Donald Aulds, M.D.
Interstitial cystitis (IC) is a syndrome identified with recurring pain in the pelvic region and bladder. No two individuals show the same symptoms, and symptoms may vary from time to time in the same individual. People may experience pressure, tenderness, or severe pain over the bladder and pelvic region. Other symptoms that may show up include frequent urination, an urgent sensation to urinate, and an increase in discomfort when the bladder fills or empties. The discomfort may worsen in women at the time of the period or during intercourse. It is considered to be a long-term inflammation of the bladder wall. Recently, cases that do not fit the strictest definition of IC have been referred to as painful bladder syndrome (PBS). These syndromes are more frequent in women than men, and it has been estimated that 1.3 million Americans suffer from IC and PBS. The cause of IC is unknown but is usually diagnosed by ruling out other conditions. It can easily be misdiagnosed as a urinary tract infection and patients can go for years before a correct diagnosis is made. It usually shows up in women between ages 30 and 40 and may be a manifestation of other chronic inflammatory conditions of the body, such as irritable bowel syndrome and fibromyalgia. IC does not usually run in families although occasional reports have appeared in medical literature where it has been reported in mother and daughter. The difficulty in working with IC is that the symptoms may improve and then reoccur weeks, months or years later with no explanation as to why.
How is IC diagnosed?
Since the symptoms of IC are similar to other conditions of the pelvis and bladder, there is no definitive test that can identify IC. Therefore, it must be considered when other conditions have been ruled out. The diagnosis is based on two criteria: the presence of pain in the bladder, usually coupled with frequency and/or urgency of urination and the absence of other diseases that could the cause of the symptoms. This criterion was established by the National Institute of Diabetes and Digestive and Kidney Diseases. The diagnosis is usually made by the following tests:
- Urinalysis and urine culture
- Cystoscopy – the placement of a scope into the bladder to see the bladder walls and bladder wall biopsy can be performed to diagnose the chronic inflammation and rule out bladder cancer.
- In men culture of prostatic secretions – this technique is used to rule out a prostate infection which can be treated with antibiotics
- Urinary dynamic studies – reveals how much urine must be in the bladder to give the sensation that one needs to urinate
What are the treatments available for IC?
There has not been a cure found at this time for IC, but research is still ongoing to attempt to find a safe and effective approach. Results of therapies may vary from person to person. The following are approaches that have been used to try to improve the symptoms and patterns of IC:
- Bladder hydrodistention - filling the bladder with fluid. Usually the fluid is held for 10 to 15 minutes and then emptied. This type of treatment is usually done weekly for 6 to 8 weeks, and most women will see improvement within a month of the treatment.
- Bladder training – a method of using relaxation techniques to train the bladder to go at specific times
- Physical therapy may help ease pelvic floor spasms associated with IC
- Diet medication – The idea is to remove foods and beverages that may irritate the bladder, such as aged cheeses, artificial sweeteners, alcohol, citrus, chocolate, coffee, cranberry juice, fava, cured meats, onions, rue, MSG, sour cream, soy, sourdough bread, tea, tofu, tomatoes, and yogurt.
- Medications – The only medication that has FDA approval for IC is Elmiron, which seems to coat the bladder wall. It has been reported to improve symptoms in 30 percent of patients. It has been reported that a patient may have to take the medications for three to four months before seeing improvement. It may upset the stomach, cause hair loss in a small number of patients, and affect liver function.
- Aspirin and ibuprofen may improve the pain by decreasing the inflammation.
- Electrical nerve stimulation – Mild electrical pulses (TENS) have been used to stimulate the nerves of the bladder to increase blood flow to the bladder wall and strength the pelvic muscles.
- Stop smoking as it worsens symptoms since the byproducts of tobacco are excreted through the bladder.
- Exercise – Stretching exercises may help symptoms.
- Surgery – usually considered only when other approaches have been unsuccessful or the pain is disabling. Surgery is usually performed by a urologist and so risks and benefits should be discussed fully with the urologist.
In people diagnosed with IC, treatment results will vary. When results of therapy are not successful, depression may occur, the individual may have to change their lifestyle to compensate for the pain, and emotional trauma may result. It is always recommended that the person be under the care of a physician. Talk to your doctor if you suspect that you have symptoms that might be diagnosed as IC.