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Interstitial Cystitis

Definition


Disease: Interstitial Cystitis Interstitial Cystitis
Category: Genito-urinary diseases
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Disease Definition:

Interstitial cystitis — also called painful bladder syndrome — is a chronic condition characterized by a combination of uncomfortable bladder pressure, bladder pain and sometimes pain in your pelvis, which can range from mild burning or discomfort to severe pain.

While Interstitial cystitis can affect children and men, most of those affected are women. Interstitial cystitis can have a long-lasting adverse impact on the quality of life.

The severity of symptoms resulting from interstitial cystitis usually fluctuates, and certain people may go through periods of remission. Several different medications and other therapies provide relief even though there isn’t any treatment that reliably eliminates interstitial cystitis.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The signs and symptoms of interstitial cystitis vary from person to another. If one has interstitial cystitis, symptoms may also vary over time, periodically flaring in response to common triggers such as menstruation, seasonal allergies, stress and sexual activity.
The following are symptoms of interstitial cystitis:

 

  • Pain in the pelvis (suprapubic) or between the vagina and anus in women or the scrotum and anus in men (Perineal)
  • Chronic pelvic pain
  • A persistent, urgent need to urinate
  • Pelvic pain throughout sexual intercourse. Men may have painful ejaculation as well
  • Frequent urination, usually of small amounts, during the day and night. People suffering from severe interstitial cystitis may urinate as frequently as 60 times a day.

 

Some people suffering from interstitial cystitis have only pain, and some go through only frequent, urgent urination. Most affected people, however, experience both pain and frequent, urgent urination.
Even though interstitial cystitis signs and symptoms may be similar to those of a chronic urinary tract infection, urine cultures are usually free of bacteria. Yet, a worsening of symptoms may occur when a person suffering from interstitial cystitis gets a urinary tract infection.
If someone is experiencing chronic bladder pain or urinary urgency and frequency, he/she contacts the doctor.

Causes:

The bladder is a hollow, muscular, balloon-shaped organ that stores urine until one’s ready to empty it. The bladder expands in adults until it’s full and then signals the brain that it’s time to urinate, through communicating the pelvic nerves. This creates the urge to urinate in most people. These signals somehow get mixed up in the condition of interstitial cystitis and one feels the need to urinate more frequently and with smaller volumes of urine than most people.
Several people suffering from interstitial cystitis are likely to experience a defect in the protective lining (epithelium) of their bladder. For instance, a leak in the epithelium may allow toxic substances in urine to irritate one’s bladder wall.
Suggested but unproven factors that may contribute to interstitial cystitis include a heredity, allergy, infection or autoimmune reaction.
These factors are related to a greater risk of interstitial cystitis.

Sex: Women receive a diagnosis of interstitial cystitis far more frequently when compared to men or children. Men can have almost identical symptoms to those of interstitial cystitis, but they’re more often related to an inflammation of the prostate gland (prostatitis).
Age: Most people suffering from interstitial cystitis are diagnosed in their 30s or 40s.
Other chronic disorders: Interstitial cystitis may be associated with other chronic pain syndromes, like irritable bowel syndrome and fibromyalgia. Any common connection between these syndromes is unknown.

Complications

Complications:

The following are the complications that may be caused by interstitial cystitis:


Reduced bladder capacity: Interstitial cystitis can lead to a stiffening of the wall of the bladder and reduced bladder capacity that is to say less urine is held in the bladder.
Lower quality of life: Frequent urination and pain may interfere with social activities, work and other activities of daily life.
Relationship troubles: Frequent urination and pain may strain one’s personal relationships, and sexual intimacy is commonly affected.
Emotional troubles: The chronic pain and interrupted sleep related to interstitial cystitis may result in emotional stress and can contribute to depression. Such is the case with depression or anxiety that can similarly worsen symptoms of interstitial cystitis.

Treatments:

No simple treatment exists to eliminate the signs and symptoms of interstitial cystitis, and no one treatment works for everyone. The person may need to try various treatments or combinations of treatments before he/she finds an approach to relieve symptoms.


