Introduction

Interstitial cystitis is an ongoing bladder problem that causes an urgency to urinate, frequent urination, and pain.  Episodes may come and go.  Although there is no cure for interstitial cystitis, there are a variety of treatments that can help to relieve symptoms.

Anatomy

Your urinary tract system consists of your kidneys, bladder, and urethra.  Your kidneys are a pair of bean-shaped organs located in the lower back area.  The kidneys filter waste products and extra fluid from your blood, creating urine.  Urine is composed of mainly water and metabolic waste products.  From the kidneys, urine travels through two tubes (ureters), to the bladder.

Your bladder holds and collects the urine that arrives from the kidneys.  When a certain level of urine has accumulated in the bladder, your bladder sends signals to your brain so you know that it is time to urinate.  Urination is a voluntary action.  When you are ready, the bladder walls (detrusor muscle) contract and the pelvic floor muscles relax.  A valve-like muscle on the bladder (urinary sphincter) opens and allows urine to empty from the bladder.

Urine is carried from the bladder to the outside of your body through a tube called the urethra.  The urethra and bladder have a protective lining (epithelium).  The female urethra is short and ends above the vaginal opening.  The male urethra is longer and ends at the tip of the penis.  When you have finished urinating, the urinary sphincter closes.

Causes

Although the exact cause of interstitial cystitis is unknown, researchers suspect that several factors may contribute to it.  It appears that some people with interstitial cystitis may have a problem with their bladder lining that allows urine to contact and irritate the bladder muscles.  Researchers also speculate that it may be a hereditary condition.  Other possible causes include an autoimmune disorder, allergic or inflammatory reaction, infection, or a problem with the nerves that conduct pain.

Symptoms

Symptoms of interstitial cystitis vary from person to person.  You may have one symptom or a combination of symptoms, including frequent urination, an urgent need to urinate, and pain.  Your symptoms may change over time.  When you do go to the bathroom, you may only void small amounts.

You may experience pain in your bladder area, lower back, lower abdomen, genital area, and pelvic region.  Your pain may be ongoing or come and go.  The pain may range from mild to severe and feel like pressure or burning.  Women may have pain during sexual intercourse.  Men may experience pain during orgasm.

The symptoms of interstitial cystitis are similar to that of a urinary tract infection.  However, interstitial cystitis is not an infection.  In fact, people with interstitial cystitis may have repeated negative test results for a urinary tract infection before they are diagnosed.  People with interstitial cystitis may certainly develop an urinary tract infection, and when they do, the symptoms tend to be more bothersome.

Diagnosis

Your doctor will review your medical history, conduct a physical examination, and test a sample of your urine.  Although there is not one specific test to diagnose interstitial cystitis at this time, there are several tests that are helpful.  Your doctor will rule out other conditions that have similar symptoms, such as an urinary tract infection, vaginal infection in women, or prostrate problems in men.  In some cases, additional tests may be ordered.

Your doctor may use a cystoscope to view the inside of your lower urinary tract.  A cystoscope is a thin tube with a viewing instrument.  It is carefully inserted through the urethra.  The bladder is expanded with air or water to open the bladder folds and provide a better view.  A cystoscopy allows your doctor to check for problems inside of the bladder or urethra.  Although most people with the condition do not experience it, bleeding or sores on the bladder wall can be indicative of interstitial cystitis.

A potassium sensitivity test is a procedure in which water and potassium are placed in the bladder at different times via a catheter.  You will be asked to rate your level of discomfort each time.  People with interstitial cystitis may experience pain, discomfort, or urgency with the potassium solution.  People with healthy bladders rate the solutions the same.

Urodynamic testing is another way to learn more about bladder function.  Urodynamic testing evaluates the muscle strength in the bladder walls and sphincter.  For this procedure, a catheter is inserted into the bladder to fill the bladder with water.  A monitor records the pressure when the bladder is filling and when it empties.  Pressure in a healthy bladder increases slightly while filling.  People with interstitial cystitis may have a bladder that is unable to hold a lot of urine, and therefore feel discomfort while it is filling.

Treatment

The goal of treatment is to relieve symptoms.  Unfortunately, at this time, there is no cure for interstitial cystitis.  Treatment for interstitial cystitis is different for everyone.  There are several different types of treatment, and you may find that a combination of treatments relieves your symptoms the best.  It is common to try various treatments before finding the one or ones that produce the best results for you.  Treatments may include medications, nerve stimulation, bladder distention, or surgery.

For some people, over-the-counter pain medications can help relieve symptoms.  Prescription medications, such as antihistamines and certain antidepressants, can also help.  There is one FDA approved prescription medication (pentosan polysulfate) that specifically targets the bladder.  It appears that the medication works to repair the bladder wall and decrease inflammation.

Another FDA approved prescription medication (dimethyl sulfoxide, “DMSO”) is a  treatment that is administered directly to the bladder through a catheter.  Researchers are not sure how DMSO works, but it appears to reduce inflammation and pain.  Steroid or heparin medication may be combined with DMSO treatments.

Transcutaneous nerve stimulation (TENS) is another type of treatment option that is sometimes paired with physical therapy.  With TENS, pads are placed strategically on the pelvic and lower back area.  The stimulation device delivers gentle electrical impulses via wires.  TENS can help strengthen the pelvic floor muscles, reduce urinary frequency, relieve pain, and increase blood flow.

In addition to being a diagnostic tool, cystoscopy is also used as a treatment method.  Cystoscopy is used to stretch open (distend) the bladder with water or gas.  Bladder distention can temporarily improve symptoms for some people and can be repeated.

Surgery for interstitial cystitis is reserved as an option for people with severe symptoms that do not respond to other treatments.  Bladder augmentation, fulguration, and resection are types of surgery to help treat interstitial cystitis.  Bladder augmentation is used to remove a damaged portion of the bladder or enlarge a bladder that is too small or has very high pressure.  This is a major surgery that uses sections of bowel to surgically reconstruct the bladder.  Following the procedure, you may need to use a catheter to empty your bladder.

Fulguration (electrodesiccation) is a minimally invasive procedure used to burn sores (ulcers) from the inside of the bladder.  Resection, another minimally invasive procedure, uses incisions to remove sores from the inside of the bladder. For both fulguration and resection, the surgeon uses thin surgical instruments that are inserted through the urethra.

Prevention

Although symptoms of interstitial cystitis may subside or go into remission, recurrences are common.  You may identify foods or beverages that trigger a flare-up and avoid them.  The following are common triggers: carbonated drinks, caffeine, chocolate, citrus fruits, food containing large amounts of vitamin C, alcohol, spices, pickled foods, and tomatoes.

Am I At Risk

Interstitial cystitis occurs predominantly in women in their 30s and 40s, but it may also develop in men or children.  It is  suspected that the condition may be under-diagnosed in men.

Complications

The symptoms of interstitial cystitis can interfere with your social life, work, and relationships. Make sure to discuss your concerns with your doctor.  Your doctor is happy to offer suggestions or recommendations for assistance and support.