Dear Dr. Gott: After reading your column in my local paper about the 85-year-old lady with a stinging and burning sensation while urinating, I decided to write again. I had written before, but never did see any response.

I have a condition called interstitial cystitis. This condition has almost the same symptoms as a bladder infection, except the burning does not continue after urinating. There is no known cause and no known cure. My urologist has checked me every six months and cauterises the lesions in the lining of my bladder. This has given me a lot of relief.

Please inform your readers about this condition, since I was told that many people have this but are not diagnosed and treated for it.

Reply: Interstitial cystitis (also known as painful bladder syndrome) is a relatively common condition affecting about 1.3 million people. Of that, nearly 1.2 million are women.

The condition causes recurring pain or discomfort in the bladder and pelvis. Symptoms vary from person to person, and with a vast variation. The most common symptoms include mild discomfort to intense bladder or pelvic pain and an urgent or frequent need to urinate. Pain may vary in intensity as the bladder fills or empties. Women's symptoms may worsen during menstruation and sometimes during intercourse.

Because of the dramatic variations in symptoms and severity, most researchers believe it may be the result of several disorders, not just one. Because of this, some authorities have begun using the term painful bladder syndrome (PBS) for cases that do not meet the strict guidelines of interstitial cystitis (IC). In order to receive the diagnosis of IC, the patient must meet all of the criteria set by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Regardless of the final diagnosis of IC or PBS, the bladder wall may become scarred or stiff due to irritation. Pinpoint bleeding often results. Up to 10 percent of sufferers may also experience ulcers. Blood in the urine and urine leakage are also common consequences of IC/PBS.

The cause remains unknown, but there have been a few important findings in recent years. For example, a substance known as antiproliferative factor (APF) has been found almost exclusively in the urine of people with IC. It appears that APF blocks normal cell growth on the lining of the bladder. Another finding is that many women with IC/PBS may have other conditions, such as fibromyalgia or irritable bowel syndrome.

There are several options available. An initial treatment. which can also be used as a diagnostic tool, is bladder distention, which stretches the bladder. It is not clear why this helps some people, but it may be that it increases the capacity and interferes with pain signals. Symptoms may worsen for up to 48 hours after the procedure but should return to normal or show improvement within two to four weeks. Another procedure, known as bladder instillation (also known as a bladder bath or wash), involves filling the bladder with a solution that is usually held for 10 to 15 minutes before emptying.

There are several oral medications available. Bladder training may also be beneficial. There are several surgical options, but these should be considered only when all other treatment options fail. These can include ulcer removal, bladder augmentation or even complete removal of the bladder.

Anyone who experiences painful urination should be examined and tested for bladder or urinary-tract infections. If infection is not the cause, referral to a urologist for more comprehensive testing should be considered.

Dr. Peter Gott is a retired physician and the author of 'Dr. Gott's No Flour, No Sugar Diet' and 'Dr. Gott's No Flour, No Sugar Cookbook'. Contact him c/o United Media, 200 Madison Avenue., fourth floor, New York, New York 10016.