Interstitial Cystitis – What is it, Symptoms and Treatments

Interstitial Cystitis – What it is, Symptoms and Treatments that many are unaware of. Furthermore, Interstitial Cystitis (in-tur-STISH-ul sis-TIE-tis) – also called painful bladder syndrome – is a chronic condition that causes bladder pressure, bladder pain, and sometimes pelvic pain . Pain ranges from mild to severe discomfort. The bladder is a hollow, muscular organ that stores urine. The bladder expands until it is full and then signals your brain that it is time to urinate by communicating via the pelvic nerves. This creates the urge to urinate for most people.

With Interstitial Cystitis , these signs are mixed together – you feel the need to urinate more often and with smaller volumes of urine than most people. Interstitial Cystitis most often affects women and can have a lasting impact on quality of life. While there is no cure, medications and other therapies can offer relief.

Causes of Interstitial Cystitis:  The exact cause of Interstitial Cystitis is not known, but many factors are likely to contribute. For example, people with Interstitial Cystitis may also have a defect in the protective lining (epithelial) of the bladder. A leak in the epithelium can allow toxic substances in the urine to irritate the bladder wall. Other possible unproven contributing factors include an autoimmune reaction, heredity, infection, or allergy.

Symptoms of Interstitial Cystitis:  The signs and symptoms of Interstitial Cystitis vary from person to person. If you have Interstitial Cystitis , your symptoms can also vary over time, periodically burning in response to common triggers such as menstruation, sitting too long, stress, exercise, and sexual activity. The signs and symptoms of Interstitial Cystitis include:

• Pain in the pelvis or between the vagina and anus in women
• Pain between the scrotum and anus in men (perineum)
• chronic pelvic pain
• A persistent and urgent need to urinate
• Frequent urination, often in small amounts, throughout the day and night (up to 60 times a day)
• Pain or discomfort as the bladder fills and relieves after urinating.
• Pain during intercourse.

The severity of symptoms is different for everyone, and some people may experience symptom-free periods. Although the signs and symptoms of Interstitial Cystitis  may be similar to those of a chronic urinary tract infection, there is usually no infection. However, symptoms can get worse if a person with Interstitial Cystitis  gets a urinary tract infection.

When to See a Doctor:  If you are suffering from chronic bladder pain or urinary urgency and frequency, contact your doctor.

Interstitial Cystitis Risk Factors:  These factors are associated with an increased risk of Interstitial Cystitis :

• Your sex. Women are diagnosed with Interstitial Cystitis more often than men. Symptoms in men can mimic Interstitial Cystitis , but they are more often associated with an inflammation of the prostate gland (prostatitis).
• Your skin and hair color. Having fair skin and red hair has been linked to a higher risk of Interstitial Cystitis .
• Age. Most people with Interstitial Cystitis are diagnosed during their 30s or older.
• Having a chronic pain disorder. Interstitial Cystitis  may be associated with other chronic pain conditions such as irritable bowel syndrome or fibromyalgia.

Risk Complications of Interstitial Cystitis: Interstitial  cystitis can result in a number of complications, including:

• Reduced bladder capacity. Interstitial Cystitis can cause the bladder wall to harden, which allows your bladder to hold less urine.
• Lower quality of life. Frequent urination and pain can interfere with social activities, work and other activities of daily living.
• Sexual intimacy issues. Frequent urination and pain can damage your personal relationships and sexual intimacy can suffer.
• Emotional problems. The chronic pain and disrupted sleep associated with Interstitial Cystitis can cause emotional stress and can lead to depression.

Diagnosing Interstitial Cystitis:  The following may be helpful in diagnosing Interstitial Cystitis :

• Medical history and bladder diary. Your doctor will ask you to describe your symptoms and may ask you to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass.
• Pelvic exam. During a pelvic exam, your doctor examines your external genitals, vagina, and cervix, and feels your abdomen to assess your internal pelvic organs. Your doctor may also examine your anus and rectum.
• Urine test. A sample of your urine is analyzed for signs of a urinary tract infection.
• cystoscopy. Your doctor inserts a thin tube with a small camera (cystoscope) through the urethra, showing the lining of the bladder . Your doctor may also inject fluid into your bladder to measure your bladder capacity. Your doctor may perform this procedure, known as hydrodistention, after you’ve been put to sleep with an anesthetic medication to make you more comfortable.
• Biopsy. During cystoscopy under anesthesia, your doctor may remove a tissue sample (biopsy) from your bladder and urethra for examination under a microscope. This is to check for bladder cancer and other rare causes of bladder pain.
• Urine cytology. Your doctor collects a urine sample and examines the cells to help rule out cancer.
• Potassium sensitivity test. Your doctor puts (instills) two solutions — water and potassium chloride — into your bladder , one at a time. You are asked to rate on a scale of 0 to 5 the pain and urgency you feel after each solution is instilled. If you experience noticeably more pain or urgency with the potassium solution than with the water, your doctor may diagnose Interstitial Cystitis . People with normal bladders cannot tell the difference between the two solutions.

