Interstitial Cystitis

Interstitial cystitis affects the bladder. This chronic condition can cause pain and pressure.

It is not yet known what causes interstitial cystitis. Experts believe that many factors can play a role. For example, an epithelium defect may contribute by allowing certain urine-related toxic substances to irritate the wall of the bladder.

• While unproven, an autoimmune reaction, infection, heredity, and allergies are also being studied as potential causative factors.
• Fortunately, there are treatments that may help patients to manage their symptoms.

Risk Factors

Women tend to develop this condition more often than men. It generally develops when they are in their 30s and older. Having red hair and fair skin is also a risk factor of this condition. Additionally, interstitial cystitis appears to occur more often in those with other chronic pain disorders, such as fibromyalgia and irritable bowel syndrome.

Symptoms

The severity of symptoms ranges greatly. The symptoms may also flare periodically, such as when a person is under stress or having their menstrual cycle. Potential symptoms include:

• In women, pelvic pain or discomfort in between the anus and vagina
• Feeling the need to urinate urgently
• Painful intercourse
• Persistent need to urinate
• As the bladder fills, discomfort can increase and then be alleviated with urination
• Chronic pelvic pain
• Frequent urination (some people may urinate as many as 60 times daily)

Treatment

It is important to get a definitive diagnosis prior to working with the patient on a potential treatment regimen. The following can be helpful in diagnosis:

• Getting a full medical history
• Urine testing to look for possible infection
• Biopsy to rule out rarer causes for bladder discomfort
• Potassium sensitivity testing to help diagnose the condition
• Pelvic exam to assess the pelvic organs
• Cystoscopy to explore the bladder lining or to measure bladder capacity
• Urine cytology to rule out cancer

Medications may be tried first since they are non-invasive and can be adjusted or combined to work toward an effective method of treatment. To alleviate pain, non-steroidal anti-inflammatory drugs may be prescribed. Antihistamines may help to alleviate urinary frequency and urgency. Tricyclic antidepressants may block pain and relax the bladder. Pentosan polysulfate sodium may restore the inner bladder surface, but exactly how it works is not known. Before a patient experiences pain relief and a reduction in urinary frequency, it could take up to six months.

Nerve stimulation might be used to reduce urinary urgency by strengthening the bladder muscles. Bladder distention may also be helpful to improve symptoms by helping to stretch the bladder.

While rarely considered, surgery is a possible treatment. Bladder augmentation works to increase the bladder capacity. Resection or fulguration might be used if ulcers are present in the bladder and require surgical treatment.