Interstitial Cystitis: Symptoms and Treatment

The urinary bladder is a hollow muscular organ. Collection of urine causes the wall of the bladder to stretch, sending a signal to the brain; which manifests in the form of urge to urinate. Interstitial cystitis, also known as painful bladder syndrome, is a chronic condition that results in pain and increased frequency of urination. About 1 million American suffer from interstitial cystitis.

Causes of interstitial cystitis

Interstitial cystitis does not have a well defined cause. It is related to:

• Defect in the lining of the bladder
• Infections
• Allergic cause
• Autoimmune diseases
• Irritable bowel syndrome
• Fibromyalgia

Interstitial cystitis is more common amongst women and older individuals.

Symptoms of interstitial cystitis

This disease can manifest in multiple forms. The symptoms are:

• Increased urgency and frequency of urination
• Reduced volume of urine
• Pain during sexual intercourse
• Pain in the pelvis and perineum
• Pain in lower abdomen that gets worse with filling of bladder.

If you have been experiencing any of the above mentioned symptoms it is advisable to contact your health care provider.

Diagnosis of interstitial cystitis

Your provider will first like to hear about your symptoms and then will like to record a detailed history followed by a general physical examination. Following this your provider might order a few tests to confirm the diagnosis. The tests ordered can be:

• Urine test: you will be asked to provide a sample of your urine in a small sterile container. The sample will be cultured to look for microbes. The sample will also be analysed under a microscope to look for the presence of cells in urine
• Biopsy of the bladder wall and urethra: this procedure is done under anaesthesia; a small sample of tissue will be taken from the wall of the urinary bladder and the urethra, the tube through which urine is excreted from the body
• Cystoscopy: a thin tube with a light source and camera will be inserted into your bladder via the urethra to inspect the bladder wall
• Potassium sensitivity test: your provider will fill your bladder with water, followed by a solution of potassium chloride, one at a time. You will be asked to compare the pain and urgency you with water and potassium chloride. Increase intensity of pain and urgency with potassium chloride indicates that you might have interstitial cystitis
• Bladder hydrodistention: your bladder will completely filled with an irrigation fluid for 1-2 minutes. The volume of fluid will be noted after which the bladder will be emptied  and re – examined.

Treatment of interstitial cystitis

There is no cure for interstitial cystitis yet, though there are treatments which can help in controlling your symptoms.

• Lifestyle changes: small changes like wearing loose clothes to reduce pressure on bladder, low impact exercise have been shown to reduce symptoms. You will also be advised to cut down on stress. Another is to train your bladder to hold more urine; for example, if you need to urinate every 25 minutes, try to increase that time gradually to 30 minutes. Specific food items like coffee, mono sodium glutamate (MSG), alcohol, carbonated beverages, chocolate, citrus fruits, artificial sweeteners, spicy food and cranberry juice have been shown to aggravate the symptoms in some patients.
• Medical therapy: medicines that may help reduce the symptoms are
• Amitriptyline to reduce pain
• Pentosan
• Hydroxysine to reduce urgency and frequency
• NSAISs like ibuprofen and naproxen
• Bladder hydrodistenstion: your bladder will be completely filled with fluid for less than 10 minutes. This procedure is indicated for individuals who benefited from the diagnostic bladder hydrodistention
• If you have an ulcer in your bladder it will be cauterised, fulgurised or resected
• Instillation therapy: drugs like DMSO are instilled into the bladder weekly, to reduce the inflammation in the bladder
• TENS (Transcutaneous Electrical Nerve Stimulation): electrical stimulation via wires in your lower back or just above your pubic area may help in reducing pain, increase blood supply to the bladder and strengthen the muscles responsible for bladder control.
• Sacral nerve stimulation: small electrodes are placed in the lower back to stimulate the nerve that connects your bladder to the spinal cord. Stimulation of this nerve helps in reducing the urgency and frequency of urination
• Bladder augmentation: your surgeon will increase the capacity of your bladder by introducing a patch of intestine into your bladder wall. This procedure is one of the last resort. It only helps reduce urgency and frequency.

Sources

• Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol.  2015; 193(5):1545-53 (ISSN: 1527-3792)Hanno PM; Erickson D; Moldwin R; Faraday MM
• Interstitial cystitis/bladder pain syndrome: symptoms, screening and treatment. Nurs Womens Health.  2011; 15(6):496-507 (ISSN: 1751-486X)Gish BA