Interstitial Cystitis Treatments:  No single treatment eliminates the signs and symptoms of Interstitial Cystitis , and no treatment fits all. You may need several treatments or combinations of treatments before you find an approach that will alleviate your symptoms.

Physical Therapy:  Working with a physical therapist can relieve pelvic pain associated with muscle tenderness, restrictive connective tissue, or muscle abnormalities in your pelvic floor.

Oral Medications: Oral  medications that can improve the signs and symptoms of Interstitial Cystitis include:

• Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), to relieve pain.
• Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax the bladder and block pain.
• Antihistamines, such as loratadine (Claritin, others), which can reduce urinary urgency and frequency and relieve other symptoms.
• Pentosan polysulfate sodium (Elmiron), which is approved by the Food and Drug Administration specifically for the treatment of Interstitial Cystitis . How this works is unknown, but it may restore the inner surface of the bladder, which protects the bladder wall from substances in the urine that can irritate it. It can take two to four months before you start to experience pain relief and up to six months to experience a decrease in urinary frequency.

Nerve Stimulation: Nerve  stimulation techniques include:

• Transcutaneous electrical nerve stimulation (TENS). With TENS, gentle electrical pulses relieve pelvic pain and, in some cases, reduce urinary frequency. TENS can increase blood flow to the bladder. This can strengthen the muscles that help control the bladder or trigger the release of substances that block pain. Electrical wires placed in your lower back or just above your pubic area deliver electrical pulses – the time and frequency of therapy depends on what works best for you.
• Sacral nerve stimulation. Your sacral nerves are a primary link between your spinal cord and nerves in your bladder. Stimulating these nerves can reduce urinary urgency associated with Interstitial Cystitis With sacral nerve stimulation, a thin wire placed near the sacral nerves sends electrical impulses to your bladder, similar to what a pacemaker does to your heart. If the procedure lessens your symptoms, you may have a permanent device surgically implanted. This procedure does not manage the pain of Interstitial Cystitis , but it can help relieve some symptoms of urinary frequency and urgency.

Bladder distention:  Some people notice a temporary improvement in symptoms after cystoscopy with bladder distention. Bladder distention is the stretching of the bladder with water. If you have long-term improvement, the procedure can be repeated.

Bladder Instilled Medications: In bladder  instillation , your doctor places prescription medication dimethyl sulfoxide (Rimso-50) into your bladder through a thin, flexible tube (catheter) inserted through your urethra. The solution is sometimes mixed with other medications, such as a local anesthetic, and remains in your bladder for about 15 minutes. You urinate to expel the solution.

You can receive dimethyl sulfoxide – also called DMSO – treatment weekly for six to eight weeks and then have maintenance treatments as needed – for example, for up to a year. A newer approach to bladder instillation uses a solution containing the drugs lidocaine, sodium bicarbonate and pentosan or heparin.

Surgery:  Doctors rarely use surgery to treat Interstitial Cystitis because removing the bladder does not relieve pain and can lead to other complications. People with severe pain or those whose bladders can hold only small volumes of urine are potential candidates for surgery, but usually only after other treatments have failed and symptoms affect quality of life. Surgical options include:

• Fulguation. This minimally invasive method involves inserting instruments through the urethra to burn ulcers that may be present with Interstitial Cystitis .
• Resection. This is another minimally invasive method that involves inserting instruments through the urethra to cut the ulcers.
• Bladder enlargement. In this procedure, a surgeon increases the capacity of your bladder  by placing a bowel patch on your bladder . However, this is only performed in very specific and rare instances. The procedure does not eliminate pain, and some people need to empty their bladders with a catheter many times a day.

Alternative Medicine:  Two complementary and alternative therapies show some promise in treating Interstitial Cystitis :

• Guided Imagination. This type of therapy employs visualization and direct suggestion using imagery to help you imagine healing, with the hope that the body will follow the mind’s suggestions.
• Acupuncture. During an acupuncture session, a practitioner places numerous fine needles into your skin at specific points on your body. According to traditional Chinese medicine, precisely placed acupuncture needles relieve pain and other symptoms by rebalancing the flow of vital energy.
• Western medical doctors tend to believe that acupuncture increases the activity of your body’s natural pain relievers. These treatments have not been well studied for Interstitial Cystitis , so be sure to discuss the use of these therapies with your doctor.