Interstitial cystitis (IC) is a collection of chronic symptoms affecting the bladder and is also known as painful bladder syndrome. IC may also be referred to as bladder pain syndrome (BPS), and chronic pelvic pain. When the kidneys filter liquid waste products from the bloodstream, the waste is called urine and is stored in the bladder. When the bladder is full, the nerves and muscles send signals to your brain, giving you the urge to urinate.
People with IC feel constant or intermittent pain and pressure in and around their bladders. They may feel the urge to urinate dozens of times per day, and experience bladder pain and burning while urinating.
The particular symptoms can be different for each patient and can range from mild to severe. Diagnosis of IC is difficult and its causes are not well-understood, which leads some experts to believe that it may actually be a group of several different diseases. Both men and women can develop IC, but the overwhelming majority of patients are female, and most patients start experiencing IC symptoms in their 40s.
About 5% of IC patients have persistent IC symptoms for more than 2 years and 5% of patients have end-stage disease defined as very hard bladders with low bladder capacity and terrible pain. Many of these patients also have Hunner’s ulcers. Also called Hunner’s lesions or Hunner’s patches, it is a subtype of interstitial cystitis and is not an ulcer in the usual sense. They are distinct areas of inflammation on the bladder wall that characterize the classic form of IC. A procedure called cystoscopy will be performed by your doctor to check for the presence of Hunner’s ulcer on your bladder wall.
While there is no known cure for interstitial cystitis, there are a few methods that can relieve its chronic pain symptoms.
Symptoms of Interstitial Cystitis
Symptoms of interstitial cystitis are difficult to pin down. The IC symptoms may come and go, or they may be a constant for months or even years, lowering your quality of life. IC/BPS is not an infection, but it may feel like a bladder infection. In some cases, IC symptoms disappear without any treatment. Some common symptoms include:
- Chronic pain and pressure that increase as the bladder fills with urine
- Sharp or dull, aching pain in the pelvis, lower back, vulva, vagina, or urethra
- Painful, stinging, or burning urination (dysuria)
- Urinary frequency (more than 8 times per day)
- Immediate and urgent need to urinate, even after emptying the bladder
- Painful sexual intercourse
Another complication of IC is the possibility of bladder ulcers. IC causes inflammation in the bladder, which may lead to ulcers in some patients, called Hunner’s ulcers.
Symptoms may sometimes worsen during your period, or as a result of stress. The symptoms may also be aggravated by certain foods or drinks.
Although signs and symptoms of IC may resemble those of urinary incontinence or a chronic urinary tract infection, there’s usually no infection. However, symptoms may worsen if a person with IC gets a urinary tract infection. The more severe cases of interstitial cystitis/painful bladder syndrome can affect your life and your loved ones. Some people with interstitial cystitis/painful bladder syndrome have other health issues such as irritable bowel syndrome, fibromyalgia, and other chronic pain syndromes.
Causes of Interstitial Cystitis
Painful bladder syndrome is not very well understood and may have several interacting causes. The cause of IC isn’t known. One diagnostic test will not tell you if you have it. Doctors often run many tests to rule out other possible causes of IC symptoms. There is no cure for IC, but treatments can help most people feel better. Experts believe a number of conditions could cause the problem:
- Your bladder tissue is irritated or damaged by chemicals found in your urine.
- Your body reacts to the bladder’s inflammation by releasing chemicals that cause painful symptoms.
- An autoimmune disorder is causing your body to attack the bladder.
- The nerves surrounding your bladder are overly stimulated, resulting in pain during routine urinary functions.
- Some other condition is simultaneously causing inflammation in the bladder.
How is Interstitial Cystitis Diagnosed?
Because painful bladder syndrome is so difficult to identify, your doctor will instead focus on ruling out other possible conditions, such as sexually transmitted infections, a urinary tract infection, bladder cancer, and kidney stones. Your doctor will also check for endometriosis – a gynecological condition which causes similar symptoms.
Your doctor may recommend these tests:
You provide a sample of urine in a cup. A negative urine culture is a characteristic of interstitial cystitis.
Post-void residual urine volume
Your doctor administers an ultrasound after you urinate to measure the amount of fluid remaining in your bladder.
Your doctor takes a small sample of tissue from your urethra or bladder for testing.
Your doctor examines the inside of your urethra and bladder using a very narrow, flexible tube with a lens at the end.
Under anesthesia, your doctor can fill your bladder with a fluid or gas to get a better understanding of the problem. This can also serve a therapeutic purpose.
Treatment of Interstitial Cystitis
For about half of patients, the symptoms of painful bladder syndrome simply disappear on their own. For others, the symptoms can be chronic, a daily and nightly struggle for comfort and relief. Fortunately, there are several techniques and treatment options available that may work for you. You may need to try a combination of methods and may take a few weeks to clear up.
You and your health care provider may be able to treat your interstitial cystitis (IC) with lifestyle changes, bladder training, physical therapy, medicines, bladder hydrodistention, bladder instillation, surgery, or a combination of these treatments.
Talk to your doctor about these treatment options:
If you’re urinating frequently, try to extend the interval of time between bathroom trips.
Stress can trigger painful symptoms. Find time to relax and cut stressors from your life.
Regular exercise can help relieve symptoms, even low-intensity exercises like walking or stretching.
Avoid wearing tight pants that put pressure on your bladder.
Changing eating or drinking habits
Some foods may trigger symptoms, like spicy or acidic foods, alcohol, caffeine, artificial sweeteners, sodas, and chocolate. Keep a food diary to keep track of foods that may be causing symptoms.
If lifestyle changes aren’t enough to keep your symptoms at bay, talk to your gynecologist about medical intervention options, such as:
Therapeutic exercises can train your pelvic muscles to relax. Patients experiencing IC/BPS often have tenderness and/or pain in the pelvic floor area, and sometimes manipulative physical therapy can reduce symptoms. There is evidence that physical therapy exercises to strengthen the pelvic floor muscles do not improve symptoms, and often make them worse, so activities such as Kegel exercises are not recommended for patients with IC/BPS.
A few different drugs have been shown to be helpful in controlling painful bladder syndrome, including Pentosan, Amitriptyline, and Hydroxyzine, an antihistamine.
Pain medication can help manage your pain.
Injectable steroids may help with ulcers.
Dimethyl sulfoxide (DMSO)
This drug may fight inflammation, and is introduced into the bladder via catheter.
In this procedure, you are put under anesthesia and the doctor slowly fills your bladder with fluid or gas. For some patients, this can provide relief of symptoms for up to six months.
Very severe cases of painful bladder syndrome may fail to respond to any of these treatment methods. In these cases, more intensive treatments may be recommended.
Botox can paralyze the bladder muscles, numbing the pain. This is usually a temporary relief.
Your doctor can surgically implant small electric devices to control your nervous responses.
A surgeon could re-route your urine away from your bladder, bypassing the problem altogether. This procedure can be risky and is sometimes considered a last resort option.
If you are suffering from Interstitial Cystitis or have any questions about it or bladder conditions in general, please talk to your doctor.
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