Interstitial Cystitis
The bladder is a hollow organ located in the lower part of the abdomen that functions to collect urine before removing it from the body through the urethra. Interstitial cystitis, also called painful bladder syndrome, is a chronic condition characterized by an inflammation of the bladder wall tissue. Interstitial cystitis is more common in young and middle-aged women.
Causes
The exact cause of interstitial cystitis is unknown. A defect in the protective lining of the bladder may allow toxic substances in the urine to cause irritation of the bladder wall, resulting in interstitial cystitis. Other factors such as an increased number of histamine-producing cells in the bladder or an autoimmune reaction may also contribute to the development of interstitial cystitis.
Symptoms
People with interstitial cystitis may experience the following symptoms:
- An urgent need to urinate, often small amounts, throughout the day and even at night
- Women may experience pressure, pain or tenderness in the pelvis or in the perineum which is often aggravated with filling of the bladder.
- Men may experience pain or discomfort in the penis or the scrotum
- Decreased bladder capacity
- Painful sexual intercourse
In most women, symptoms usually worsen around the menstrual cycle. Stress may also aggravate the symptoms.
Diagnosis
There is no single definitive test to diagnose interstitial cystitis. A variety of diagnostic tests and procedures may be required to identify the condition. Your doctor will take a detailed medical history to rule out other conditions such as urinary tract infections, bladder cancer, endometriosis, kidney stones, and sexually transmitted infections.
The following tests may be helpful to rule out other possible conditions:
Urine test: A sample of urine is obtained either by catheterization or by the "clean catch" method for culture and sensitivity.
Cystoscopy: This is a procedure to examine the inside of the bladder using a cystoscope, a thin tube with a small camera at one of its ends. Your doctor may instil a liquid into your bladder, to expand it for optimal viewing. This allows the doctor to visualize the entire inner lining of the bladder. Cystoscopy may be done to check for signs of cancer, bladder stones, bladder wall inflammation, bleeding or ulcers in the bladder, and to measure bladder capacity.
Biopsy: During cystoscopy, the doctor may remove a small sample of tissue (biopsy) from the bladder for examination under a microscope. A biopsy may help rule out bladder cancer.
Treatment
There is no definitive cure for interstitial cystitis. However, several treatment options are available to help ease the symptoms.
Lifestyle and home remedies: Some people with interstitial cystitis find relief with dietary changes, bladder training, wearing loose clothing, reducing stress, quitting smoking, performing pelvic floor exercises and stretching exercises.
Dietary changes: There is no scientific evidence linking diet to interstitial cystitis, but some patients believe that certain foods or drinks such as alcohol, tomatoes, spices, chocolate, caffeinated and citrus drinks, high-acid foods, and artificial sweeteners may aggravate the symptoms of interstitial cystitis.
Keep a food and drink diary to track the foods that aggravate the symptoms. Patients may try eliminating these products from their diet for a couple of weeks. Then gradually reintroduce them one at a time to determine if they increase your symptoms. It's important to ensure you eat a healthy and well-balanced diet.
Oral medications: Oral medications that may improve the symptoms of interstitial cystitis include over-the-counter pain relievers, antihistamines, and tricyclic antidepressants. The most common oral medication for interstitial cystitis is pentosan polysulfate sodium that is believed to assist in the restoration and protection of the inner surface of the bladder from the toxic substances in urine. Before taking pentosan, inform your doctor if you're pregnant or planning to become pregnant.
Bladder distention: Bladder distention refers to stretching of the bladder with liquid to help relieve symptoms of interstitial cystitis.
Bladder instillation: Also called bladder wash or bath, this is a procedure during which the bladder is filled with a liquid medicine that is drained after a particular period of time. This treatment may be performed every 1-2 weeks for a six to eight-week cycle and may be performed at home.
Nerve stimulation: This therapy uses mild electrical pulses to stimulate the nerves that control the bladder. Nerve stimulation can address the problems of urinary urgency and frequency of urination.
Surgery: Surgery is only considered when all other treatment modalities have failed and in patients with severe pain.