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Interstitial Cystitis

by Patrick J. Shenot, MD

Interstitial cystitis is noninfectious bladder inflammation.

  • Interstitial cystitis causes pain above the bladder, in the pelvis, or in the lower abdomen, and the frequent and urgent need to urinate, sometimes with incontinence.

  • Doctors need to examine the inside of the bladder with a flexible viewing tube (cystoscopy) and do a biopsy of the bladder.

  • There is no cure, but symptoms can be relieved with changes in diet and urination habits, drugs to relieve pain, and pentosan.

Interstitial cystitis was once thought to be relatively uncommon. However, doctors now think it may be more common than originally thought and that it may be responsible for other problems, such as chronic pelvic pain. Although men and children can be affected, about 90% of cases of interstitial cystitis occur in women.

The cause is unknown. But doctors think that damage to the cells lining the bladder may allow substances in urine to irritate the bladder. Cells usually involved with allergic reactions (mast cells) may be involved in bladder changes, but their exact role is unclear.

Symptoms of Interstitial Cystitis

Initially, people with interstitial cystitis may have no symptoms. Symptoms usually appear gradually and worsen over years as the bladder wall is damaged. People have pain or pressure over the bladder or in the pelvis or lower abdomen. People also feel the need to urinate frequently and urgently, often many times per hour. Symptoms worsen as the bladder fills and diminish when people urinate. In very severe cases, people may sit on the toilet for hours, letting urine dribble out continuously.

Symptoms may worsen during ovulation or menstruation, seasonal allergies, physical or emotional stress, or sexual intercourse. Foods with high potassium content (for example, citrus fruits, chocolate, caffeinated drinks, and tomatoes), spicy foods, tobacco, and alcohol may cause symptoms to worsen.

Diagnosis of Interstitial Cystitis

  • A doctor's evaluation

  • Cystoscopy

The diagnosis of interstitial cystitis is suggested by symptoms. Doctors do a complete examination, often including a pelvic examination in women and a digital rectal examination. Tests are needed to determine whether another condition might be causing the symptoms. For example, doctors do urinalysis and culture to look for infections.

Examination of the bladder with a flexible viewing tube (cystoscopy) is done so doctors can examine the lining of the bladder. Sometimes doctors do a biopsy of the bladder at the same time to rule out cancer.

Sometimes doctors put a solution containing potassium directly into the bladder to determine how the bladder lining responds to potassium and other potential irritants.

Treatment of Interstitial Cystitis

  • Dietary changes

  • Stress reduction and pelvic muscle exercises

  • Bladder training

  • Drugs

  • Sometimes surgery if other treatments are ineffective

Doctors are able to help up to 90% of people with interstitial cystitis, but complete eradication of symptoms is rare.

Dietary changes are the first step in treatment. People avoid spicy foods and foods that are high in potassium because these foods may further irritate the bladder. Tobacco and alcohol should also be avoided.

Stress reduction and pelvic muscles exercises (for example, Kegel exercises) done with biofeedback may help.

People also are taught to change their urination habits. Bladder training is a technique that involves having the person follow a fixed schedule for urinating while awake. The doctor works with the person to establish a schedule of urinating every 2 to 3 hours and suppressing the urge to urinate at other times (for example, by relaxing and deeply breathing). As the person becomes better able to suppress the urge to urinate, the interval is gradually lengthened.

Drugs are often needed. People may need to take analgesics to lessen pain. Antidepressants may also lessen pain and help relax the bladder. Antihistamines may also help decrease urinary urgency. Pentosan may be given by mouth to help restore the lining of the bladder. If oral pentosan is not effective, doctors may use a catheter to place a solution of pentosan directly into the bladder. Doctors may also instill a solution of dimethyl sulfoxide into the bladder. The person holds the solution in the bladder for 15 minutes and then urinates to remove the solution. These solutions may relieve pain and urgency for some time but usually these treatments need to be repeated.

Doctors sometimes try to relieve pain and urgency by stimulating the nerves coming off of the spinal cord (called nerve roots) that control the bladder. Another possible option is to stretch the bladder with fluid or gas. The treatment, called bladder hydrodistention, may relieve symptoms.

Doctors often combine treatments to provide more relief. However, if combined treatments are ineffective, surgery may be tried.