Interstitial cystitis

Overview

Interstitial cystitis (IC) is a complex, chronic disorder characterized by an inflamed or irritated bladder wall. Once believed to be extremely rare, IC is now known to affect 3 million to 8 million women and 2 million men in the U.S. It can lead to scarring and stiffening of the bladder, decreased bladder capacity and glomerulations (pinpoint bleeding).

The effects of IC vary, but mild cases may include only discomfort and an inconsistent urinary frequency. However, moderate to severe symptoms can include the constant need for bathroom access, limited ability to travel and lack of sleep due to the pain and constant need to urinate. Pain with sexual activity is also common.

Anyone can experience IC, but it’s prevalent among people in their late 20s through their 50s. Heredity may also play a role: If a parent or sibling has IC, you are 17 times more likely to also get the condition.

IC may also be known as:

  • Bladder pain syndrome (BPS)
  • ​Frequency-urgency-dysuria syndrome

Causes

The exact cause of IC is unknown. Scientists are investigating theories to understand what causes IC and appropriate treatments, and many believe multiple factors may play a role.

The various causes of IC/BPS may include changes in the surface lining of the bladder, nerve abnormalities of the bladder wall and autoimmune problems. The symptoms may also be related to diseases affecting other parts of the body, because 40 percent of patients have other disorders such as irritable bowel syndrome, fibromyalgia, migraine headaches and even depression.

Most people with IC find that certain foods make their symptoms worse, including most commonly: citrus fruits, tomatoes, chocolate, coffee and potassium-rich foods. Other foods that bother many patients are alcoholic beverages, caffeinated beverages, spicy foods, and some carbonated beverages.

Symptoms

About 5 to 10 percent of IC patients have inflammation called Hunner’s lesions that can be seen on the bladder surface. In most patients, the bladder wall looks normal. Further testing will make sure you don’t have signs of infection or any other obvious bladder disease.

The following are the most common symptoms of IC. However, each individual may experience symptoms differently. Symptoms may include:

  • Frequent urination
  • Feelings of pressure, pain and tenderness around the bladder, pelvis and perineum (the area between the anus and vagina or anus and scrotum)
  • Painful sexual intercourse
  • In men, discomfort or pain in the penis and scrotum
  • In most women, symptoms may worsen around the menstrual cycle

Stress may also intensify symptoms, but stress does not cause symptoms to occur.

The symptoms of IC may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

Diagnosis

Because there is no definitive test to diagnose IC, and because symptoms of IC are similar to other urinary disorders, a variety of diagnostic tests and procedures may be necessary. In addition to a complete medical history and physical examination, diagnostic procedures for IC may include the following:

  • Urinalysis – laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection or excessive protein.
  • Urine culture and cytology
  • Cystoscopy (also called cystourethroscopy) – an examination in which a scope (a flexible tube and viewing device) is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.
  • Bladder wall biopsy – a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if cancer or other abnormal cells are present.
  • Laboratory examination of prostate secretions (in men)

Treatment

Specific treatment for IC will be determined by your doctor based on:

  • Your age, overall health and medical history
  • Extent of the disease
  • Your tolerance for specific medications, procedures or therapies
  • Expectations for the course of the disease
  • Your opinion or preference

Currently, there is no specific way to diagnose IC, and no cure for IC, making it difficult to treat. Thus, treatments are primarily focused on relieving symptoms, and may include:

  • Bladder distension – a procedure aimed at increasing bladder capacity and interfering with pain signals that are being transmitted by the nerve cells in the bladder.
  • Bladder instillation (also called a bladder wash or bath) – the bladder is filled with a solution that is held for varying periods of time, from a few seconds to 15 minutes, before being drained through a catheter.
  • Medication
  • Transcutaneous electrical nerve stimulation (TENS) – mild, electric pulses enter the body for minutes to hours two or more times a day either through wires placed on the lower back, or through special devices inserted into the vagina in women or into the rectum in men.
  • Bladder training – the patient voids at designated times and uses relaxation techniques and distractions to help keep to the schedule. Gradually, the patient tries to lengthen the time between the scheduled voids.
  • Surgery

Management of IC may also include:

  • Diet modification – no scientific evidence links diet to IC, but some doctors and patients believe that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages and high-acid foods may contribute to bladder inflammation. Thus, eliminating these substances from the diet may help to eliminate some symptoms.
  • Not smoking – many people with IC feel that smoking makes their symptoms worse.
  • Exercise – this may help relieve symptoms or hasten remission. There is no evidence that stress causes IC; however, if a person has IC, physical or mental stress can make the symptoms worse.

Consult your doctor with any questions or concerns you may have regarding this condition.

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