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Interstitial Cystitis

Interstitial Cystitis: What You Need to Know

  • Interstitial cystitis is a chronic pain condition. Diagnosis and treatment can be difficult, as the exact cause is unknown.

  • No specific test exists to diagnose interstitial cystitis; it is often diagnosed after other conditions have been ruled out.

  • Genetic and immune disorders, recurrent bacterial infections, and pelvic floor dysfunction are possible factors that can lead to this condition.

  • Excessive frequency of urination, urinary urgency, and urethra, bladder or pelvic pain are common symptoms.

  • Treatment is divided into five phases, ranging from lifestyle changes to injections to surgery.

What is interstitial cystitis?

Interstitial cystitis, also called painful bladder syndrome, is considered to be a chronic pain condition. The exact cause is unknown. People who have this condition may report pain in the urinary tract (urethra and/or bladder) in addition to frequent trips to the bathroom.

The bladder is a muscular sac located in the pelvis that stores and then empties urine. When it fills, pelvic nerves send messages to the brain, creating the urge to urinate. People with interstitial cystitis may feel this sensation of filling as painful, leading to a more urgent and frequent need to urinate.

What causes interstitial cystitis?

The exact cause of interstitial cystitis is unknown. Researchers have identified certain factors that may contribute to the development of interstitial cystitis, including:

  • Recurrent bacterial infections (cystitis)

  • Pelvic floor dysfunction

  • Genetics and immune disorders

  • An association with other chronic pain conditions (fibromyalgia and irritable bowel syndrome)

  • Bladder and bowel dysfunction

What are the symptoms of interstitial cystitis?

Interstitial cystitis symptoms vary from person to person. Your symptoms may include:

  • Urethra, bladder or pelvic pain

  • Urinary frequency (up to 60 times per day in severe cases)

  • Urinary urgency

Because providers do not know the cause of interstitial cystitis, it is challenging to diagnose and treat. It is considered as a diagnosis only after other conditions have been ruled out, such as urinary tract infection or endometriosis. Physical examination and diagnostic tests may help physicians rule out other treatable conditions.

How is interstitial cystitis diagnosed?

There is no specific test to diagnose interstitial cystitis. Instead, your doctor may do a medical history, review your symptoms and use diagnostic tests to rule out other conditions before identifying interstitial cystitis.

Tests may include:

  • Pelvic exam: Your doctor may perform a comprehensive pelvic exam to examine your external genitals and internal pelvic organs.

  • Urine test: A urine test will help your doctor rule out another condition, such as a urinary tract infection.

  • Urodynamic testing: Urodynamic, or bladder, testing measures how the bladder and urethra are functioning to store and release urine. Your doctor may measure how efficiently and fast your bladder can empty with these bladder tests.

  • Cystoscopy: Cystoscopy is a minimally invasive procedure where your physician puts a cystoscope (a thin, lighted tube) into your urethra (the tube connecting your bladder to the outside of your body) to view your bladder. This test can rule out other problems, such as cancer. The doctor can see findings, such as ulcers, through the cystoscope in some patients with interstitial cystitis (painful bladder syndrome). Your doctor may also perform a hydrodistension at this time, distending the bladder to help with diagnosis and treatment for this condition. Learn more about cystoscopy for women.

  • Biopsy: During cystoscopy, your doctor may remove a small sample of your bladder or urethra tissue to examine under a microscope if you have abnormal findings on your cystoscopy. The bladder biopsy is used to rule out other bladder diseases.

What are the treatments for interstitial cystitis?

While there is no cure for interstitial cystitis, there are treatments that can help manage your bladder symptoms and treat your pain and discomfort. No single treatment works for all people with this condition. Treatment must be chosen for each patient based on symptoms. For most people with interstitial cystitis, a combination of treatments is the best approach. Finding the optimal individual treatment protocol may also require a period of trial and error. Treatments are divided into five phases:

  • First phase: lifestyle changes

  • Second phase: prescription drugs

  • Third phase: neuromodulation therapy, ulcer cauterization and injections

  • Fourth phase: cyclosporine

  • Fifth phase: surgery

Your provider would decide the best treatment(s) for you based on your symptoms. These are some of the treatments that may occur during the diagnosed phases:

  • Bladder training: Helps you regain control over urination through learning to hold in urine for longer periods of time.

  • Diet modifications: Reducing bladder irritants may help decrease bladder pain, urgency and urinary frequency symptoms.

  • Pelvic floor physical therapy: Relaxes and lengthens tight muscles and releases knots within the pelvic floor muscles. This can also help assist with bladder training.

  • Bladder instillations: Uses a catheter (thin, flexible tube) to place a mixture of medicines directly into the bladder to relieve pain and discomfort. This can be performed initially in the office setting, with many patients then learning to perform these instillations at home.

  • Oral medications: Help relieve pain and reduce inflammation. These may include antihistamines, antidepressants, nonsteroidal anti-inflammatory drugs and pentosanpolysulfate sodium (the only FDA-approved oral drug for interstitial cystitis).

  • Cystoscopy with hydrodistension: Stretches the bladder with water using a cystoscope. Although it is not exactly known how it works, the treatment may reduce bladder symptoms, such as pain, urgency and urinary frequency, in some patients with this condition.

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