Intercystitis
Interstitial cystitis is chronic inflammation of the wall of the urinary bladder. Inflammation can lead to scarring, pinpoint bleeding of the bladder wall, and a decreased bladder capacity.
Causes
Because bacteria, fungi or viruses are rarely found in the urine of people with interstitial cystitis, the cause is unclear. Possible causes include:
- An autoimmune response that occurs following a bacterial infection of the bladder
- Bacteria that cling too tightly to the wall of the bladder to be detected in the urine
- A "leaky" inner lining of the bladder that allows irritating substances in the urine to come into contact with the bladder wall
Risk Factors
- Sex: female
- History of childhood bladder problems
Symptoms
The symptoms of interstitial cystitis vary from person to person. They can also occur in cycles. Some people experience periods of intense symptoms followed by periods of remission. Pain can be severe enough to keep people from working or even walking.
Symptoms can include:
- Discomfort, pain, or pressure in the bladder or pelvic area
- Frequent need to urinate (up to 60 times per day in severe cases)
- Urgent need to urinate
- Pain during intercourse
- Blood and pus in the urine
- Shrunken bladder
Diagnosis
A doctor will ask about your symptoms and medical history, and perform a physical exam. In addition, your urine will be tested for pus and bacteria. If bacteria are present in the urine, you will likely be diagnosed with acute cystitis—a typical bladder infection. If no bacteria are present, your doctor will likely do other tests.
A diagnosis of interstitial cystitis will only be made after other conditions have been ruled out and a cystoscopy with bladder distention has been done. This consists of distending (stretching) the bladder to its full capacity by instilling gas or liquids through the cystoscope. A cystoscopy will help your doctor see if there is scarring, bleeding, or inflammation on the bladder wall.
Treatment
There is no treatment to cure interstitial cystitis. Treatment is aimed at relieving symptoms. You may have to try several different treatments before you experience relief.
Treatments include:
Bladder Distention
Some people experience relief after the bladder distention—done during the cystoscopy—is done.
Bladder Instillation
During bladder instillation, a "wash" is put into the bladder through a tube in the urethra. It is held for anywhere from a few seconds to 15 minutes and then voided. There are several different types of solutions used. Some coat the bladder and are thought to decrease the inflammation.
Medication
Medications may include:
- Bladder coating - taken orally, they can coat and protect the bladder
- Antidepressants and pain relievers - for pain relief
- Antihistamines - may help stop the cycle of inflammation
- Antispasmodics - may alleviate frequency and urgency of urination
Diet
Many people find that changes in diet can help relieve pain. Finally, in the Summer of 2006, researchers Barbara Shorter RD and Robert Moldwin MD provided concrete proof that diet does exacerbate IC symptoms when they released the preliminary data for the first formal research study on diet and IC in a lecture on the Interstitial Cystitis Network. Foods commonly reported to aggravate interstitial cystitis include:
- Coffees (Regular & Decaf)
- Teas (Regular, Green & Blended Herbals)
- Chocolate
- Artificial sweeteners
- Alcohol
- Acidic foods
- Carbonated beverages
Transcutaneous Electrical Nerve Stimulation (TENS)
A Transcutaneous Electrical Nerve Stimulator, or TENS, is an external device that sends mild electrical impulses into the body. It has been helpful in relieving pain and decreasing frequency of urination in some people.
Bladder Training
Some people are able to train the bladder to have better control by setting a regular timed schedule for emptying their bladder. The amount of time between voidings is gradually increased. Bladder training should be attempted only after pain relief has been accomplished.
Surgery
Surgery is a treatment of last resort. It is used after all other treatment methods have been exhausted and if the pain is severe. Many people continue to have pain even after surgery.
Prevention
There are no guidelines for preventing interstitial cystitis because the cause is unknown.
Organizations
- Interstitial Cystitis Association
- Interstitial Cystitis Network
- ICU Texas
- The Cystitis and Overactive Bladder Foundation
- The Interstitial Cystitis Association
Resources
In addition to traditional IC therapies, diet modification remains a core self help strategy as foods that are irritating to the bladder dramatically worsen the symptoms that patients may experience. Foods high in acid and/or caffeine (such as all coffees, regular teas, green teas, sodas, diet sodas, artificial sugars and most fruit juices) should be avoided. The daily goal of patients should be to soothe rather than irritate the bladder wall.
- The Top Five List of Forbidden Foods
- IC Survival Guide by Robert Moldwin, MD
- A Taste of the Good Life: A Cookbook for an IC Diet
- Confident Choices: Customizing the IC Diet
- The ICN Special Report on Diet