Interstitial cystitis

(IC; Painful Bladder Syndrome)

Interstitial cystitis – Definition

Interstitial cystitis is chronic inflammation of the wall of the bladder. Inflammation can lead to scarring, pinpoint bleeding of the bladder wall, and decreased space to hold urine. Although the symptoms are similar to those of a bladder infection, there is usually no clear cause.

Interstitial cystitis – Causes

Because bacteria, fungi, or viruses are rarely found in the urine of people with interstitial cystitis, the cause is unclear. Possible causes include:

• An autoimmune response that occurs following a bacterial infection of the bladder
• Bacteria that cling too tightly to the wall of the bladder
• A leaky inner lining of the bladder that allows irritating substances in the urine to come into contact with the bladder wall

Interstitial cystitis – Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for interstitial cystitis include:

• Sex: occurs in women nine times more often than in men
• Race: 90% of cases occur in Caucasians
• Genetics: higher rate in first degree relatives
• Stress
• Associated pain disorders: fibromyalgia or chronic fatigue syndrome
• History of childhood bladder problems
• Irritable bowel syndrome

Interstitial cystitis – Symptoms

The symptoms of interstitial cystitis vary from person to person. They can also occur in cycles. Some people experience periods of intense symptoms followed by periods without symptoms. Pain can be severe enough to keep people from working or even walking.

Symptoms can include:

• Discomfort, pain, or pressure in the bladder or pelvic area when the bladder is full and relief when the bladder is emptied
• Urgent need to urinate
• Frequent need to urinate (up to 60 times per day in severe cases)
• Pain during and after intercourse or during orgasms
• Blood and pus in the urine
• Depression
• Pain in the vulva or vagina in women, or in the testes, groin, or tip of penis
• Constipation
• Nocturia (urination at night, especially when excessive) from once to over 12 times every night

Interstitial cystitis – Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. In addition, your urine will be tested for pus and bacteria. If bacteria are present in the urine, you will likely be diagnosed with acute cystitis — a typical bladder infection. If no bacteria are present, your doctor will likely do other tests.

A diagnosis of interstitial cystitis will only be made after other conditions have been ruled out. Cystoscopy with bladder distention may be done. This consists of distending (stretching) the bladder to its full capacity by introducing liquids through the cystoscope. If interstitial cystitis is present, there may be key changes in the wall of the bladder following this distension (usually called glomerulations, or occasionally Hunner’s ulcers). These results usually confirm a diagnosis of interstitial cystitis. Random biopsy of the bladder might be performed if any abnormality is seen.

Interstitial cystitis – Treatment

There is no known treatment to cure interstitial cystitis. Treatment is aimed at relieving symptoms. Treatment depends on your symptoms. You may have to try several different treatments before you improve.

Treatments include:

Bladder Distention

Some people experience relief after a bladder distention (during the cystoscopy) is done.

Bladder Instillation

During bladder instillation, a “wash” is put into the bladder through a tube in the urethra. It is held for anywhere from a few seconds to 15 minutes and then voided. There are several different types of solutions used. Some coat the bladder and are thought to decrease the inflammation. An example of this is called Hanno “cocktail.” It contains heparin and sodium bicarbonate.

Medicine

Medicines may include:

• Bladder coating — taken orally to coat and protect the bladder
• Antidepressants and pain relievers — for pain relief
• Antihistamines — may help stop the cycle of inflammation
• Antispasmodics — may alleviate frequency and urgency of urination

Diet

There is no research linking diet to interstitial cystitis. However, many people find that changes in diet can help relieve pain. Different people have different “trigger” foods. Foods commonly reported to aggravate interstitial cystitis include:

• Coffee
• Chocolate
• Artificial sweeteners
• Alcohol
• Acidic foods
• Carbonated beverages

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS uses an external device that sends mild electrical impulses into the body. It has helped relieve pain and decrease the frequency of urination in some people.

InterStim Therapy

InterStim therapy uses an approved device. It has been reported to possibly provide relief in some patients with interstitial cystitis who do not respond to other treatments. The electronic device is implanted into the sacral nerve roots of the spinal cord. Electrical impulses are sent to these roots in regular intervals. The impulses are sent to adjust the neural output of the pelvic nerves supplying the bladder.

While some patients have reported some relief, they appear to be in the minority. Doctors do not know yet what makes the device helpful.

Bladder Training

Some people are able to train their bladder to have better control by setting a regular, timed schedule for emptying their bladder. The amount of time between voids is gradually increased. Bladder training should be attempted only after pain relief has been accomplished.

Surgery

Surgery is used after all other treatment methods have been exhausted and the pain remains severe. One approach is to increase the capacity of the bladder by adding a segment of bowel to the distensible portion of the bladder (ie, bladder augmentation). Another approach is to remove the entire bladder (ie, cystectomy). These surgeries are rarely done for this condition. Many people continue to have pain even after surgery.

Interstitial cystitis – Prevention

There are no guidelines for preventing interstitial cystitis because the cause is unknown. However, recurrence or aggravation of interstitial cystitis could be reduced by avoiding the following foods or drinks:

• Caffeine-containing beverages
• High-acid citrus fruits
• Spicy foods
• Vinegar
• Chocolate
• Fermented foods
• Alcohol