My UTI reduces me to tears. But DR SCURR reveals hope is at hand

My wife is 85 and has been suffering with interstitial cystitis and urinary tract infections (UTIs) almost constantly for eight years. Her pain is often so intense she is reduced to tears. Is there anything that might relieve her suffering?

Name and address supplied.

Dr Martin Scurr replies: I’m sorry to hear your wife suffers so considerably with her symptoms. Interstitial cystitis, or chronic bladder pain syndrome, as it’s now known, can be miserable.

It’s different from a standard UTI because, while the symptoms are similar (often a sense of pressure, as well as extreme discomfort, urinary frequency and urgency), there is no identifiable infection.

It is possible to have UTIs alongside chronic bladder pain syndrome, as your wife has. That is why it’s important to have detailed investigations such as urine tests to rule out which condition is causing her symptoms (as UTIs can be treated with antibiotics).

When it comes to chronic bladder pain syndrome, as you say in your longer letter, more detailed investigations – including urine tests and a cystoscopy (using a thin probe with a camera at its tip) to examine the interior of the bladder – have failed to detect an identifiable cause.

One theory is that the condition might be triggered by previous infection, or a leak in the bladder tissue, causing ulcers.

Treatment for it involves managing symptoms – there is no cure as such – with painkillers and medications that make you pee less. If these don’t work then there are treatments that can be given into the bladder to protect the lining.

There is a similar, more treatable condition, urinary syndrome of the menopause – where the urogenital tissues, including the lining of the vagina, urethra and entry to the bladder, become thinner – which causes the same symptoms, but no infection.

To distinguish between the two conditions is far from easy but in post-menopausal women a trial of topical oestrogen cream or pessaries is worth considering, as it can be dramatically effective.

If this hasn’t worked after between two and four months, then the diagnosis would be chronic bladder pain syndrome.

Your wife doesn’t need to see a urologist or a uro-gynaecologist. An informed GP could prescribe either oestrogen cream or, oestrogen pessaries (e.g. Vagifem). The benefit in terms of her overall state could be considerable in time. There is good reason to be optimistic.

I’ve seen adverts online for tDCS – headsets you use to treat depression at home. Do they work?

Andrew Howe, St.Neots, Cambridgeshire.

Dr Martin Scurr replies: I recently wrote about the undoubted benefit of another type of brain stimulation called TMS (transcranial magnetic stimulation).

This uses a magnetic field to activate cells in specific areas of the brain and multiple trials show it to be effective in treating depression that’s resistant to medication.

Unfortunately, tDCS (transcranial direct current stimulation) is not as effective.

This uses a gentle electric current, rather than a magnetic field, to make neurons in a region of the brain that is often less active in people with depression more ‘excitable’.

In small studies, where the participants knew if they were getting the real treatment or a sham one, tDCS appeared to be of great benefit.

The problem is that it is impossible to know if the improvement was due to the brain stimulation or the placebo effect.

And in larger trials involving those with more severe depression, tDCS has had little or no effect. These include a recent study in which 160 patients in Germany were given a six-week course of tDCS or a sham treatment. Neither the participants nor the researchers knew who was receiving which – and tDCS was found to be no better than the sham device.

That said, this type of brain stimulation does seem to be safe. My view is that it is worth trying if you have mild depression and if antidepressants didn’t work for you or caused bad side-effects. But don’t expect too much.

In my view… Life-saving spray to replace EpiPens

EpiPens are lifesaving for people having an anaphylactic reaction – but I’ve come across young patients more frightened by the injector needle than the potentially lethal reaction itself.

Another problem is that these injectors last for 12 to 18 months, and can go out of date without the patient, or even the supplier, realising. I once collected a prescription for a patient only to find that it would be out of date within six months: it had sat on the pharmacy shelf for too long.

I know of plenty of cases where younger patients don’t want to be seen carrying them.

But there’s now a great new option, Neffy, an adrenaline nasal spray that’s as effective as an EpiPen. It’s also more convenient to carry in a purse or pocket. And, I’m told, it has a longer shelf-life – possibly up to five years.

Plus, for needle phobics that prob