Interstitial Cystitis
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Interstitial Cystitis

Pronounced: In-tur-STI-shul sis-TY-tis

En Español (Spanish Version)

Definition

Interstitial cystitis is chronic inflammation of the wall of the bladder. Inflammation can lead to scarring, pinpoint bleeding of the bladder wall, and a decreased bladder capacity. Although the symptoms are similar to those of a bladder infection , there is usually no clear cause.

The Bladder

The bladder

© 2008 Nucleus Medical Art, Inc.

Causes

Because bacteria, fungi, or viruses are rarely found in the urine of people with interstitial cystitis, the cause is unclear. Possible causes include:

  • An autoimmune response that occurs following a bacterial infection of the bladder
  • Bacteria that cling too tightly to the wall of the bladder
  • A "leaky" inner lining of the bladder that allows irritating substances in the urine to come into contact with the bladder wall

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for interstitial cystitis include:

  • Sex: female to male ratio 9:1
  • Race: Caucasians 90%
  • Genetics: higher rate in first degree relatives
  • Stress
  • Associated psychological disorders: fibromyalgia or chronic fatigue syndrome
  • History of childhood bladder problems

Symptoms

The symptoms of interstitial cystitis vary from person to person. They can also occur in cycles. Some people experience periods of intense symptoms followed by periods of remission. Pain can be severe enough to keep people from working or even walking.

Symptoms can include:

  • Discomfort, pain, or pressure in the bladder or pelvic area when the bladder is full and relief when the bladder is emptied
  • Urgent need to urinate
  • Frequent need to urinate (up to 60 times per day in severe cases)
  • Pain during and after intercourse
  • Blood and pus in the urine
  • Depression
  • Men with pain in testes, groin, or tip of penis
  • Constipation
  • Nocturia (urination at night, especially when excessive) from once to over 12 times every night

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. In addition, your urine will be tested for pus and bacteria. If bacteria are present in the urine, you will likely be diagnosed with acute cystitis—a typical bladder infection. If no bacteria are present, your doctor will likely do other tests.

A diagnosis of interstitial cystitis will only be made after other conditions have been ruled out and a cystoscopy with bladder distention has been done. This consists of distending (stretching) the bladder to its full capacity by instilling liquids through the cystoscope. If interstitial cystitis is present, there will be characteristic changes in the wall of the bladder following this distension (usually called glomerulations, or occasionally Hunner’s ulcers). These findings are usually interpreted as confirming a diagnosis of interstitial cystitis. Random biopsy of the bladder might be performed if any abnormality seen.

Treatment

There is no treatment to cure interstitial cystitis. Treatment is aimed at relieving symptoms. Treatment depends on your symptoms. You may have to try several different treatments before you experience relief.

Treatments include:

Bladder Distention

Some people experience relief after the bladder distention (during the cystoscopy) is done.

Bladder Instillation

During bladder instillation, a "wash" is put into the bladder through a tube in the urethra. It is held for anywhere from a few seconds to 15 minutes and then voided. There are several different types of solutions used. Some coat the bladder and are thought to decrease the inflammation. Usually these types of treatments are used only if various oral medications have not been effective at relieving the particular symptoms which may be present.

Medication

Medications may include:

  • Bladder coating—taken orally to coat and protect the bladder
  • Antidepressants and pain relievers—for pain relief
  • Antihistamines—may help stop the cycle of inflammation
  • Antispasmodics—may alleviate frequency and urgency of urination

Diet

There is no research linking diet to interstitial cystitis. But many people find that changes in diet can help relieve pain. Different people have different "trigger" foods. Foods commonly reported to aggravate interstitial cystitis include:

  • Coffee
  • Chocolate
  • Artificial sweeteners
  • Alcohol
  • Acidic foods
  • Carbonated beverages

Transcutaneous Electrical Nerve Stimulation (TENS)

TENS uses an external device that sends mild electrical impulses into the body. It has been helpful in relieving pain and decreasing frequency of urination in some people.

Interstim Therapy

Interstim therapy uses an approved device which has been reported to possibly provide symptomatic relief in some patients with interstitial cystitis refractory to more conventional treatments. This is an electronic device which is implanted into the sacral nerve roots of the spinal cord. Electrical impulses are sent to these roots in regular intervals. This is meant to modulate the neural output of the pelvic nerves supplying the bladder.

While some patients have reported some relief, they appear to be in the minority. Doctors do not know yet what makes the device helpful.

Bladder Training

Some people are able to train their bladder to have better control by setting a regular timed schedule for emptying their bladder. The amount of time between voidings is gradually increased. Bladder training should be attempted only after pain relief has been accomplished.

Acupuncture

Pain from interstitial cystitis may be treated with acupuncture. Talk to your doctor to learn more about this option.

Surgery

Surgery is a treatment of last resort. It is used after all other treatment methods have been exhausted and if the pain remains severe. The usual approaches include either increasing the capacity of the bladder by adding a segment of bowel to the distensible portion of the bladder (ie, bladder augmentation) or by removing the entire bladder (ie, cystectomy).This surgeries are rarely done for this condition. Many people continue to have pain even after surgery.

Prevention

There are no guidelines for preventing interstitial cystitis because the cause is unknown. However, recurrence or aggravation of interstitial cystitis could be reduced by avoiding the following foods or drinks:

  • Caffeine-containing beverages
  • High-acid citrus fruits
  • Spicy foods
  • Vinegar
  • Chocolate
  • Fermented foods
  • Alcohol

RESOURCES:

Interstitial Cystitis Association
http://www.ichelp.com

Interstitial Cystitis Network
http://www.ic-network.com

CANADIAN RESOURCES:

BC Health Guide
http://www.bchealthguide.org/

Canada Health Portal
http://chp-pcs.gc.ca/CHP/index_e.jsp

References:

Cystitis and Overactive Bladder Foundation website. Available at: http://www.interstitialcystitis.co.uk .

Interstitial cystitis and related disorders. Walsh P, ed. In: Campbell’s Urology . 8th ed. Philadelphia, PA: WB Saunders; 2002.

Interstitial Cystitis Association website. Available at: http://www.icamail@achelp.org .

Interstitial Cystitis Network website. Available at: http://www.ic-network.com .

National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www2.niddk.nih.gov/ .

Nordling J. Interstitial cystitis: how should we diagnose it and treat it in 2004? Curr Opin Urol . 2004;14:323-327.



Last reviewed February 2008 by Miguel Antelo, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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