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淺談間質性膀胱炎(Interstitial Cystitis)

張貼日期
2020-06-19
張貼單位
本院
內  容

30歲的蔡小姐,從事美甲工作數年,對於指甲彩繪頗有心得。透過她的巧手,客人的指甲總能煥然一新、變得粉彩晶亮。除此之外,蔡小姐參加全國性指甲彩繪比賽,也屢屢獲得大獎。只是不知道為什麼,蔡小姐這半年來總是覺得一直想尿尿,一天上廁所的次數,可以高達20至30次,晚上也要起來4~5次。就連幫客人彩繪指甲時,也必須頻頻向客人說聲對不起,暫時離開去上個廁所。雖然總是想要忍住不尿,但是那種一陣一陣下腹痙攣疼痛感,會不停地襲上來,直到尿液排出才會比較舒緩一些。頻尿的症狀,使得的蔡小姐一直不敢跟朋友出去玩。她也曾經就醫,醫師告訴她可能是膀胱發炎或是膀胱過動症,服藥後症狀卻始終無法改善。為了小便,工作被打斷、晚上失眠,下了班也只敢待在家裡,讓蔡小姐實在好困擾!
蔡小姐來本院就診後,經過醫師詳細問診以及尿液檢查排除泌尿道感染,於膀胱鏡檢查時發現,膀胱黏膜有多處出血點與破皮的現象,確診為間質性膀胱炎。於是在醫生建議下接受口服藥物以及玻尿酸膀胱灌注治療,治療後,頻尿與下腹悶痛的情形漸漸有改善,不僅在上班時,不再為頻尿所困擾;下班之後,也可以和朋友一起出去玩,晚上睡眠也改善,整個人都精采了起來。
衛福部新營醫院泌尿科陳建升主任表示,間質性膀胱炎對很多人來說是很陌生的疾病,它好發於女性,尤其是30~40歲之間。主要症狀包括頻尿、急尿、下腹部漲痛或是會陰部疼痛,尤其是在憋尿的時候,疼痛感會特別明顯,排尿後痛感則會減輕。長期下來,這些症狀除了造成身體不適,對於情緒精神,甚至性生活方面影響甚鉅,病患往往會合併焦慮與憂鬱症狀。
間質性膀胱炎並不像泌尿道感染一樣,是由細菌感染所造成的,它的成因一般認為,是由於膀胱黏膜層的破損,尿液物質滲入膀胱壁刺激之後,產生症狀,在膀胱鏡檢查時會有獨特的表徵(如:多處出血點與黏膜潰瘍破皮的現象)。間質性膀胱炎與膀胱過動症的表現也很像,都是以頻尿為主,但是,間質性膀胱炎的患者在膀胱漲尿時會有下腹的疼痛感,而膀胱過動症的患者則無。
陳醫師說明,針對間質性膀胱炎的治療,以恢復膀胱黏膜的完整性為目標,目前治療藥物採玻尿酸的膀胱灌注或口服藥物為主,除此之外,也可以灌注肝素或以肉毒桿菌施打、內視鏡膀胱水擴張或是膀胱黏膜潰瘍切除手術對某些患者也會有幫助。建議患者盡量避免吃含鉀離子或柑橘類水果、煎炸食物、辛辣刺激性食物及咖啡、濃茶、酒及碳酸飲料。
陳醫師叮嚀,間質性膀胱炎是一種慢性疾病,患者必須要有耐心,持續地接受治療,調整生活作息,才能讓膀胱恢復健康。


Miss Tsai is 30-year-old and has been engaged in nail art for several years. She has a lot of experience in nail painting. Through her skillful hands, the customers’ nails can always be renewed and become shiny and pastel. In addition, Miss Tsai participated in the national nail painting competitions and won many awards.
However, Miss Tsai has always felt like peeing all the time in the past six months. The number of times to go to the toilet can be as high as 20 to 30 times a day, and Miss Tsai has to get up 4~5 times at night. Even when helping guests paint their nails, Miss Tsai must frequently say sorry to the guests and leave to go to the bathroom temporarily. Although Miss Tsai always tries to hold urinating, the painful sensation of lower abdominal cramps will continue to come up until the urine is expelled. The symptom of frequent urination also made Miss Tsai afraid of not going out with friends. She also went to see doctors. The doctors told her that inflammation of the bladder or overactive bladder might be the underlying causes, but her symptoms could not be improved after taking the medicine. The symptoms of urination interrupted the work and night sleep. Miss Tsai could only stay at home after work. She was really bothered by the urination……
Miss Tsai then came to our hospital for help. Through the detailed consultation and urine examination to rule out urinary tract infection. During the cystoscopic bladder distension examination, multiple bleeding spots and ulcerations in the bladder mucosa were noted, which were compatible with the characteristics of interstitial cystitis. Miss Tsai received oral medication and hyaluronic acid bladder infusion therapy, her urinary frequency and lower abdominal pain gradually improved. Not only did she no longer suffer from urinary frequency, she could also go out with friends after work. She could sleep better at night and lead a colorful life~
Interstitial cystitis is a very unfamiliar disease to many people. It occurs mostly in women, especially at the age between 30 and 40. Its’ main symptoms include urinary frequency, urgency, and lower abdomen pain or perineal pain, especially when holding back urine, the pain will be particularly obvious, and the pain will decrease after urination. In the long run, these symptoms not only cause physical discomforts, but also have a great impact on mood, spirit, and even sexual life. Patients often have symptoms of anxiety and depression.
Interstitial cystitis is not like the urinary tract infection, which is caused by bacterial infection. Scientists find that the cause of interstitial cystitis is the damage of the bladder mucosal layer. Some inorganic materials, such as potassium ion, penetrate the bladder wall through the mucosal defects, the symptoms of interstitial cystitis can then occur. There will be unique signs during the cystoscopic bladder distension examination (such as: multiple bleeding points and mucosal ulcers). The symptom of interstitial cystitis and overactive bladder is also very similar. Urinary frequency is the major compliant in both diseases. However, patients with interstitial cystitis will have pain in the lower abdomen when the bladder is full with urine, but patients with overactive bladder do not.
The treatment of interstitial cystitis is aimed at restoring the integrity of the bladder mucosa. At present, the main treatment drugs are hyaluronic acid. In addition, heparin or botulinum can also be injected into the bladder. Endoscopic bladder water distension or bladder mucosal ulcer resection can also be helpful for some patients. It is recommended that patients avoid eating potassium ions rich citrus fruits, fried foods, spicy foods, coffee, strong tea, wine and carbonated beverages.
Interstitial cystitis is a chronic disease. Patients must be patient, receive treatment continuously, and adjust their daily routines to restore health to the bladder!

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