Interstitial Cystitis

Alternate Names
painful bladder syndrome

Definition of Interstitial Cystitis

Interstitial cystitis refers to a type of chronic inflammation of the bladder that has no known cause.

What is going on in the body?

Interstitial cystitis causes pain in the bladder and surrounding pelvis. The bladder is chronically inflamed, or irritated. The cause is currently unknown, but many theories have been proposed and are being studied.

What are the signs and symptoms of the condition?

Bladder and pelvic pain are key symptoms of interstitial cystitis. The pain is often relieved temporarily by urinating. Some people have mild pain, while others have severe pain.

Other common symptoms include:

• dyspareunia, or painful intercourse
• getting up at night to urinate (nocturia)
• an urgent need to urinate (urgency)
• urinary frequency

In women, symptoms are often worse during menstrual periods although most women have pain throughout the month

What are the causes and risks of the condition?

Ninety percent of the people with interstitial cystitis are adult women. The cause of interstitial cystitis is unknown.

Some researchers believe it is an autoimmune disorder, or one in which the body produces antibodies against its own tissues. They believe that the antibodies are formed after the person has a bladder infection. Other experts believe that interstitial cystitis is caused by a type of bacteria that are in the bladder cells. They think that these bacteria are not detectable by routine urine tests.

Some researchers think that there may be chemicals in urine that irritate people with interstitial cystitis. They have not yet specifically identified any of these substances although potassium balance in the bladder wall seems to be a factor.

Women diagnosed with interstitial cystitis often have higher rates of several other conditions. These include:

• allergies
• fibromyalgia, a disorder causing pain in the muscles
• inflammatory bowel disease, a disorder causing diarrhea and cramping
• irritable bowel syndrome
• skin sensitivity
• systemic lupus erythematosus, which is also an autoimmune disorder
• vulvodynia, or diffuse burning of the vaginal lips

What can be done to prevent the condition?

At this point, interstitial cystitis is not preventable.

How is the condition diagnosed?

Diagnosis of interstitial cystitis begins with a medical history and physical exam. Special forms can be completed by the patient and a score assigned to determine if IC is the possible diagnosis.

The healthcare provider will order tests to rule out other conditions and diseases. These tests may include:

• culture of prostate secretions in men
• urinalysis
• urine culture, to check for infection

After other conditions have been ruled out, the provider may perform a cystoscopy with bladder distention. This procedure is done under regional or general anesthesia. Water is injected into the bladder. The cystoscope, a thin, lighted tube, is inserted through the urethra into the bladder.

The provider can see the inside of the bladder through the tube. If interstitial cystitis is present, the inside of the bladder wall will often show small ulcers and tiny areas of inflammation. However, these are also seen sometimes in people who do not have any bladder symptoms.

A test called the potassium stimulation test can be done in the doctor's office to help make the diagnosis. A high concentration potassium solution is instilled into the bladder and if the patient has interstitial cystitis, severe pain will ensue.

What are the long-term effects of the condition?

There is no evidence that interstitial cystitis leads to more dangerous conditions such as cancer. However, it does have a negative affect on quality of life. The extent of the problem varies from person to person. Some people have only one or two very bad episodes in a lifetime. For others, symptoms are much worse. Most of the time, symptoms come and go.

What are the risks to others?

Interstitial cystitis is not contagious and poses no risk to others.

What are the treatments for the condition?

Treatment of interstitial cystitis focuses on relief of symptoms. There is no cure. The general approach is to start with the therapy that has the fewest side effects. If this does not work, individuals may want to try other things.

Although the role of diet in interstitial cystitis hasn't been proven, many people find symptom relief by eliminating certain foods. It may be helpful to eliminate one food at a time to see if symptoms go away.

Foods often associated with interstitial cystitis include:

• alcohol
• artificial sweeteners
• caffeine
• chocolate
• citrus foods and drinks
• foods high in uric acid
• spices
• tomatoes

Some people report that smoking makes their symptoms worse. Cigarette smoking is a cause of bladder cancer. So it makes sense to quit smoking.

Bladder training may be helpful for some people with the condition. The person follows a set schedule for urinating. The time period between urination is gradually increased.

One medical option is bladder distention, which treats the stiffness of the bladder wall. Some people with interstitial cystitis can only hold a small amount of urine. They need to urinate frequently.

After the initial cystoscopy with bladder distention, symptoms often get worse for a week or two. When the initial reaction goes away, most people will experience some relief. This can last from 1 to 6 months.

A bladder instillation, or bladder wash, can also relieve symptoms. A solution of dimethyl sulfoxide, or DMSO, is inserted into the bladder with a catheter. It is held in the bladder for about 15 minutes.

Another solution that may be instilled in what is called "rescue therapy" includes the mixture of sodium bicarbonate, heparin and xylocaine.

A variety of oral medicines are used to treat interstitial cystitis. These include:

• antidepressants, such as amitriptyline (i.e., Elavil), to relieve pain and help deal with stress or doxepin (i.e., Sinequan) which may relieve frequency
• antihistamines, such as hydroxyzine (i.e., Atarax, Vistaril) which may also relieve pain
• antiprostaglandins, such as ibuprofen (i.e., Advil, Motrin) and aspirin, to relieve pain
• narcotics, such as codeine, for the most severe cases
• pentosan polysulfate sodium, or Elmiron, which is believed to repair defects in the bladder lining (Elmiron has become the most frequently prescribed drug for IC)
• "triple therapy" with hydroxyzine, doxepin and pentosan polysulfate sodium

Transcutaneous electrical nerve stimulation, or TENS, may be used for pain relief. Wires are placed on the body or in the vagina or rectum. A mild electric current is passed through the wire.

Researchers are not sure why the TENS works. Some theories about the electric pulse is that it:

• improves blood flow to the bladder
• starts the release of pain-blocking substances
• strengthens pelvic muscles that control the bladder

When interstitial cystitis does not respond to anything else, surgery may be a last resort.. It is performed only in the worst cases. Results are often less than expected.

Possible procedures include:

• augmentation, which increases the bladder capacity
• complete removal of the bladder
• creation of an artificial bladder from a piece of the person's bowel
• laser surgery to remove ulcers in the bladder
• removal of a portion of the bladder
• removal of ulcers in the bladder
• sacral nerve root stimulation, which involves permanent insertion of a nerve stimulator and wires

What are the side effects of the treatments?

Antiprostaglandins may cause stomach upset or allergic reactions. Antidepressants and antihistamines may cause drowsiness and dry mouth. Pentosan polysulfate sodium can cause abnormal liver function. Liver problems disappear when the medicine is stopped. DMSO can cause a garlic taste and odor. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.

What happens after treatment for the condition?

The course of interstitial cystitis is often unpredictable. Individuals may or may not get better with treatment. Symptoms often come and go. Treatment may be needed for years in severe cases.

How is the condition monitored?

The affected person monitors his or her symptoms. The need for repeat examinations depends on the severity of the condition and the treatments used. Any new or worsening symptoms should be reported to the healthcare provider.