Hydrodistention is a medical procedure involving the controlled filling and stretching of an internal body cavity or joint using sterile fluid. This technique allows for both diagnostic evaluation and therapeutic intervention within specific anatomical spaces. The process typically takes place under anesthesia to ensure patient comfort and facilitate adequate distention. Its application focuses on conditions where stretching a confined space can provide relief or aid in diagnosis.
Medical Applications of Hydrodistention
Hydrodistention is commonly utilized for Interstitial Cystitis or Bladder Pain Syndrome (IC/BPS) and Adhesive Capsulitis, also known as Frozen Shoulder. For IC/BPS, the procedure can be both diagnostic and therapeutic. Diagnostic use involves examining the bladder lining for pinpoint hemorrhages, called glomerulations, or Hunner’s ulcers after distention, which are indicative of the condition. Therapeutically, the stretching of the bladder wall is thought to increase bladder capacity and potentially disrupt overactive nerve signals, offering relief from chronic pain, frequency, and urgency symptoms.
For Adhesive Capsulitis, hydrodistention aims to improve range of motion and reduce pain. This condition involves inflammation and fibrosis of the shoulder joint capsule, leading to adhesions and contractures that severely limit movement. During the procedure, a mixture of sterile saline, corticosteroid, and local anesthetic is injected into the joint capsule. The fluid pressure mechanically stretches the tightened capsule and helps break up adhesions, thereby enhancing tissue flexibility. This mechanical stretching can also promote tissue remodeling and repair by stimulating the release of cytokines and growth factors.
The Hydrodistention Procedure
The hydrodistention procedure is performed in an outpatient setting under general or regional anesthesia. Before the procedure, patients are advised not to eat or drink anything after midnight. For bladder hydrodistention, the patient lies on their back with legs gently elevated in stirrups. A thin, flexible tube with a camera, called a cystoscope, is then inserted through the urethra into the bladder.
The physician first inspects the bladder walls. Sterile fluid is then slowly infused into the bladder until it is distended to a predetermined pressure. The fluid is held in the bladder for one to ten minutes. After this period, the fluid is drained, and the bladder is re-inspected for any changes or abnormalities on the lining. For frozen shoulder, the procedure involves injecting the fluid mixture directly into the shoulder joint capsule, often guided by ultrasound.
Recovery and Expected Outcomes
Following bladder hydrodistention, patients may experience temporary bladder pain, cramping, and increased urinary frequency. Some blood in the urine is also common, which usually resolves within a few days. This discomfort subsides over a few days to a week, though some individuals may experience symptoms for several weeks. Patients are encouraged to drink plenty of water to help flush the bladder and prevent infection.
For frozen shoulder, immediate post-procedure soreness in the shoulder area is common. Pain relief medications and ice packs are recommended to manage these symptoms. Recovery timelines vary, but many patients report an improvement in pain and function within days to a week after the procedure. While hydrodistention can provide relief, results are not always permanent and can vary among individuals, with improvements sometimes lasting for several months.
Role in Overall Treatment
Hydrodistention is considered one component within a broader treatment strategy rather than a standalone cure. For individuals with frozen shoulder, the procedure creates a “window of opportunity” by reducing pain and improving range of motion. This immediate improvement makes it possible for patients to engage in intensive physical therapy, which is a necessary step to maintain the newly gained range of motion and achieve lasting benefits. Without diligent post-procedure exercise and rehabilitation, the shoulder can stiffen again.
For Interstitial Cystitis/Bladder Pain Syndrome, hydrodistention is used when less invasive therapies, such as dietary modifications, behavioral changes, or oral medications, have not provided adequate relief. It may be combined with other bladder treatments, such as intravesical instillations of medications, to enhance and prolong symptom relief. The American Urological Association guidelines consider cystoscopy with hydrodistention a third-line treatment for IC/BPS.