Cystitis - interstitial; IC
Interstitial cystitis is a long-term (chronic) problem in which pain, pressure, or burning is present in the bladder. It is also called painful bladder syndrome.
The bladder is a hollow organ with a thin layer of muscle that stores urine. When your bladder fills up with urine, it sends a signal to your brain, telling the muscles to squeeze. In most people, these signals are not sent until your bladder is almost full. If you have interstitial cystitis, the signal to empty your bladder is sent more often or when your bladder is not very full.
The condition most often occurs between ages 30 to 40, although it has been reported in younger people.
Women are 10 times more likely to have IC than men.
The exact cause of this condition is unknown.
Symptoms of IC are chronic. They have a tendency to come and go with periods of lesser or worse severity. Common symptoms include:
- Bladder pressure or discomfort (mild or severe)
- Urge to urinate often
- Burning pain in the pelvic area
- Pain during intercourse
Many people who have long-term interstitial cystitis are also depressed because of the pain and changes to their lifestyle.
Exams and Tests
Your health care provider will look for other causes of your symptoms. These include:
- Sexually transmitted infections
- Bladder cancer
- Bladder infections
- Kidney or ureteral stones
Tests are done on your urine to look for infection or cells that suggest cancer inside the bladder. During a cystoscopy, the provider uses a special tube with a small camera on the end to look inside your bladder. A sample or biopsy of the lining of your bladder may be taken.
Tests at your provider's office may also be done to show how much urine must be in the bladder before you feel the need to urinate and how well you empty.
There is no cure for IC, and there are no standard treatments. Treatment is based on trial and error until you find relief. Results vary from person to person.
DIET AND LIFESTYLE CHANGES
Some people find that making changes in their diet can help control symptoms. Try to avoid foods and beverages that can cause bladder irritation. Stop eating certain foods, one at a time, to see if your symptoms get better. Reduce or stop consuming caffeine, chocolate, carbonated beverages, citrus drinks, and foods with a high level of vitamin C.
Other foods that the Interstitial Cystitis Association lists as possibly causing bladder irritation are:
- Aged cheeses
- Artificial sweeteners
- Fava and lima beans
- Meats that are cured, processed, smoked, canned, aged, or that contain nitrites
- Most fruits, except blueberries, honeydew melon, and pears
- Nuts, except almonds, cashews, and pine nuts
- Rye bread
- Seasonings that contain MSG
- Sour cream
- Sourdough bread
You and your provider should discuss methods you can use for bladder training. These may include training yourself to urinate at specific times or using biofeedback to relieve pelvic floor muscle spasms.
MEDICINE AND PROCEDURES
Combination therapy may include medicines such as:
- Pentosan polysulfate sodium, the only medicine taken by mouth that is approved for treating IC
- Tricyclic antidepressants, such as amitriptyline, to relieve pain and urinary frequency
- Vistaril (hydroxyzine pamoate), an antihistamine that causes sedation and helps reduce urinary frequency
Other therapies include:
- Over-filling the bladder with fluid while under general anesthesia, called bladder hydrodistention
- Medicines placed directly into the bladder, including dimethyl sulfoxide (DMSO), heparin, or lidocaine
- Bladder removal (cystectomy) for extremely difficult cases, which is rarely done anymore
Treatment results vary. Some people respond well to simple treatments and dietary changes. Others may require extensive treatments or surgery.
When to Contact a Medical Professional
Call your provider if you have symptoms of interstitial cystitis. Be sure to mention that you suspect this disorder. It is not well recognized or easily diagnosed.
Ferri FF. Interstial cyctitis. In: Ferri FF, ed. Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier Mosby; 2016:712-713.
French LM, Bhambore N. Interstitial cystitis/painful bladder syndrome. Am Fam Physician. 2011;83(10):1175-1181. PMID: 21568251 www.ncbi.nlm.nih.gov/pubmed/21568251.
Hanno PM. Bladder pain syndrome (interstitial cystitis) and related disorders. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 11th ed. Philadelphia, PA: Elsevier; 2016:chap 14.
Hanno PM, Burks DA, Clemens JQ, et al; Interstitial Cystitis Guidelines Panel of the American Urological Association Education and Research, Inc. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. JUrol. 2011;185(6):2162-2170. PMID: 21497847 www.ncbi.nlm.nih.gov/pubmed/21497847.