Interstitial cystitis is chronic inflammation of the wall of the bladder. Inflammation can lead to scarring, pinpoint bleeding of the bladder wall, and a decreased bladder capacity. Although the symptoms are similar to those of a bladder infection, there is usually no clear cause.
Causes
Because bacteria, fungi, or viruses are rarely found in the urine of people with interstitial cystitis, the cause is unclear. Possible causes include:
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An autoimmune response that occurs following a bacterial infection of the bladder
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Bacteria that cling too tightly to the wall of the bladder
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A "leaky" inner lining of the bladder that allows irritating substances in the urine to come into contact with the bladder wall
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors for interstitial cystitis include:
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Sex: female to male ratio 9:1
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Race: Caucasians 90%
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Genetics: higher rate in first degree relatives
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Stress
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Associated psychological disorders: fibromyalgia or chronic fatigue syndrome
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History of childhood bladder problems
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 of remission. Pain can be severe enough to keep people from working or even walking.
Symptoms can include:
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Discomfort, pain, or pressure in the bladder or pelvic area when the bladder is full and relief when the bladder is emptied
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Urgent need to urinate
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Frequent need to urinate (up to 60 times per day in severe cases)
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Pain during and after intercourse
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Blood and pus in the urine
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Depression
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Men with pain in testes, groin, or tip of penis
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Constipation
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Nocturia (urination at night, especially when excessive) from 1-12+ times every night
Diagnosis
Your doctor will ask about your symptoms and medical history, and perform a physical exam. 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 and a cystoscopy with bladder distention has been done. This consists of distending (stretching) the bladder to its full capacity by instilling gas or liquids through the cystoscope. If interstitial cystitis is present, there will be characteristic changes in the wall of the bladder following this distension (usually called glomerulations, or occasionally Hunner’s ulcers). These findings are usually interpreted as confirming a diagnosis of interstitial cystitis. Random biopsy of the bladder might be performed if any abnormality seen.
Treatment
There is no 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 experience relief.
Treatments include:
Bladder Distention
Some people experience relief after the 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. Usually these types of treatments are used only if various oral medications have not been effective at relieving the particular symptoms which may be present.
Medication
Medications may include:
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Bladder Coating–taken orally, they can coat and protect the bladder
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Antidepressants and pain relievers–for pain relief
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Antihistamines–may help stop the cycle of inflammation
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Antispasmodics–may alleviate frequency and urgency of urination
Diet
There is no research linking diet to interstitial cystitis. But 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:
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Coffee
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Chocolate
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Artificial sweeteners
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Alcohol
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Acidic foods
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Carbonated beverages
Transcutaneous Electrical Nerve Stimulation (TENS)
TENS uses an external device that sends mild electrical impulses into the body. It has been helpful in relieving pain and decreasing frequency of urination in some people.
Interstim Therapy
Interstim therapy uses an approved device which has been reported to possibly provide symptomatic relief in some patients with interstitial cystitis refractory to more conventional treatments. This is an electronic device which is implanted into the sacral nerve roots of the spinal cord. Electrical impulses are sent to these roots in regular intervals, in a manner designed to hopefully modulate the neural output of the pelvic nerves supplying the bladder. While some intersitlal cystitis patients have reported some relief, these patients appear to be in the minority of all patients treated. The actual mechanism whereby this device seems to work favorably has yet to be demonstrated.
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 voidings is gradually increased. Bladder training should be attempted only after pain relief has been accomplished.
Acupuncture
Pain from interstitial cystitis may be treated with acupuncture. Talk to your doctor to learn more about this option.
Surgery
Surgery is a treatment of last resort. It is used after all other treatment methods have been exhausted and if the pain remains severe. The usual approaches include either increasing the capacity of the bladder by adding a segment of bowel to the distensible portion of the bladder (ie, bladder augmentation) or by removing the entire bladder (ie, cystectomy). Many people continue to have pain even after surgery.
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 avoding the following foods or drinks: caffeine-containing beverages, high-acid citrus fruits, spicy foods, vinegar, chocolate, fermented foods, and alcohol.
RESOURCES:
Interstitial Cystitis Association
http://www.ichelp.com
Interstitial Cystitis Network
http://www.ic-network.com
References:
Cystitis and Overactive Bladder Foundation website. Available at: http://www.interstitialcystitis.co.uk.
Interstitial cystitis and related disorders. In: Campbell’s Urology , 8th ed. Walsh P ed. Philadelphia, PA: WB Saunders; 2002.
Interstitial Cystitis Association website. Available at: http://www.icamail@achelp.org.
Interstitial Cystitis Network website. Available at: http://www.ic-network.com.
National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www2.niddk.nih.gov/.
Nordling J. Interstitial cystitis: how should we diagnose it and treat it in 2004? Curr Opin Urol . 2004; 14:323-7.
