Systemic lupus erythematosus (SLE), commonly known as lupus, is a chronic autoimmune disease where the body’s immune system mistakenly attacks its own healthy tissues and organs. This widespread inflammation can affect various parts of the body, including the joints, skin, kidneys, and nervous system. Lupus can indeed affect the bladder, leading to inflammation and dysfunction that manifest as a range of urinary issues. The disease’s impact on the bladder can sometimes be an early indicator of lupus itself.
Mechanisms of Bladder Involvement
Lupus can impact the bladder through several processes. One primary mechanism involves direct inflammation of the bladder wall, known as lupus cystitis. This occurs when the immune system targets the bladder’s tissues, leading to inflammation and damage. This inflammation can cause the bladder wall to thicken and its capacity to decrease, potentially leading to scarring if not managed. Although rare, lupus cystitis can sometimes present even before a formal lupus diagnosis is made.
Another way lupus can affect bladder function is through neurogenic bladder dysfunction. Lupus can impact the nerves that regulate bladder control. This nerve involvement can disrupt communication between the bladder and the brain, leading to problems with bladder emptying or control. Conditions like myelopathy or peripheral neuropathy, which can occur in lupus, may contribute to these neurological issues.
Kidney involvement, specifically lupus nephritis, can indirectly influence bladder function. Lupus nephritis is an inflammation of the kidneys where autoantibodies damage the filtering units. When kidneys are not functioning properly, they may produce altered urine, which can affect bladder behavior. Medications used to treat lupus, such as corticosteroids and immunosuppressants, can also increase the risk of urinary tract infections or contribute to bladder inflammation.
Identifying Bladder Symptoms
When lupus affects the bladder, individuals may experience various symptoms. Frequent urination (urinary frequency) is common, often accompanied by a sudden, strong urge (urgency). Patients may need to urinate more often during the day and wake up multiple times at night (nocturia).
Pain or a burning sensation during urination (dysuria) is another symptom. Pelvic or lower abdominal discomfort is also reported. Some individuals may experience difficulty completely emptying their bladder, leading to urinary retention, or involuntary leakage of urine (incontinence).
Blood in the urine (hematuria) can also occur. Additionally, recurrent urinary tract infections (UTIs) that are difficult to treat are more common in people with lupus. Bladder inflammation from lupus can mimic UTI symptoms, making accurate diagnosis important.
Diagnosis and Treatment Approaches
Diagnosing bladder involvement in lupus begins with a review of medical history and symptoms. A physical examination assesses overall health and identifies signs of inflammation or discomfort. Urine tests, including urinalysis and urine culture, check for infection, blood, or protein. Lupus cystitis may not always show abnormalities in routine urine tests.
Imaging studies are often used to evaluate the bladder’s structure and function. An abdominal ultrasound, CT scan, or MRI can reveal issues like bladder wall thickening, reduced capacity, or fluid buildup in the kidneys. A cystoscopy, which involves inserting a thin tube with a camera to visualize the bladder lining, may be performed. Urodynamic studies assess bladder pressures and urine flow, providing insights into nerve and muscle function.
Treatment for lupus-related bladder issues is individualized and aims to reduce inflammation, manage symptoms, and preserve bladder function. Immunosuppressive medications, such as corticosteroids, mycophenolate mofetil, or cyclophosphamide, are used to control underlying lupus activity. These medications work by calming the overactive immune system.
Symptom management strategies are also employed. These include medications to alleviate bladder spasms or pain, and approaches to improve bladder emptying. Lifestyle adjustments, such as modifying diet to avoid bladder irritants and managing fluid intake, can be beneficial. Bladder training and physical therapy may be recommended to improve bladder control and function. If new or worsening bladder symptoms arise, it is important to consult a healthcare professional.