Interstitial Cystitis

What Is Interstitial Cystitis?

Interstitial cystitis is also known as painful bladder syndrome or frequency-urgency-dysuria syndrome. It affects up to 4 million males and up to 8 million females in the U.S. It also more frequently affects people over age 30 or people with other conditions that cause chronic pain.

The inflammation of the bladder wall caused by interstitial cystitis can lead to scarring and stiffening of the bladder. Common symptoms include:

• Pain or irritation in the bladder region
• Discomfort as your bladder fills with urine
• Urinating more often and feeling like you need to pee right away
• Only peeing a small amount
• Worsening pain during menstruation for reproductive-age women

What Causes Interstitial Cystitis?

The exacts causes of interstitial cystitis are not fully understood. Experts suspect that certain medical conditions may put you at greater risk for developing interstitial cystitis. These include:

• Autoimmune disease
• Allergies
• Bladder lining defects
• Vascular disease
• High levels of protein or other substances in urine
• Infections

How Is Interstitial Cystitis Diagnosed?

The symptoms of interstitial cystitis are similar to other urinary disorders. A variety of tests may be performed by healthcare providers in order to rule out other urinary conditions.

In addition to a physical exam and reviewing your symptoms and health history, your healthcare provider may conduct tests that include:

• Pelvic exam: Your healthcare provider will perform and external and internal assessment of your pelvis, reproductive organs and urinary tract to look for abnormalities.
• Urinalysis: Lab test of urine to look for abnormal levels of protein, white blood cells, glucose, bacteria or other substances.
• Urine culture: With this test, bacteria found in urine is grown in a lab. It can identify specific types of bacteria strains present in a urine sample.
• Cytology: This tests exams a urine sample for abnormal cells that may indicate cancer
• Cystoscopy: A flexible tube with a viewing device is inserted into the urethra to examine the urinary tract and bladder.
• Bladder wall biopsy: Tissue samples from the bladder are collected and examined under a microscope to look for abnormal cells such as cancer cells.

Interstitial Cystitis Treatment

Interstitial cystitis can be difficult to treat. Since there is no cure, treatments are aimed at managing pain and other symptoms. They include:

Oral medications: Medication used to treat the symptoms of interstitial cystitis include:

• Non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen
• Tricyclic antidepressants to relax the bladder and ease pain
• Antihistamines to reduce urinary urgency and frequency
• Pentosan polysulfate sodium, which over time can restore the inner surface of the bladder and protect it from irritating substances in urine.

Transcutaneous electrical nerve stimulation (TENS): This nerve stimulation technique can help ease bladder pain and urinary frequency and urgency. With TENS, a special device delivers mild electrical pulses to the pelvic area, which may increase blood flow to the bladder and strengthen the muscles that control the bladder. TENS therapy sessions can be tailored to the individual patient’s needs, and can last anywhere from a few minutes to several hours.

Sacral nerve stimulation: With this technique, a surgically implanted device sends electrical impulses to the sacral nerve, which links the nerves in the spinal cord and bladder. This technique can calm the nerve and reduce urination frequency and urgency.

Bladder distention: This technique uses water to stretch the bladder, which can increase its capacity and may help with pain, frequency and urgency.

Botox: Botulinum toxin (Botox) injections are sometimes used to slow muscle activity and help the bladder store more urine, decreasing frequency and urgency. Botox is injecting into the bladder wall using a cystoscope.

Physical therapy: Working with a physical therapist can help some patients relieve pelvic floor pain and learn exercises aimed at strengthening and relaxing the pelvic floor muscles.

Surgery: Surgery to remove all or part of the bladder may be done in severe cases. This is done rarely and only if other treatments don't work.

Lifestyle Changes

While not proven, there is some anecdotal evidence that certain lifestyle changes can help manage the symptoms of interstitial cystitis. These include:

• Diet. Some believe that eliminating certain foods and beverages thought to increase bladder inflammation may improve symptoms of interstitial cystitis. These include alcohol, tomatoes, spices, chocolate, caffeinated drinks, citrus drinks, and other high-acid foods.
• Smoking. Smoking can make symptoms worse, so quitting smoking may help some people find relief from symptoms.
• Exercise. Exercise may help ease symptoms of interstitial cystitis.
• Reducing stress. Stress can make symptoms worse in patients with interstitial cystitis.