Interstitial Cystitis

What is Interstitial Cystitis?

Interstitial Cystitis (IC), or Chronic Cystitis, is a pain disorder of the bladder in which the affected individual feels a frequent, persistent and urgent need to urinate.

As the bladder fills with urine, the urine applies pressure to the pelvic nerves. These nerves signal to the brain that it is time to urinate. In individuals with interstitial cystitis, these signals malfunction and the individual feels a “phantom” sensation to urinate more often and with increased urgency, even if there is little urine available to expel.

The condition often results in pain and discomfort, which may have adverse effects on the afflicted individual’s physical and mental health.

Interstitial Cystitis Symptoms

Symptoms of interstititial cystitis include:

• Increased urinary urgency
• Increased urinary frequency
• Inability, or perceived inability, to fully empty bladder (urinary retention)
• Pelvic pain, which may increase as the bladder fills
• Pelvic pressure, which may increase as the bladder fills
• Painful sexual intercourse
• Disruptions in the social, home, and work life of the affected individual

Interstitial Cystitis Causes

The exact cause of IC is unknown, though researchers believe it may be a result of a defect in the epithelium, a protective lining in the bladder that separates urine from the bladder wall. Breaches in the epithelium may allow toxins from the urine to reach the wall, causing irritation and discomfort.

Since the risk of developing interstitial cystitis increases if other family members have been diagnosed, researchers believe that it may be hereditary.

Other researchers believe that the condition may develop as a byproduct of an autoimmune reaction, infection, or allergy.

Interstitial cystitis appears to affect women more often than men, and the risk of developing interstitial cystitis increases with age. Symptoms may worsen in response to triggers, including menstruation, physical or mental stress, physical inactivity, exercise, and sexual activity.

Interstitial Cystitis Diagnosis

To diagnose iterstitial cystitis, physicians will begin by ruling out other problems that may be causing symptoms.

The physician will begin by performing a pelvic exam, to rule out malformations of the genitals and abdomen.

Next, the physician may order a urine culture to rule out infection. If there is no infection, the physician may order a cystoscopy, a procedure in which a lighted scope is inserted through the urethra via a catheter for the purpose of examining the bladder. During this procedure, the physician may inject liquid into the bladder to test its capacity, perform a biopsy of the urethra or bladder, or conduct a potassium sensitivity test, in which water and a potassium chloride solution are alternately injected into the bladder. If the patient feels more pain or pressure when the potassium chloride solution is present, s/he is likely to have interstitial cystitis.

Does Interstitial Cystitis ever go away?

Interstitial Cystitis is a chronic condition for which there is no cure. However, symptoms may improve or temporarily disappear with treatment and lifestyle modifications.

Interstitial Cystitis Treatment

• Dietary Changes: Individuals suffering from Interstitial Cystitis may benefit from avoiding food and beverages that may exacerbate the condition, including spicy and acidic foods, carbonated beverages, caffeine, and alcohol. Increased water consumption may dilute irritants in the urine and thereby relieve symptoms.
• Clothing Modifications: Wearing loose-fitting clothing or modifying clothing with elastic to reduce pressure on the abdomen and pelvic area may relieve symptoms.
• Bladder Training: Bladder training is conducted by timing urination at half hour intervals, and then gradually extending the length of the intervals to condition the individual’s urge to urinate. Relaxation and distraction techniques are employed to help overcome urinary urgency and help the individual wait until the next scheduled interval.
• Over-the-counter Oral Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may help relieve pain. Antihistamines such as loratadine and pseudoephedrine may reduce feelings of urgency. Antacids may nullify the effects of trigger-inducing acidic foods.
• Prescription Oral Medications: Prescription medications such as Elmiron (pentosan polysulfate) may reduce symptoms of Interstitial Cystitis by restoring the protective lining  of the bladder wall. Tricyclic antidepressants such as amitriptyline or imipramine may help reduce pain and relax the bladder.
• Bladder Instillation: Bladder instillation is a procedure in which the bladder is rinsed with a prescription medication – dimethyl sulfoxide, lidocaine, sodium bicarbonate, pentosan, or heparin – via a catheter inserted into the urethra. If effective, this procedure may be repeated every six to eight weeks to reduce symptoms.
• Bladder Distention: Bladder distention is a procedure in which the bladder is stretched with water. If effective, the procedure may be repeated as necessary to reduce symptoms.
• Physical Therapy: Low-impact exercises and stretches that target the affected area may help relieve tension in the pelvic floor and improve urination.
• Transcutaneous Electrical Nerve Stimulation: Mild electronic pulses delivered by wires places on the pubic area or lower back increase blood flow to the bladder, relieving pain and reducing feelings of urgency.
• Sacral Nerve Stimulation Therapy: Small wires are implanted near the sacral nerve and deliver electronic pulses to the bladder, reducing feelings of urgency.
• Surgery: Generally explored as a last resort due to the potential of serious complications, surgery to modify or augment the bladder may improve quality of life for patients experiencing severe pain as a result of Interstitial Cystitis:
  • Fulguration or resection, in which ulcers resulting from interstitial cystitis are burned away with a small instrument inserted through the urethra.
  • Bladder augmentation, in which the capacity of the bladder is increased with a patch of intestine.