Interstitial Cystitis

Interstitial cystitis (IC), also called painful bladder syndrome, is a breakdown in the normal protective lining of the bladder wall. When this surface lining is damaged, urinary chemicals can leak into the surrounding tissues causing pain, inflammation and increased urinary frequency.

The symptoms of IC are similar to a urinary tract infection, but lack an identifiable cause such as bacterial infection. IC is thought to affect up to 12% of women.

While the cause of IC is unknown, the condition generally occurs between the ages of 30 and 40 and has been reported in younger people. Also, women are 10 times more likely to have IC than men.

IC symptoms vary not only from patient to patient but also from one day to the next in a single individual. Similar to those of a urinary tract infection, some common IC symptoms include:

• Pain during intercourse
• Pelvic pain, which worsens with bladder filling or certain foods
• Urinary discomfort
• Urinary frequency (up to 60 times a day in severe cases)
• Urinary urgency

The diagnosis of IC is based on the presence of the characteristic pattern of symptoms of urgency, frequency, and/or pelvic pain in any combination and is frequently misdiagnosed as a urinary tract infection (UTI). For this reason, there is, on average, a four-year delay between the time the first symptoms occur and the diagnosis is made. The diagnosis is made by ruling out other causes. Tests include:

• Urinalysis: An examination of the composition of the patient’s urine.
• Urodynamics: A technique that measures pressure in the bladder and urine flow.
• Urine cytology: Determines abnormal cells in the urine.
• Cystoscopy: A thin tube with a tiny camera is inserted into the urethra to view any abnormalities in the urethra or bladder.

The key principle in treating IC is to use multiple therapies to control whatever is causing the symptoms. Patients with mild IC may not need much therapy and sometimes diet modification or stress reduction can help. Those with a severe condition may require more therapies, including:

• Physical therapy, biofeedback, and bladder re-training: The pelvic floor muscles may need strengthening or relaxation in some situations.
• Medication: Multimodal pain management strategies, tricyclic antidepressants, and antihistamines to reduce pain and urination frequency. The oral medication pentosan polysulfate is believed to provide a protective coating to the bladder, allowing it to heal. Some medications can be instilled in the bladder by a catheter to help provide more immediate relief. These are often referred to as “bladder cocktails.” Medicines that are given this way include heparinoid compounds (heparin) and DMSO (dimethyl sulfoxide), which relieves pain and inflammation.
• Cystoscopic evaluation: A scope is done to evaluate the bladder and ensure there are no causes, other than IC, for the symptoms. This also may find Hunner’s lesions which can be fulgurated or burned to relieve symptoms.
• Bladder hydrodistention: In this procedure the physician overfills the bladder while the patient is under general anesthesia.
• Botox injection: The physician injects Botox directly into the bladder muscle, partially paralyzing it to reduce overactivity, but leaving enough control to empty the bladder voluntarily.

Following a healthy diet is important to avoiding future episodes of interstitial cystitis.