Interstitial Cystitis

Interstitial cystitis (also known as painful bladder syndrome) is a condition in which the person suffers from chronic pain and pressure in the urinary bladder (sometimes extending towards the pelvis). Urinary bladder is a muscular organ that holds the urine. The bladder dilates when urine from kidney is transported via ureter. Once the bladder is full, the muscular walls signals the brain via pelvic nerves that it’s time to empty out the bladder (via urination). In interstitial cystitis, these signals are messed up resulting into more frequent urination but in smaller volumes.

Classic Symptoms Of Interstitial Cystitis

In Interstitial Cystitis, the pain can be moderate to severe depending upon the triggering factors. The intensity of discomfort increases during stress, menstrual periods, workout, sexual activity or when sitting for extended periods of time. However, the symptoms may vary from person to person. Some affected people may report asymptomatic episodes of interstitial cystitis. Symptoms include:

• Chronic pelvic pain
• In women, pain is felt in the pelvic region or between anus and vagina
• In men, pain is felt in the perineum (area between scrotum and anus)
• Persistent urinary urgency
• Frequent urination (may exceed to 60 times per day)
• Painful sex
• Spike in the severity of pain when bladder is full (and relieves upon emptying)

Symptoms of interstitial cystitis often mimics urinary tract infection.

What Causes Interstitial Cystitis?

The exact cause is not clear but certain factors may aggravate the risk of developing interstitial cystitis. For example, a defective epithelium of urinary bladder may lead to leakage due to which the toxic substances in the urine can directly irritate the bladder walls. Besides this, infection, hereditary factors, autoimmune or allergic reaction can also contribute to this condition.

Risk Factors

• Being women increases the risk of developing interstitial cystitis due to anatomical factors
• Redheads with fair complexion also suffers from ore frequent episodes for poorly understood reasons
• Individuals aged 30 or above are usually at higher risk
• It is thought to be associated with other chronic pain disorders such as, fibromyalgia or irritable bowel syndrome

Complications

Interstitial cystitis can lead to a number of complications, including:

• Stiff urinary bladder which reduces the urine holding capacity
• A person’s social life, work and other activities are also compromised due to pain and associated symptoms
• It will also affect sexual life and create hindrance in establishing intimate relationship
• Low quality of life leads to emotional problems and isolation which leads to depression

Diagnosis Of Interstitial Cystitis

Interstitial cystitis is diagnosed by a variety of tests:

• Your doctor may ask you to maintain the record of fluid intake and volume of urine produced
• A complete pelvic examination
• Anal and/or rectal examination
• To rule out urinary tract infections, a urine test also mandatory
• Urine cytology (cell examination) and biopsy are done to eliminate the risk of bladder cancer
• Cystoscopy is examining of bladder lining via camera that is inserted through urethra. Along with cystoscopy, hydrodistension is performed to check the bladder capacity. The fluid is injected under anesthesia.
• Potassium sensitivity is another diagnostic test in which bladder is filled with water and potassium solution, separately. Patient is asked to rate the urgency and pain after each filling. Normal people are unable to tell the difference while people with interstitial cystitis will feel more pain and urgency with potassium solution.

Treatment

Depending upon condition, single or combination of treatments are required:

• Physical therapy eases pain related to pelvic floor muscles and restrictive connective tissues.

• Oral medications:

• Non-steroidal anti-inflammatory drugs (ibuprofen, naproxen)
• Antihistamines (loratadine) for reducing urgency and frequency
• Tri-cyclic anti-depressants (imipramine, amitriptyline) for bladder relaxation and pain
• Pentosan polysulfate sodium (Elmiron), an FDA-Cleared drug specifically for interstitial cystitis treatment.

• Nerve stimulation methods:

• Transcutaneous electrical nerve stimulation (TENS): This method involves delivery of mild electrical impulses to resolve the pelvic pain and reduce the urinary frequency.
• Sacral nerve stimulation: Urinary urgency is also relieved by stimulation of sacral nerves which is the basic link between nerves in the bladder and spinal cord.

Bladder distension: Cystoscopy followed by bladder distension is beneficial for temporary relief of symptoms.

Bladder instillation: Bladder is filled with prescription drugs (dimethyl sulfoxide, sometimes in combination with anesthetics) via thin catheter.

Surgery: Surgery is generally performed as the last resort because removing bladder may lead to whole new set of complications without relieving the pain complaints. It is suggested when other treatments don’t work and quality of life is greatly affected. Options include:

• Resection
• Fulguration
• Bladder augmentation

Besides these pharmacological treatments, alternative options such as acupuncture and guided imagery (psychological therapy) are found to be helpful.

Lifestyle Changes

• Avoid food that aggravate your symptoms. For instance, caffeine, carbonated drinks, citrus food, and vitamin C enriched food.
• Train your bladder and set times to use bathroom.
• Avoid wearing tight clothes or belts as they exert pressure on the abdomen.
• Avoid smoking.
• Indulge yourself in easy stretching workouts.
• Join support groups.

References

• He, Y. Q., Zhang, W. T., Shi, C. H., Wang, F. M., Tian, X. J., & Ma, L. L. (2015). Phloroglucinol Protects the Urinary Bladder Via Inhibition of Oxidative Stress and Inflammation in a Rat Model of Cyclophosphamide-induced Interstitial Cystitis. Chinese medical journal, 128(7), 956.
• Hanno, P. M., Erickson, D., Moldwin, R., & Faraday, M. M. (2015). Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. The Journal of urology, 193(5), 1545-1553.