Interstitial cystitis (IC) is a chronic inflammation of the bladder that can cause pelvic and abdominal pain and pressure,frequent urination, urgency (feeling like you need tourinate), and incontinence.Discomfort can range from a mild burning sensation to severe pain. The degree of discomfort can be persistent or infrequent, and some people have periods of remission.
According to the Interstitial Cystitis Association, IC affects between four and 12 million people in the United States. Although children and adult men can get IC, women account for 90 percent of the cases (ICA).
IC is also known as painful bladder syndrome (PBS), bladder pain syndrome (BPS), and chronic pelvic pain (CPP).
The exact cause of IC is not known but researchers believe that several factors may damage the lining of the bladder and trigger the disorder. These include:
- trauma to the bladder
- overdistention of the bladder, usually due to long periods without a bathroom break
- weakened or dysfunctional pelvic floor muscles
- autoimmune disorders
- bacterial infection
- hypersensitivity or inflammation of pelvic nerves
- spinal cord trauma
Many people with IC also have irritable bowel syndrome or fibromyalgia. Some researchers believe that IC may be part of a generalized inflammatory disorder that affects multiple organ systems. Researchers are also investigating the possibility that people may inherit a predisposition to IC. Although it is not common, IC has been reported to afflict blood relatives. Cases have been seen in mother and daughter, as well as in two or more sisters (NKUDIC).
Research is ongoing to determine the cause of IC and to develop more effective treatments.
You may experience one or more of the following symptoms:
- chronic or intermittent pain in the pelvis
- pelvic pressure or discomfort
- urinary urgency (feeling that you need to urinate)
- frequent urination day and night
- pain during sexual intercourse
Your symptoms mayvary from day-to-day, and you may experience periods where you are symptom-free. Symptoms may worsen if you develop a urinary tract infection.
There are no tests that can be used to make a definitive diagnosis of IC. Because IC shares many of the same symptoms of other bladder disorders, your doctor will need to rule these out first. These other disorders include:
- urinary tract infections
- bladder cancer
- chronic prostatitis (in men)
- chronic pelvic pain syndrome (in men)
- endometriosis (in women)
You will be diagnosed with IC once your doctor determines that your symptoms are not due to one of these disorders.
IC can cause several complications, including:
- reduced bladder capacity due to stiffening of the bladder wall
- lower quality of lifeas a result of frequent urination and pain
- difficulties with relationships and sexual intimacy
- sleep disturbances
- anxiety and depression
There is no cure or definitive treatment for IC. Most people use a combination of treatments, and you may have to try several approaches before you settle on the therapy that provides the most relief. IC treatments may include:
Your doctor may prescribe one or more of the following drugs to help improve your symptoms:
- pentosanpolysulfate sodium (Elmiron), which has been approved by the Food and Drug Administration to treat IC. Doctors do not know exactly how pentosan works, but it may help repair tears or defects in the bladder wall.You should not take pentosan if you are pregnant or are planning to become pregnant.
- nonsteroidal anti-inflammatories, including ibuprofen, naproxen, aspirin, and others, for pain and inflammation
- tricyclic antidepressants to help relax your bladder and block pain
- antihistamines to decrease urinary urgency and frequency
Bladder distention is the stretching of the bladder using water or gas. It can help relieve symptoms in some people, possibly by increasing the capacity of the bladder and by interrupting pain signals transmitted by nerves in the bladder. It can take two to four weeks to notice improvement.
Bladder instillation involves filling the bladder with a solution containing dimethyl sulfoxide (Rimso-50), also called DMSO. The DMSO solution is held in the bladder for 10 to 15 minutes before it is emptied. One treatment cycle typically includes up to two treatments per week for six to eight weeks, and the cycle can be repeated as needed.
It is thought that the DMSO solution may reduce inflammation of the bladder wall. It may also prevent muscle spasms that cause pain, frequency, and urgency.
Electrical Nerve Stimulation
Transcutaneous electrical nerve stimulation (TENS) delivers mild electrical pulses through the skin to stimulate the nerves to the bladder. TENS may help relieve symptoms by increasing blood flow to the bladder, strengthening pelvic muscles that help control the bladder, or triggering the release of substances that block pain.
Many people with IC believe that specific foods and beverages make their symptoms worse. The offending foods include alcohol, tomatoes, spices, chocolate, anything with caffeine, and acidic foods like citrus fruits and juices.Your doctor will discuss with you how to determine if you are sensitive to any foods or beverages.
Although there is no proven correlation between smoking and IC, smoking is definitely linked to bladder cancer. It is possible that quitting smoking may lessen or relieve your symptoms.
Gentle stretching exercises may help relieve your symptoms.
Techniques designed to lengthen the time between urinating may help relieve symptoms. Your doctor can discuss these techniques with you.
Learning to deal with life’s stresses and the stress of having IC may provide symptom relief. Modalities such as meditation and biofeedback may be helpful.
There are several surgical options to increase the size of the bladder and remove or treat ulcers in the bladder. Surgery is rarely used and is considered only when symptoms are severe and other treatments have failed to provide relief.Your doctor will discuss these options with you if you are a candidate for surgery.
There is no cure for IC. It can last for years or even a lifetime, so the main goal of treatment is to find the combination of therapies that best provide long-term symptom relief.