Interstitial Cystitis (Painful Bladder Syndrome)
What is interstitial cystitis (IC)?
Interstitial cystitis (IC) or painful bladder (PBS) is defined as a pain, pressure, or discomfort in the suprapubic or bladder area which can cause urinary frequency or the urge to urinate that has been present for at least six weeks.
Who gets interstitial cystitis (IC)?
Men, women and children can all be diagnosed with IC. It is estimated that approximately 83,000 men and 1.2 million women in the US suffer from IC.
Symptoms and Causes
What causes interstitial cystitis (IC)?
The causes for IC are not completely understood. IC may be related to such medical conditions as:
- Autoimmune disease.
- Defects in the lining of the bladder.
- Vascular (blood vessel) disease.
- Mast cell (cells that cause allergic symptoms) abnormalities.
- Presence of abnormal substances in the urine.
- Unidentified infections.
What are the symptoms of interstitial cystitis (IC)?
Symptoms of IC/PBS 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 interstitial cystitis (IC) include the following:
- Suprapubic or pelvic pain.
- Pressure or discomfort when the bladder is filling.
- Having to urinate frequently.
- Urinating small amounts.
Diagnosis and Tests
How is interstitial cystitis (IC) diagnosed?
There are no definitive tests to diagnose IC/PBS. It is important to rule out other infections and conditions so your doctor may run different tests, including:
- 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.
- Cystoscopy: 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/PBS patients experience temporary relief of their symptoms.
Management and Treatment
How is interstitial cystitis (IC) treated?
Although IC/PBS 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/PBS may become more severe, or may disappear. Even if symptoms disappear, they may return after days, weeks, months or years.
Treatments for IC/PBS are aimed at relieving symptoms. Doctors will help decide the appropriate treatment for the patient. For some patients, treatments are combined.
Interstitial cystitis/painful bladder treatments can include:
- Diet: Some people with IC/PBS find that certain foods or drinks make their symptoms worse. 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/PBS, acidic foods may irritate the bladder. If this is the case, your doctor may recommend taking an antacid with meals to reduce the amount of acid that gets into the urine. You may also want to remove certain foods from your diet, such as:
- Carbonated beverages
- Artificial sweeteners
- Physical activity: Exercise and physical activity may help relieve the symptoms of IC/PBS. Exercises can include:
- Gentle stretching
- Reducing stress: Stress can trigger flare-ups and symptoms in someone who has IC/PBS. Learning stress reduction methods and setting aside time for relaxation may make living with IC/PBS easier.
- Physical therapy: The pelvic muscles hold the bladder in place and help control urination. Exercising these muscles may help reduce the symptoms of IC/PBS. Your doctor or physical therapist can help you perform this exercises correctly.
- Bladder retraining: 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.
- Oral medications: Pentosan polysulfate sodium (Elmiron®) is a medication approved for treating the pain of IC. This medication may have to be taken for up to six 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 amitriptyline (Elavil) 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.
- Bladder instillations: Another treatment is to fill the bladder with a liquid medicine. You place a small catheter or tube in the urethra and fill the bladder with medicine.
- Bladder stretching/hydrodistension: Bladder stretching or hydrodistension is a procedure that is performed in the operating room under anesthesia. The bladder is filled with sterile water in order to distend the bladder and increase the amount of urine you can hold.
- Nerve stimulation: Nerve stimulation is a treatment that helps regulate the bladder. These treatments are more helpful in reducing urgency and urinary frequency but sometimes can help with the bladder/suprapubic pain.
- Surgery: Surgery to treat IC/PBS 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.