Interstitial Cystitis

Overview

Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a chronic bladder health issue. It is a feeling of pain and pressure in the bladder area. Along with this pain are lower urinary tract symptoms which have lasted for more than 6 weeks, without having an infection or other clear causes.

 

Experts do not know exactly what causes IC/BPS, but there are many theories, such as:

  • A defect in the bladder tissue, which may allow irritating substances in the urine to penetrate the bladder.
  • A specific type of inflammatory cell, called a mast cell. This cell releases histamine and other chemicals that lead to IC/BPS symptoms.
  • Something in the urine that damages the bladder.
  • Changes in the nerves that carry bladder sensations so pain is caused by events that are not normally painful (such as bladder filling).
  • The body’s immune system attacks the bladder. This is similar to other autoimmune conditions..

No specific behaviors (such as smoking) are known to increase your risk of IC. Having a family member with IC/BPS may increase your risk of getting IC/BPS. Patients with IC/BPS may have a substance in the urine that inhibits the growth of cells in the bladder tissue. So, some people may be more likely to get IC/BPS after an injury to the bladder, such as an infection.

 

At this time, there is no medical test that can say a person has IC/BPS. Also, there is no test to say a person does not have IC/BPS. To make a diagnosis, your urologist will first decide whether the symptoms are typical of IC/BPS. Next, they need to rule out other health issues that might be causing the symptoms. More tests may be needed to find out whether the patient has IC/BPS.

Signs & Symptoms

Symptoms usually include one or more of the following:

  • Urinating frequently. IC patients average about 16 times per day – some up to 60 times per day.
  • Inability to hold much urine.
  • Awaken more than once a night to urinate.
  • Urge to urinate sometimes even after emptying the bladder.
  • Unexplained pain and pressure in the vagina, pelvis, lower abdomen or external genitalia.

Diagnosis & Treatment

IC can affect people of any age, race or sex. It is, however, most commonly found in women. Recent data suggest there may be greater than 700,000 cases of IC in the United States. Commonly with IC, tests for bacterial urinary tract infections, other urological disorders, tumors, and sexually transmitted diseases are negative.

 

No single treatment works for all people with IC/BPS. Treatment must be chosen for each patient based on symptoms. Patients usually try different treatments (or combinations of treatments) until good symptom relief occurs. It is important to know that none of these IC/BPS treatments works right away. It usually takes weeks to months before symptoms improve. Even with successful treatment, the condition may not be cured. It is simply in remission. But, most patients can get significant relief of their symptoms and lead a normal life with treatment.

Treatment usually includes one or more of the following.

 

Oral Medications
Elmiron® which received FDA approval in 1996. It is the only oral medication approved specifically for use in IC. It is believed to work by repairing a thin or damaged bladder lining.

 

Though not approved by the FDA for the treatment of IC, the following medications have also been useful for treating the condition. These include tricyclic antidepressants such as amtriptyline, based on their analgesic and sedative properties; anti-inflammatory agents, antispasmodics, antihistamines and muscle relaxants.

 

Bladder Instillations
This includes bladder distention (stretching the bladder by filling it with water under general anesthesia), DMSO (a medication instilled directly into the bladder), and a mixture of other medications which can be instilled.

 

Diet
Eliminating certain foods (acidic, spicy) may decrease the severity of IC symptoms. Also, smoking, drinking caffeine and alcoholic beverages may aggravate IC.

 

Biofeedback
Biofeedback is a technique that assists in identifying and relaxing pelvic muscles and is useful for people who are interested in taking an active part in helping their IC.