Oral medications
The following are oral medications that improve signs and symptoms of interstitial cystitis:

 

 

  • Ibuprofen and other nonsteroidal anti-inflammatory drugs, to relieve pain.
  • Tricyclic antidepressants, like imipramine or amitriptyline in order to aid in relaxing the bladder and preventing pain.
  • Antihistamines, like loratadine and diphenhydramine that may decrease urinary urgency and frequency and relieve other symptoms.

 

Pentosan may be prescribed as an oral medication, the only oral drug approved by the Food and Drug Administration particularly for interstitial cystitis. It isn’t known how it works, but it may restore the inner surface of the bladder that protects the bladder wall from substances in urine that could irritate it. It may take two to four months before the person begins to feel pain relief and up to six months to experience a decrease in urinary frequency. Minor gastrointestinal disturbances and potential hair loss may be included among side effects only to reverse as soon as one stops taking the drug. If you're a woman, it is important to inform the doctor in case she is pregnant or planning to become pregnant before taking pentosan.


Nerve stimulation
Transcultaneous electrical nerve stimulation (TENS) uses mild electrical pulses to relieve pelvic pain and, in certain cases, reduce urinary frequency. Electrical wires are positioned on either the lower back or right above the pubic area, and pulses are administered for minutes or hours, two or more times a day, depending on the length and frequency of therapy that works best for the affected person. In certain cases a TENS device may be inserted into a woman’s vagina or a man’s rectum.
Through raising blood flow to the bladder, TENS may relieve pain and urinary frequency related to interstitial cystitis strengthening the muscles that aid in managing the bladder or triggering the release of substances that prevent pain from occurring.
Another possible nerve stimulation treatment is sacral nerve stimulation. Modulation of the sacral nerves, a primary link between the spinal cord and nerves in the bladder, that may decrease feelings of urinary urgency that accompany interstitial cystitis. With sacral nerves stimulation, a thin wire positioned near the sacral nerves delivers electrical impulses to the bladder, resembling what a pacemaker does for the heart. When the procedure successfully lessens one’s symptoms, a permanent device may be surgically implanted.


Bladder distention
Certain people notice a short term improvement in symptoms after undergoing cystoscopy with bladder distention. Bladder distention is the stretching of the bladder with water or gas. The procedure may be performed over and over again as a treatment when the response is long lasting.

Medications instilled into the bladder
The prescription medication dimethyl sulfoxide, or DMSO, (Rimso-50) in bladder instillation is positioned into the bladder through a thin, flexible tube (catheter) inserted through the urethra. The solution is occasionally mixed with other medications, like local anesthetic. The solution is expelled through urination after remaining in the bladder for 15 minutes. Delivering DMSO directly to the bladder may reduce inflammation and possibly prevent muscle contractions that result in frequency, pain and urgency.
DMSO may initially be performed as a weekly treatment for six to eight weeks, and then perform maintenance treatments as needed, usually, every couple of weeks, for up to one year.
A garlic-like taste and odor may last up to 72 hours after treatment. DMSO can affect the liver, so that the liver will be monitored how it is functioning with blood tests. This procedure may be painful or it may worsen symptoms for some people. In case this takes place, the affected person should consult a doctor about other treatment options.
Using a solution containing a trio of medications is a newer approach to bladder instillation, such as lidocaine, sodium bicarbonate and heparin. This combination of drugs instilled directly into the bladder significantly relieved urinary pain and urgency in the majority of people participating in a clinical trial.


Surgery
Surgery is seldom used as interstitial cystitis treatment due to the fact that the removal of part or the entire bladder doesn't relieve pain and can lead to other complications. Possible candidates for surgery involve those who have either severe pain or whose bladders can hold only very small volumes of urine, though even then surgery is often considered only after other treatments have failed. The following are surgical options:


Bladder augmentation: The damaged portion of the bladder is removed by surgeons in this kind of operation and replaced with a piece of the colon, but the pain still remains and some women need to empty their bladders with a catheter multiple times a day.
Fulguration: This minimally invasive technique involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
Resection: Insertion of instruments through the urethra to cut around any ulcers is involved in this minimally invasive method.
Fulguration and resection are not always effective and could potentially worsen the symptoms.

Prognosis:

Not Available

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