Interstitial Cystitis

Interstitial cystitis (IC), also known as bladder pain syndrome, is a chronic condition characterized by bladder pressure, bladder pain, and urinary symptoms such as frequency and urgency. The symptoms can range from mild discomfort to severe pain, significantly impacting quality of life. Despite ongoing research, the exact cause of IC remains unclear, making diagnosis and treatment challenging. This article explores the etiology, diagnosis, and treatment options for interstitial cystitis.

Causes

The cause of interstitial cystitis is not fully understood, but several factors are believed to contribute to the development of the condition:

  • Defective Bladder Lining: One hypothesis is that the protective glycosaminoglycan (GAG) layer of the bladder epithelium is defective, allowing irritating substances in urine to penetrate and trigger inflammation.
  • Autoimmune Response: Some researchers suggest that IC may be an autoimmune condition, where the body's immune system mistakenly attacks bladder tissue, leading to inflammation and pain.
  • Genetic Predisposition: There may be a genetic component, as IC appears to be more common in individuals with a family history of the condition.
  • Nerve Involvement: Abnormal nerve signaling in the bladder may contribute to the chronic pain and urgency associated with IC.
  • Allergic Reactions: Some individuals with IC report a history of allergies, suggesting that allergic processes might play a role in the pathogenesis.
  • Infections: Though not caused by a bacterial infection, some researchers propose that IC might develop following repeated or severe urinary tract infections.

Diagnosis

Diagnosing interstitial cystitis involves a process of exclusion, as there is no definitive test for the condition. The following steps are typically involved:

  • Medical History and Symptom Assessment: A detailed medical history and description of symptoms are essential. Patients often report frequent urination, urgency, and pain that worsens as the bladder fills and improves after urination.
  • Physical Examination: A pelvic exam may be conducted to rule out other conditions that could cause similar symptoms.
  • Urinalysis and Urine Cultures: These tests help exclude urinary tract infections or other abnormalities.
  • Cystoscopy: This procedure involves inserting a cystoscope through the urethra to visually inspect the bladder. It can help identify bladder wall inflammation or pinpoint areas of bleeding (glomerulations), which are sometimes seen in IC. Patients with blood in the urine will need this testing done and a cystoscopy may be considered in other situations.
  • Exclusion of Other Conditions: Conditions such as bladder cancer, urinary tract infections, and gynecological disorders must be ruled out.

Treatment Options

Treatment for interstitial cystitis is often individualized and may involve a combination of therapies:

  • Dietary Modifications: Many patients find relief by avoiding foods and beverages that can irritate the bladder, such as caffeine, alcohol, spicy foods, acidic foods, and artificial sweeteners.
  • Medications:
    • Oral Medications: Pentosan polysulfate sodium (Elmiron) is specifically approved for IC and may help restore the bladder lining, however, it is associated with changes in the retina, causing vision changes. Antihistamines (ex. hydroxyzine) and tricyclic antidepressants (ex. amitriptyline) can also be used to relieve symptoms.
    • Intravesical Therapy: This involves directly instilling medications into the bladder. These are also known as bladder cocktails. In our clinic, we typically recommend a combination of a steroid, lidocaine, and heparin.
  • Physical Therapy: Pelvic floor physical therapy can be beneficial, particularly if muscle tenderness or spasms are present. We recommend pelvic floor muscle relaxation exercises while waiting to see a physical therapist who will give individualized recommendations to help with pain.
  • Hydrodistention: A cystoscopy performed under general anesthesia in which the bladder is filled to capacity under low pressure which can be helpful for pain.
  • Nerve Stimulation: Techniques such as sacral nerve stimulation or percutaneous tibial nerve stimulation may help alleviate pain and urinary symptoms.
  • Surgical Options: Surgery is considered a last resort and may involve procedures to increase bladder capacity or, in severe cases, bladder removal.
  • Alternative Therapies: Some patients find relief with acupuncture, biofeedback, or other complementary therapies, such as aloe vera capsules.

Interstitial cystitis is a complex condition that requires a multifaceted approach to management. Patients should work closely with healthcare providers to develop a personalized treatment plan that addresses their specific symptoms and needs. Ongoing research continues to improve our understanding of IC, offering hope for more effective treatments in the future. Please reach out to the Texas Tech Physicians Urology Clinic to schedule an appointment with one of our providers if you are concerned you have interstitial cystitis.