms.

The goal of fibromyalgia treatment is to improve the physical and mental health and quality of life. This goal implies helping manage distressing symptoms, but with decreased dependence on the medical care system. The common recommendations of education, exercise, and pharmacotherapy are often appropriate. Comorbid conditions, such as arthritis and obesity, should be treated because they can contribute to increasing physical and mental symptoms. In fibromyalgia; you are best person to guide your physician, as there are no set rules or standard of protocol which can be effective. The treatment which have been best and efficacious for you in past can be repeated. Because medical therapy is unsatisfactory, patients find their way to alternative therapies. Some of these therapies may be helpful to individual patients, such as massage, water therapy, spa treatment, and acupuncture. So, your decision to choose them supersede the physician's recommendations. The research, in addition to the clinical experience, indicates that the addition of education and a behavioral or cognitive-behavioral component to fibromyalgia treatment protocols is warranted. A combination of the Patient Education, Cognitive-Behavioral Therapy, Relaxation Techniques, and Complementary and Alternative Medicine is suppose to bring the best outcome in quality of life.

For the management of the fibromyalgia using the principles of comprehensive nonpharmacologic pain management represented by the acronym ExPRESS; has been suggested.

1) Ex is for exercise.

2) P is for psychiatric comorbidity, because depression and anxiety disorders are common in chronic pain conditions and contribute significantly to pain and disability.

3) R is for regaining function; this often involves helping patients with activity pacing so that they do not do too much on days when they feel good and do too little on days when they feel bad.

4) E is for education; Web sites hosted by the Arthritis Foundation and the National Fibromyalgia Association are the best education sites.

5) S is for sleep hygiene, which is necessary for many who have developed counterproductive habits.

6) Finally, S is for stress management, which includes any number of elements, such as CBT, relaxation techniques, hydrotherapy, and gentle exercise to name just a few.

The helpful measures for sleep are;

1) Mild exercise in evening.
2) Acupuncture
3) Melatonin
4) Valerian root
5) Avoid caffeinated beverages in the late afternoon or evening
6) Avoid large meals near bedtime,
7) Avoid alcohol
8) Relaxation techniques
9) Meditation
10 Yoga.

This is a link for OTC sleep medications;

The small bladder may need surgery to increase its capacity. There is a prescription medication called as ProBanthine, which may help in decreasing the night frequency of urination. I would also suggest cystoscopy (camera exam) if not yet done to rule out Interstitial cystitis for your increased frequency of urination. Following measures also can help in decreasing the urinary frequency;

1) pelvic floor relaxation techniques; biofeedback, hypnosis, meditation, yoga
2) trial of antimuscarinic therapy
3) neuromodulation
5) Medications;
a) anesthetics,
b) antispasmodics,
c) muscle relaxants, and
d) alpha-blockers

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

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Customer: replied 4 years ago.

already having treatment for my bladder have been for about 5 week now only one more left to go. having a catheter but in and something put in my bladder have to leave in for 30 mins then go loo but so far it doesn't seem to be working just giving me more stomach pain then I already had. dealing with is bad enough but and can cop to a point its just the not sleeping all night then having to go to work or on my day off being in that much pain and that tried that don't feel like or have angry to do anything and feel like people for ex my family don't understand they just think I am being lazy. I have tried some of thing you talk about for then pain I get but only thing that really helps in any way at all it heat.

Expert:  Dr. Arun Phophalia replied 4 years ago.

Hello Lucy,

I can understand your symptoms and severity. Your symptoms are suggestive of interstitial cystitis (IC). The cause of interstitial cystitis is not very clear. It is though that bladder muscles or the nerves in the bladder or the central nervous system become too sensitive and this causes the increased frequency or the pain. The internal lining of the bladder in IC changes and this change can be primarily responsible for the symptoms or the change is secondary to other problems like Antiproliferative factor (APF), which changes the bladder.

Pentosan polysulfate sodium is an oral medication that is suppose to repair the lining of the bladder in people with IC.

Bladder instillation medications like lidocaine, heparin or pentosan polysulfate sodium, and sodium bicarbonate helps to repair the bladder lining and decrease nerve sensitivity in the bladder. This is being done for you, already.

Amitriptyline and gabapentin are to reduce to pain of the bladder spasm

Surgery entails either a new bladder reconstruction or destruction of the nerves in the internal lining of the bladder.
Following is the comprehensive treatment protocol;

1) Medications;

a) Medications to improve bladder lining; Pentosan polysulfate sodium (PPS)

b) Medications to decrease pain; Gabapentin, hydroxyzine, montelukast

c) Bladder instillation; The combination of medications is lidocaine, heparin or pentosan polysulfate sodium, and sodium bicarbonate. It is believed that this combination helps to repair the bladder lining and decrease nerve sensitivity in the bladder.

2) Physical therapy; Pelvic floor physical therapy (PT) may be recommended to decrease tightness in these muscles. PT can decrease bladder or pelvic pain as well as urinary urgency and frequency. Physical therapist works on the patient's body to manually "release" the tightness, tender points, trigger points, and restricted movement of the connective tissues and muscles.

3) Exercises; Many patients feel that gentle stretching exercises help relieve IC/PBS symptoms.

4) Electrical stimulation; sacral nerve stimulation.

5) Behavioral therapies; Behavioral therapies for urinary frequency work to slowly increase the time interval between voids, which increases the amount of urine the bladder can comfortably hold; this is called timed voiding.

6) Diet; alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation. Artificial sweeteners may aggravate the symptoms.

7) Surgery; fulguration and resection of ulcers or bladder augmentation.

It is privilege assisting you.

Please let me know, if you have any further questions.

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Dr. Arun