Interstitial cystitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at April 14, 2016
StartDiseasesInterstitial cystitis

Interstitial cystitis (IC) is a disorder of the urinary system that causes a frequent need to urinate along with discomfort in the bladder, urethra, or lower abdomen. It can cause severe disruption of normal activities and is sometimes referred to as painful bladder syndrome.

Contents

Definition & Facts

Interstitial cystitis is a medical syndrome in which the individual experiences bladder pain, urinary urgency and pelvic pain. These symptoms occur during both the daytime and nighttime hours and are not associated with urinary tract infection or an underlying structural problem.

When bladder pain and urinary frequency, unrelated to other problems, continue for more than 6 weeks, a diagnosis of interstitial cystitis may be given; it is diagnosed by ruling out other conditions that can produce similar symptoms. A variety of treatments and lifestyle changes are used to keep symptoms in check. However, flare-ups frequently occur that may require additional treatment.

Symptoms & Complaints

The symptoms of interstitial cystitis can vary from one individual to another. It can also vary in time, sometimes causing mild or no symptoms and at other times, causing severe problems. For some patients, IC can be severe and life changing. Individuals report a variety of symptoms that include:

  • Pelvic pain between the vagina and anus in women or between the scrotum and anus in men
  • An urgent need to urinate
  • Frequent urination, sometimes as often as 60 times each day
  • Discomfort with a full bladder
  • Discomfort during sexual intercourse
  • A chronic feeling of pressure or discomfort in the lower abdomen

Causes

Research into interstitial cystitis has not yet yielded any definitive answers on the cause of the condition. However, some evidence indicates changes to the urothelium, which is the tissue lining the bladder, could play a role. It is possible that small particles leak into the bladder lining, causing chronic inflammation.

About 5 to 10 percent of patients have ulcers in the bladder lining. The studies have identified a number of triggers associated with the development of interstitial cystitis, including:

Diagnosis & Tests

No single, definitive test to determine IC currently exists. Tests to diagnose interstitial cystitis are mainly used to eliminate other causes. A physical examination is done to determine if any underlying disease is causing the problem. The physician often asks the patient to create a bladder diary to record the frequency of urination.

A pelvic examination is done to eliminate the possibility that tumors or other problems in the structure of the pelvis or urinary system may be causing symptoms. Urine tests will eliminate the possibility of infection as the cause of the discomfort. The physician will also do a potassium sensitivity test, which involves the patient reporting increased sensitivity and urgency due to the presence of potassium.

A cystoscope inserts a tiny camera into the bladder to allow the physician to see the walls of the bladder to determine problems. A solution may then be injected to measure bladder capacity. A biopsy of tissue from the bladder may also be taken. When taken together, these tests can rule out other know conditions, allowing for a diagnosis of interstitial cystitis.

Treatment and Therapy

No single medication exists that can deal with the problems of frequent, urgent urination and pain that characterizes IC. Instead, the physician will recommend a variety of treatments and lifestyle changes that can help to control symptoms, so that patients can live more comfortably with the condition. When flare-ups occur, additional measures can be undertaken to deal with them. Here are the most common treatments for IC:

  • Medications – A number of drugs are used to treat IC, including nonsteroidal anti-inflammatory drugs to relax bladder spasms and tricyclic antidepressants that can reduce urgency and pain. Pentosan polysulfate is a drug that can help to restore the bladder lining when taken over a period of two to six months.
  • Nerve stimulation, in the back or in the pelvic region, can help urinary urgency.
  • Distension of the bladder with water or gas can help to provide temporary relief of symptoms
  • Instillation of medication into the bladder – A number of different medications, or a combination of medications, are instilled into the bladder via a catheter and are held there for a period of time before being urinated out. Treatments may be done over a period of weeks.
  • Surgery – Surgery is rarely done for this condition because it can increase problems. However, sometimes removing ulcers or augmenting the bladder is necessary for relief of symptoms.

Prevention & Prophylaxis

Avoiding foods known to cause bladder irritation can provide some relief of symptoms. Caffeine, carbonated beverages, chocolate, citrus foods and foods containing high amounts of vitamin C should be avoided.

Spicy foods, pickled foods and alcohol can also cause problems. Smoking cessation, regular exercise, and stress management can all help to reduce the frequency of interstitial cystitis symptoms.