Interstitial Cystitis

What is Interstitial Cystitis?

Interstitial Cystitis, otherwise known as bladder pain syndrome or painful bladder syndrome, is a chronic inflammation of the bladder which causes bladder pressure, bladder pain, and sometimes pelvic pain. The pain can range anywhere from mild discomfort to severe; similar to what you might feel with a urinary tract infection (UTI).

The bladder is a hollow, balloon-like organ that stores urine from the kidneys and holds it until it’s ready to be expelled. As the bladder expands, the pelvic nerves communicate to the brain that it’s time to urinate. However, interstitial cystitis confuses these signals. Your brain might be telling you that it’s time to urinate more often, but you’re actually producing smaller volumes of urine. Inflammation caused by interstitial cystitis can cause the lining of cells in the bladder to scar, which can affect the way the bladder expands. In the vast majority of interstitial cystitis cases, there are pinpoint spots of bleeding visible in the lining. Ulcers and sores are also formed during inflammation.

Interstitial Cystitis Symptoms

The symptoms of chronic interstitial cystitis often vary from person to person, and the symptoms may not be recurring. Interstitial cystitis can be triggered by common events such as menstruation, prolonged sitting, stress, exercise and sexual activity.

In general, symptoms of interstitial cystitis may include:

  • Painful urination, often described as a burning sensation
  • Chronic pelvic pain - For men, between the scrotum and anus; For women, between the vagina and anus
  • Frequent urination, often small amounts, throughout the day and night. People with severe interstitial cystitis may urinate up to 60 times a day. 
  • Pain or discomfort during sexual intercourse
  • Pain or discomfort while the bladder fills - relief after urinating 
  • Hunner’s ulcers (only 5-10% of people are found to have them)

Interstitial Cystitis Causes

While the exact cause of interstitial cystitis is unknown, several explanations have been proposed and examined, such as autoimmune reaction, heredity, stress, infection, allergy, nerve theory, mast cell theory, and the presence of a toxic substance in the urine. Many suffering from interstitial cystitis could be affected by multiple factors, and may have a defect in the protective lining of the bladder.

Interstitial Cystitis Treatment

Unfortunately, no simple treatment exists to eliminate interstitial cystitis symptoms. However, there are various treatments that will help alleviate symptoms and pain. Not all treatments will work for every person, so you may need to try various combinations of treatments until you find what benefits you the most.

The American Urological Association has a consensus-based guideline for the diagnosis and treatment of interstitial cystitis in the USA. The AUA treatment guidelines include a treatment protocol ranging from conservative treatments to more invasive interventions. Here are a few remedies that may help:

Interstitial Cystitis Diet

Diet modification is a first-line method of self-treatment for interstitial cystitis. Eliminating or reducing foods in your diet that are potential bladder irritants may help relieve the discomfort or pain caused by interstitial cystitis. The following is a list of interstitial cystitis foods to avoid:

  • Caffeinated Beverages: Coffees, teas, sodas
  • Alcoholic Beverages
  • Chocolate
  • Citrus Fruits
  • High concentrations of Vitamin C
  • Hot Peppers
  • Artificial Sweeteners 

The best way to find out if a certain food is irritating your bladder is through an elimination diet. Reintroduce the foods one at a time and pay attention to which, if any, affect your symptoms.

Physical Therapy

A physical therapist may help relieve pain associated with muscle tenderness, restrictive connective tissue or muscle abnormalities in your pelvic floor that are caused by interstitial cystitis.

Medication

  • Nonsteroidal anti-inflammatory drugs: ibuprofen (Advil, Motrin IB, etc.) or naproxen (Aleve) to help relieve pain. 
  • Antihistamines: loratadine (Claritin, etc.) to help reduce urinary urgency and frequency. 
  • Tricyclic antidepressants: amitriptyline or imipramine (Tofranil) to help relax your bladder and reduce pain. 
  • Pentosan (Elmiron): approved by the Food and Drug Administration specifically for treating interstitial cystitis. 

Bladder Distention

A bladder distention is the stretching of the bladder with water or gas. This has been shown to help remedy pain and discomfort, though the improvements are temporary, usually up to two or three weeks. This is a procedure that can be repeated, but since the relief is short-term, it’s not a viable long-term treatment.

Bladder Instillation

A bladder instillation is performed by placing a single medication or a mixture of medications into your bladder through a catheter, inserted through the urethra. Urination will expel the solution. Though the effectiveness of bladder instillation is limited, being able to have direct contact of the medication with the bladder is an advantage.

Surgery

Surgery is rarely used to treat interstitial cystitis. Removing all or part of the bladder doesn’t relieve pain and can lead to other complications. However, if you’re experiencing severe pain, surgery remains an option if other treatments have failed.



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