Interstitial Cystitis

Overview

Interstitial cystitis (IC) is a chronic condition in which the urinary bladder is irritated or inflamed in the absence of any apparent underlying reason such as a urinary tract infection. The typical symptoms are a frequent urge to urinate and pain in pelvic area. The severity of symptoms ranges from mild to debilitating. Almost 90% cases of IC are seen in women. It can occur at all ages, though it is rare in children. IC is also known as:

 

  • Painful bladder syndrome (PBS)
  • Frequency-urgency-dysuria syndrome

Symptoms of Interstitial Cystitis

The type and severity of interstitial cystitis (IC) symptoms varies a lot from patient to patient. The most common symptoms are:
  • Frequent urination. Some women need to go every 20 minutes during a severe episode.
  • Pain below the navel, in the inner thighs, and/or the area between the anus and vagina. The pain may be mild to severe and intermittent or constant.
  • Pain during intercourse
  • Worsening of symptoms during periods
  • Worsening of symptoms after taking certain foods, beverages, smoking or under extreme stress

Cause of Interstitial Cystitis

The cause of interstitial cystitis is not yet known. Doctors think that it occurs because of one or more of the following causes:

 

  • Damage to the protective lining in the bladder that causes irritants in the urine to penetrate into the bladder
  • Over activation of pain nerves running in the bladder
  • Presence of a damaging substance in the urine
  • Body’s immune cells attacking the bladder

Diagnosis of Interstitial Cystitis

  • Interstitial cystitis is primarily a diagnosis of exclusion, meaning that a person is said to have it after all possible explanations for his/her symptoms have been ruled out.
  • Tests are done mainly to detect other diseases that cause similar symptoms, such as bladder cancer, urinary stones, sexually transmitted diseases and some other gynecological problems.
  • Investigations usually include:
  • Urinalysis
  • Urine culture and cytology
  • Laboratory examination of prostate secretions (in men)
  • Cystoscopy and biopsy: Your urologist may want to visualize the bladder with a narrow tube and camera inserted through the urethra and extract bladder tissue for examination
  • Urodynamic studies to see the relation between bladder pressure and pain

Treatment of Interstitial Cystitis

There is no proven cure for IC/PBS, but many options are available for symptom control. You may need to work with your urologist for some time to find the therapy or combination of therapies that work best for you. The treatment may include the following.

 

  • Bladder training — It’s a specialized program focusing on the use of pelvic floor muscles to control symptoms. Scheduled voids along with techniques to keep the schedule are used to gradually reduce the frequency of urination.
  • Biofeedback — An intravaginal device is used to regulate the contraction and relaxation of pelvic floor muscles.
  • Functional electrical stimulation — Gentle electrical currents are used to contract or relax the pelvic muscles.
  • Medicines Some IC/PBS patients benefit from oral drugs such as Ditropan, Sanctura, Vesicare, Detrol, Elavil and Elmiron.
  • Bladder distension — It involves increasing bladder capacity and blocking pain signals from the bladder.
  • Bladder instillations Repeated instillations of lidocaine, heparin and other substances into the bladder to decrease bladder pain.
  • InterStimTM Therapy — A small device is implanted beneath the skin of one buttock. It stimulates nerves to make the bladder function more normally.
  • Spinal nerve blocks — Patients not responsive to other treatments may need injections in the spine or pelvis to block pain and other symptoms.
  • Diet modification Research does not validate the influence of diet on IC/PBS, but many patients report that certain foods such as tomatoes, spices, chocolate, alcohol, caffeinated and citrus beverages aggravate symptoms. Some doctors may recommend a diet that is free of foods that might irritate the bladder.
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