Interstitial cystitis (IC) is a chronic condition that causes recurring discomfort or pain in the bladder and the surrounding pelvic region. It also causes frequent, urgent and painful urination.
When a patient has IC, the bladder wall becomes inflamed or irritated. This affects the amount of urine the bladder can hold and also causes scarring, stiffening and bleeding in the bladder.
IC should not be confused with common cystitis, a bacterial infection of the bladder that is the most common type of urinary tract infection (UTI). Unlike common cystitis, interstitial cystitis is not caused by bacteria, nor does it respond to antibiotics.
Between 700,000 to one million Americans are estimated to have IC. 90% of patients with IC are women, and the average age of onset is 40.
Interstitial cystitis is not contagious. It does not spread in the body and does not seem to worsen with time. It is not a cause of bladder cancer.
Though more research is needed, IC does not seem to affect fertility or the health of a fetus. For some women, the symptoms of IC improve or disappear during pregnancy; for other women, they get worse.
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The symptoms of interstitial cystitis (IC) vary from person to person. The same person may have different symptoms at different times. Sometimes, symptoms go away by themselves, but they also may return unexpectedly.
Symptoms often worsen during menstruation. Common symptoms range from mild discomfort, pressure and tenderness to intense pain in the bladder and the surrounding pelvic area.
Other common symptoms include:
- Urgent need to urinate
- Frequent urination
- Changes in pain intensity as the bladder fills or empties
- Irritated, scarred or stiff bladder wall
- Glomerulations (pinpoint bleeding caused by recurrent irritation) on the bladder wall
- Ulcers on the bladder wall
- Pain during sexual intercourse or other sexual activities
Rarer symptoms include the following:
- Muscle and joint pain
- Allergic reactions
- Gastrointestinal problems
IC may be associated with the following chronic diseases and pain syndromes:
- Vulvar vestibulitis
- Irritable bowel syndrome
Diagnosing interstitial cystitis can be difficult, as there are a variety of symptoms associated with this condition. Many conditions and disorders must be ruled out before a diagnosis of IC can be considered, including the following:
- Urinary tract infections
- Vaginal infections (in women)
- Chronic bacterial and nonbacterial prostatitis (in men)
- Bladder cancer
- Bladder inflammation or infection
- Radiation cystitis
- Kidney stones
- Neurological disorders
- Sexually transmitted diseases
- Low-count bacteria in the urine
Your physician has a number of diagnostic tools to help rule out other conditions and identify interstitial cystitis.
Urinalysis. A urine sample is studied under a microscope to check for blood or bacteria in the urine which may indicate urinary tract infection, urinary tract stones or other problems.
Urine culture. A urine sample is studied to determine if there is any bacteria growing in it. The bacteria is then tested to determine which drugs will most effectively treat the bacteria.
Urine cytology. An examination of the cells from the bladder lining that are in the urine. To check for prostatitis in men, prostatic fluid can be examined for signs of infection.
Cystoscopy with hydrodistention. This is the main diagnostic tool for interstitial cystitis. Since this procedure can be painful for someone with interstitial cystitis, it is usually performed while the patient is under general anesthesia.
- Cystoscopy is a procedure that allows the urologist to look directly into the bladder. A thin, flexible tube called a cystoscope is gently inserted into the bladder through the urethra. Your doctor can use the cytoscope to look for stones, ulcers and other disorders and also to perform a biopsy to check for bladder cancer and other diseases. Interstitial Cystitis is not normally associated with bladder cancer.
- Hydrodistention is a procedure in which your doctor stretches or distends the bladder by filling it with water. Then, using the cystoscope, the doctor looks for tiny bleeding hemorrhages called glomerulations on the bladder wall. Glomerulations are a major symptom of IC in 95% of patients.
Causes and Prevention
The causes of interstitial cystitis are still unknown. Researchers are currently looking into many theories of what causes IC. The results of that research could lead to potential treatments.
IC is not caused by stress, though stress reduction can be helpful and possibly reduce symptoms. IC is also not a psychosomatic disorder. While harmful bacteria can cause common cystitis, neither bacteria nor viruses seem to cause IC.
Because the cause of IC is still uncertain, no definite preventative measures exist. We do know that smoking irritates the bladder and is the number one cause of bladder cancer, so quitting may be the best preventative measure you can take against IC.
Interstitial cystitis is difficult to treat. There is not yet a cure for IC, but there are a variety of treatments that relieve its symptoms. Treatments range from changes in diet, to medications, to surgery. Surgery is only recommended after less invasive approaches have failed.
Bladder instillation, or bladder wash, delivers medication to the bladder with a solution that is held in the bladder for a short period of time then drained with a catheter.
Medication are used to treat the various symptoms of IC.
Transcutaneous electrical nerve stimulation, or TENS, provides mild electrical pulses to the body which help to block pain.
Bladder training can help the body to void at scheduled times while gradually lengthening the time that urine can be held.
Diet modification may help to alleviate symptoms in some patients through the elimination of particular foods.
Exercise can help to reduce symptoms of IC and can also speed remission.
Smoking cessation can help to reduce symptoms of IC. Giving up smoking also reduces your risk of bladder cancer.
Surgery, such as minimally invasive techniques to remove ulcers from the bladder, is only used as a last resort for the treatment of IC.