• Interstitial Cystitis

    (IC; Painful Bladder Syndrome)

    Definition

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

    The cause is unclear. Bacteria, fungi, and/or viruses are rarely found in the urine of people with interstitial cystitis. 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

    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: almost all 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

    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 in men
    • Constipation
    • Nocturia (urination at night, especially when excessive) from once to over 12 times every night

    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. This is 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 (usually called glomerulations, or occasionally Hunner's ulcers). These results usually confirm a diagnosis of interstitial cystitis. A random biopsy of the bladder might be done if any abnormality is seen.

    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 (bladder augmentation). Another approach is to remove the entire bladder (cystectomy). These surgeries are rarely done for this condition. 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 avoiding the following foods or drinks:
    • Caffeine-containing beverages
    • High-acid citrus fruits
    • Spicy foods
    • Vinegar
    • Chocolate
    • Fermented foods
    • Alcohol

    RESOURCES

    Urology Care Foundation http://www.urologyhealth.org

    Interstitial Cystitis Association http://www.ichelp.com

    Interstitial Cystitis Network & Overactive Bladder http://www.ic-network.com

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    Women's Health Matters http://www.womenshealthmatters.ca

    References

    Interstitial cystitis. American Urological Association Foundation. Available at: http://www.urologyhealth.org/urology/index.cfm?article=67. Accessed November 1, 2012.

    Interstitial cystitis and related disorders. Wein: Campbell-Walsh. Urology. 9th ed. Saunders; 2007.

    Interstitial Cystitis / Painful Bladder Syndrome. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://kidney.niddk.nih.gov/KUDiseases/pubs/interstitialcystitis/index.aspx. Updated June 29, 2012. Accessed November 1, 2012.

    Nordling J. Interstitial cystitis: how should we diagnose it and treat it in 2004? Curr Opin Urol. 2004;14:323-327.

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