What is interstitial cystitis?
Interstitial cystitis (IC) is a complex condition that is identified by chronic inflammation of the bladder muscle layers, which produces the following symptoms:
- pelvic and abdominal pain and pressure
- frequent urination
- urgency (feeling like you need to urinate, even right after urinating)
- incontinence (accidental leakage of urine)
Discomfort can range from a mild burning sensation to severe pain. The degree of discomfort can be persistent or infrequent. Some people have periods of remission.
According to the Interstitial Cystitis Association, IC affects more than 12 million people in the United States. Women are most likely to develop IC, but children and adult men can get it as well.
IC is also known as painful bladder syndrome (PBS), bladder pain syndrome (BPS), and chronic pelvic pain (CPP).
What are the symptoms of IC?
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 may vary from day to day, and you may experience periods when you are symptom-free. Symptoms may worsen if you develop a urinary tract infection.
What causes IC?
The exact cause of IC isn’t known, but researchers postulate that several factors may damage the lining of the bladder and therefore trigger the disorder. These include:
- trauma to the bladder lining (for example, from surgical procedures)
- excessive stretching of the bladder, usually due to long periods without a bathroom break
- weakened or dysfunctional pelvic floor muscles
- autoimmune disorders
- repeated bacterial infections
- hypersensitivity or inflammation of pelvic nerves
- spinal cord trauma
Researchers are also investigating the possibility that people may inherit a genetic predisposition to IC. Although it’s not common, IC has been reported in blood relatives. Cases have been seen in mother and daughter as well as in two or more sisters.
Research is ongoing to determine the cause of IC and to develop more effective treatments.
How is IC diagnosed?
There are no tests that make a definitive diagnosis of IC, so many cases of IC go undiagnosed. Because IC shares many of the same symptoms of other bladder disorders, your doctor needs 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’ll be diagnosed with IC once your doctor determines that your symptoms aren’t due to one of these disorders.
Potential complications of IC
IC can cause several complications, including:
- reduced bladder capacity due to stiffening of the bladder wall
- lower quality of life as a result of frequent urination and pain
- barriers to relationships and sexual intimacy
- issues with self-esteem and social embarrassment
- sleep disturbances
- anxiety and depression
How is IC treated?
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. Following are some IC treatments.
Your doctor may prescribe one or more of the following drugs to help improve your symptoms:
- Pentosan polysulfate sodium (Elmiron) has been approved by the Food and Drug Administration to treat IC. Doctors don’t 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, are taken for pain and inflammation.
- Tricyclic antidepressants (such as amitriptyline) help relax your bladder and also block pain.
- Antihistamines (such as Claritin) decrease urinary urgency and frequency.
Bladder distention is a procedure that stretches 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 in your symptoms.
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’s 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’s 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 discover that specific foods and beverages make their symptoms worse. Common foods that may worsen IC include:
- anything with caffeine
- acidic foods like citrus fruits and juices
Your doctor will help you 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’s possible that quitting smoking may help lessen or relieve your symptoms.
Maintaining an exercise routine may help you manage your symptoms. You may have to modify your routine so that you avoid high-impact activity that causes flare-ups. Try some of these workouts:
- tai chi
- low-impact aerobics or Pilates
A physical therapist can teach you exercises to strengthen your bladder and pelvic muscles. Talk to your doctor about meeting with a physical therapist.
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. Meditation and biofeedback may also help.
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. The main goal of treatment is to find the combination of therapies that best provides long-term symptom relief.