Ketamine is a human and animal anesthetic sometimes abused recreationally for its ability to produce a detached, perceptually altered mental state.
Along with the drug phencyclidine (PCP), it belongs to a class of substances called “dissociative anesthetics.”
Ketamine abusers who take large amounts of the drug run the risk of developing a serious urinary condition that doctors and researchers refer to variously as “ketamine bladder syndrome,” “ketamine-induced vesicopathy,” or “ketamine-induced ulcerative cystitis.”
People with this condition commonly experience pain and a number of other symptoms that include bladder incontinence and a dying off of the cells that form the bladder interior.
Dissociative anesthetics get their name because they trigger dissociation, a mental state that strongly diminishes the normal experience of being within one’s body or part of one’s surroundings. They trigger this state by interrupting the pathways that allow the central nervous system to effectively coordinate information coming in from the five senses. In a medical or veterinary setting, doctors and veterinarians rely on this dissociative interruption to significantly diminish their patients’ ability to feel pain. In addition to this pain-relieving effect, people who use or receive ketamine experience effects that include disruption of their normal memory functions, a dulled and unresponsive mental state known as catatonia, and a form of abnormal muscle rigidity called catalepsy.
Ketamine has a strong chemical resemblance to PCP. Inside the central nervous system (brain and spinal cord), it triggers an increase in the production of a vital chemical called dopamine, and also activates certain regions in the brain that normally get activated by various narcotic (opioid) drugs.
In addition, it triggers physical responses associated with the “fight-or-flight” reflex by increasing activity in a network of involuntary nerves called the sympathetic nervous system. Specific mental effects of using/abusing ketamine include detachment of the “self” from the surrounding environment, a dream-like waking state, impaired thought and communication abilities, and perceptual alterations that include various types of hallucinations.
Among its users/abusers, ketamine is well-known for its ability to alter normal urinary function. Most people who develop ketamine-related urinary problems use high doses of the drug for extended periods of time; however, these problems can also appear in short-term users who take the drug in high doses. Inside the bladder, ketamine damages cells called urothelium cells, which line the organ’s interior surfaces. Initially, the presence of the drug only slows down or stops the normal growth of these cells. Eventually though, users who increase their ketamine dosages over time will experience an actual dying off of the urothelium. Physical consequences of this cell death include shrinkage of the bladder’s overall size and internal volume, development of a form of tissue scarring called fibrosis, the formation of ulcers on the urothelium’s surface and inner layers, and obstruction of the ureter, which carries urine from the bladder.
Symptoms associated with ketamine-related bladder changes include mild to severe pain in the bladder or in the entire lower pelvic region, bloody urine, increased frequency of urination, an unpredictable urge to urinate, inability to properly control urination (i.e., incontinence), and a feeling of bladder fullness that continues even when the bladder is emptied. According to a study published in 2008 in Drug and Alcohol Dependence, these symptoms affect roughly 20 percent of all ketamine abusers who take the drug at least three or four times a week for a few months or longer. However, since many ketamine abusers actively avoid reporting their symptoms, the percentage of affected individuals may actually be significantly higher.
Treatment and Outcomes
The only way to effectively address the effects of ketamine-related bladder and urinary problems is to stop taking the drug, according to an extensive study review published in 2011 in the International Journal of Clinical Practice. In many cases, this step effectively produces a gradual return of normal or near-normal bladder and urinary function. However, many people who abuse the drug continue their habits even when they become aware of ketamine’s harmful effects. This means that, with or without full knowledge of their patients’ drug use, doctors must often treat ketamine-related damage in the same way they would treat a chronic condition called interstitial cystitis, which produces painful inflammation in the bladder wall and several other urinary symptoms also commonly found in ketamine abusers.
Unfortunately, there is no standard treatment for interstitial cystitis, and doctors must basically use trial and error to find a treatment that will work for any given individual. Potential medication options include an antihistamine called hydroxyzine pamoate (Vistaril), a drug called pentosan polysulfate sodium, certain tricyclic antidepressants that have urinary effects, and direct bladder injections of lidocaine or dimethyl sulfoxide. Additional treatment options include physical therapy, biofeedback, relaxation techniques that train the bladder and surgery.