What Is Interstitial Cystitis?
Interstitial cystitis (IC), also called bladder pain syndrome (BPS), is a chronic bladder health condition which affects over 2 million people. IC/BPS is 2 to 3 times more common in women than in men; although it is believed that the number of men may actually be higher because some men diagnosed with “prostatitis” (swelling of the gland that makes semen in men) may really have IC/BPS.
Causes of IC/BPS
Experts do not know exactly what causes IC/BPS, but there are many theories, such as:
- A defect in the bladder tissue.
- A specific type of inflammatory cell, called a mast cell that releases histamine.
- Changes in the nerves that carry bladder sensations.
- The body’s immune system attacks the bladder.
No specific behaviors are known to increase risk of IC; however, having a family member with IC/BPS may increase your risk of getting IC/BPS. Some people may be more likely to get IC/BPS after an injury to the bladder, such as an infection. At this time, there is no evidence that stress causes IC/BPS; however, it if a person has IC, physical or mental stress can make the symptoms worse.
Symptoms of IC/BPS
The symptoms of IC/BPS vary for each patient, but the most common sign is pain, often with pressure, as the bladder gets full and in other areas such as the urethra, lower abdomen, lower back, or the pelvic or perineal area. The pain may be constant or may come and go.
IC/BPS sometimes starts with urinary frequency which is the need to pass urine more often than normal. On average a person urinates no more than 7 times a day, does not have to get up at night more than once to use the bathroom. A patient with IC/BPS often has to urinate frequently both day and night.
Urgency is a sudden, compelling need to urinate. Some IC/BPS patients constantly feel an urge to urinate, even right after going to the bathroom. Other patients experience sudden, severe symptoms occurring within days, weeks or months.
Certain things may make symptoms worse. For some patients, symptoms are made worse by certain foods or drinks. Physical or mental stress may also make symptoms worse. For women, the symptoms may vary with their period. Many patients with IC/BPS also experience painful sexual problems.
How Is IC/BPS Diagnosed?
Your urologist will take a detailed medical history; perform a physical exam and urine tests for evaluation to rule out other conditions that might be causing the symptoms.
If IC is suspected, your urologist may discuss and recommend further diagnostic testing. Testing may include:
- Potassium Sensitivity Test (PST) can be performed in the office; recovery time is usually quick. A potassium solution and water is placed into the bladder one at a time, and pain/urgency scores are compared. A person who has IC feels more pain/urgency with the potassium solution than with the water, but patients with normal bladders cannot tell the difference between the two solutions. This test is diagnostic for interstitial cystitis.
- Cystoscopy with hydrodistention is performed under anesthesia. A scope or tube is inserted into the bladder. The bladder is stretched in order to see the pinpoint hemorrhages (bleeds) on the bladder wall that are the hallmark of this disease. A biopsy of the bladder wall may be necessary at this time to rule out bladder cancer and to help in the diagnosis of IC.
At this time, there is no medical test that can say a person has IC/BPS. Also, there is no test to say a person does not have IC/BPS. To make a diagnosis, your urologist will first decide whether the symptoms are typical of IC/BPS. Next, they need to rule out other health issues that might be causing the symptoms.
How Is IC treated?
No single treatment works for everyone, and no treatment is “the best.” Treatments are individualized for every patient, based on his or her symptoms. The usual course is multimodality therapy or the use of combination of medications and other treatments until the patient gets good relief of their symptom(s).
The following two treatments are currently approved by the United States Food and Drug Administration (FDA) to treat IC
- Medication: oral pentosan polysulfate sodium (Elmiron).
- Bladder instillations: dimethyl sulfoxide (DMSO) is instilled into the bladder through a catheter.
Some urologists combine DMSO with other medications such as heparin or steroids (to decrease inflammation).
A wide variety of other treatments are used for IC, even though they are not specifically approved by the FDA for this purpose. The most common ones are oral hydroxyzine, oral amitriptyline and instillation of heparin into the bladder through a catheter.
- Antihistamine: It is thought that some IC patients have too much histamine in the bladder, and that histamine promotes pain and other symptoms. Therefore, an antihistamine can be helpful in treating IC.
- Antidepressants: Amitriptyline, an antidepressant, has many effects that may improve IC symptoms. It has antihistamine effects, decreases bladder spasms, and slows the nerves that carry pain messages.
- Heparin has both anti-inflammatory and surface protective actions and may be used to help temporarily “repair” the bladder layer.
Many other IC treatments are also used, but less frequently than the ones described. Some patients do not respond to any IC therapy but can still have significant improvement in the quality of life with adequate pain management. Pain management can include non-steroidal anti-inflammatory drugs, moderate strength opiates and stronger long-acting opiates in addition to nerve blocks, acupuncture and other non-drug therapies.
Can Diet Help Control IC Symptoms?
Eliminating certain foods may decrease the severity of IC symptoms. Many patients with IC have found that simple changes in their diet can help control symptoms and flare-ups.
An IC Smart Diet avoids foods high in acid and potassium as well as beverages containing caffeine and alcohol.
IC/BPS can impact social life, exercise and sleep, and can cause a great deal of distress. IC/BPS may affect relationships with your spouse and family. Without treatment, IC/BPS symptoms make it hard to get through the day or even be able to work.
At Georgia Urology, our physicians are recognized leaders in the diagnosis and treatment of IC/BPS. We strive to provide the best possible care in the most supportive, compassionate setting. Schedule an appointment with one of our specialists.