Interstitial Cystitis (Painful Bladder Syndrome)
Interstitial cystitis (IC) is a chronic (long-lasting) bladder condition that causes discomfort and/or pain in the bladder or pelvic region. The bladder walls become inflamed and irritated, which causes the bladder to become very sensitive.
IC can cause scarring and stiffness in the bladder. When the bladder is stiff, it can’t expand as it normally does when it is filled with urine. The walls of the bladder may also get sores and bleed.
Who gets interstitial cystitis?
Men, women, and children of all ages are diagnosed with IC. An estimated 700,000 to 1 million Americans currently suffer from the disease; 80 percent of people diagnosed with IC are women.
What are the symptoms of interstitial cystitis?
Symptoms of IC vary from case to case, and can be mild, severe, occasional, or constant. The symptoms may be similar to those of a bladder infection. Women’s symptoms often get worse during menstrual periods.
Symptoms of IC include the following:
abdominal or pelvic discomfort
pain, pressure, and/or discomfort coming from the bladder
having to urinate frequently
passing only a small amount of urine
pressure in the abdomen and/or pelvis
in men, discomfort in the penis and/or scrotum
lower abdominal pain that gets worse as the bladder fills
pain during sexual intercourse
What causes interstitial cystitis?
The causes for IC are not completely understood. IC may be related to such medical conditions as:
defects in the lining of the bladder
vascular (blood vessel) disease
mast cell abnormalities
presence of abnormal substances in the urine
How is interstitial cystitis diagnosed?
There are no definitive tests to diagnose IC. To rule out other conditions, the doctor may run different tests, including urine sample and urinalysis, biopsy of the bladder wall and urethra, cystoscopy, and distention of the bladder under anesthesia.
Urine sample and urinalysis
The patient provides a urine sample, and the doctor examines it with a microscope to learn if there are any organisms, germs, pus, or white blood cells, which could mean that there is an infection. The doctor can treat the infection with antibiotics. If the urine is sterile for weeks or months and the symptoms continue, doctors may make a diagnosis of IC.
Biopsy of the bladder wall and urethra
A biopsy is a sample of tissue taken from the body in order to examine it more closely. This procedure will be done under anesthesia. Tissue may be taken from the bladder wall and urethra (the tube through which urine passes out of the body) to rule out other conditions. A biopsy can help rule out bladder cancer.
The doctor may examine the inside of the bladder with an instrument called a cystoscope. This is a long, thin scope with an eyepiece on one end. The cystoscope is gently placed up the urethra and into the bladder. The doctor can see into the bladder by looking through the eyepiece. The patient is not under anesthesia during this procedure. A cystoscopy can rule out bladder cancer. If a bladder biopsy is also planned, the cystoscopy may be performed at the same time, but this may require anesthesia.
Cystoscopy under anesthesia with bladder distension
A cystoscopy may also be done with bladder distention (stretching). The doctor will perform a cystoscopy as described above and will distend (stretch) the bladder to its maximum capacity by filling it with water. This procedure can reveal cracks in the bladder. This procedure requires anesthesia because the stretching is painful for people with IC. After this procedure, many IC patients experience temporary relief of their symptoms.
How is interstitial cystitis treated?
Although interstitial cystitis cannot be cured, there are many ways to treat it. There is no way to predict who will respond best to certain treatments. Symptoms of IC may become more severe, or may disappear. Even if symptoms disappear, they may return after days, weeks, months, or years.
Treatments for IC are aimed at relieving symptoms. Doctors will help decide the appropriate treatment for the patient. For some patients, treatments are combined.
IC treatments include the following:
Oral medications such as aspirin, ibuprofen, or acetaminophen can help with mild bladder pain. If you need a stronger form of pain medication, talk to your doctor.
Pentosan polysulfate sodium (Elmiron) is a medication approved for treating the pain of IC. This medication may have to be taken for up to 6 months before any improvement is noticed.
Medicines that treat heartburn may help the symptoms of IC by reducing the amount of acid made by the body. Muscle relaxants can help relieve the symptoms by keeping the bladder from squeezing at the wrong time.
Antidepressants can be used to relieve pain in patients with IC. Tricyclic antidepressants such as Elavil (amitriptyline) have been shown to improve pain and reduce frequent urination in patients with IC.
Narcotic pain medications are not routinely used to treat pain in IC patients.
Another treatment is to fill the bladder with a liquid medicine. This can be dimethyl sulfoxide (DMSO), or a mixture of heparin (a blood thinner) and the pain medicine lidocaine. The doctor places a small catheter or tube in the urethra and slowly fills the bladder with the medicine. These medications can ease irritation of the bladder wall.
Some people with IC find that certain foods or drinks make their symptoms worse. If you have IC, you may find it helpful to keep a diary of what you eat and drink to see if any foods or drinks cause symptoms and/or flare-ups.
For patients who have IC, acidic foods may irritate the bladder. If this is the case, you may want to remove certain foods from your diet, such as alcohol, caffeine, carbonated beverages, chocolate, tomatoes, and artificial sweeteners. Your doctor may also recommend taking an antacid with meals to reduce the amount of acid that gets into the urine.
Exercise and physical activity, such as walking, biking, and gentle stretching, may help relieve the symptoms of IC.
Stress can trigger flare-ups and symptoms in someone who has IC. Learning stress reduction methods and setting aside time for relaxation may make living with IC easier.
The pelvic muscles hold the bladder in place and help control urination. Exercising these muscles may help reduce the symptoms of IC.
Your doctor or physical therapist can help you find the muscles to exercise. One way to find the correct muscles is to imagine that you are trying to keep from passing gas. If you squeeze these muscles and feel a “pulling” feeling, you have found the right muscles for pelvic exercises.
A person who has bladder pain can get in the habit of using the bathroom as soon as he or she feels pain or urgency, even if the bladder is not full. As a result, his or her body may get used to going to the bathroom often.
Bladder retraining is a treatment to try to overcome this habit by helping you hold urine for a longer period of time. To use bladder retraining, keep a diary of how often you urinate, and how often you have the urge to urinate. Use the diary to gradually increase the length of time between bathroom breaks.
Bladder stretching is a treatment in which water is inserted into the bladder to stretch it. This helps make the bladder larger, and allows it to hold more urine. The patient is given an anesthetic to prevent pain and help to relax the bladder muscles.
Nerve stimulation is a treatment in which mild electrical pulses are sent to the nerves to control the bladder. The electrical pulses are delivered through electrodes placed on the skin. The nerves then release endorphins and block pain naturally. If this therapy works, the patient may consider having a device placed in his or her body that delivers small pulses of electricity to the nerves around the bladder.
Surgery to treat IC is used as a last resort. The surgery may remove parts of the bladder or even the entire bladder. If the patient has tried every other treatment option and pain is unbearable, surgery may be considered.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/26/2015...#15735