Interstitial cystitis (IC) is an incurable, chronic inflammation of the bladder that can become a debilitating condition for many patients. Patients with IC experience both frequent urination and urinary urgency. In addition, patients often experience lower abdominal or pelvic pain. In women, the symptoms can often become more severe just prior to their menstrual period.
IC is considered to be one of the most difficult conditions for a urologist to diagnose because a patient can experience flare ups. In up to one-half of the patients with IC, remission can last as long as 6 years.
IC has two forms, ulcerative and nonulcerative. Ninety percent of IC patients are diagnosed with nonulcerative IC.
WHAT ARE THE SYMPTOMS?
IC can cause a variety of symptoms, some of which differ between men and women. In most patients the symptoms include:
- Urinary urgency and frequency;
- Frequent nighttime urination;
- Pain in lower abdomen, urethra, or pelvic region;
- Pain frequently associated with sexual intercourse;
- Increasing pain as the bladder fills and decreasing pain as the bladder empties; and
- An increase in symptoms during menstruation.
In addition to most of the above listed symptoms, men may also experience:
CAUSES AND RISK FACTORS
The cause of IC is unknown.
A diagnosis of IC is a diagnosis of exclusion. Some of the conditions that physicians must rule out include:
- Bladder inflammation or infection;
- Sexually transmitted diseases;
- Enlarged prostate (in men);
- Bacterial prostatitis (in men); or
- Non-bacterial prostatitis (in men).
To help diagnose IC, the physician will usually conduct a patient history and physical exam, which may include a pelvic exam in women and a digital rectal exam in men. The physician usually instructs the patient to record the frequency of urination in a 24-hour period in a log.
Along with the log, urine cultures and cytology may help the physician exclude conditions that may cause symptoms similar to IC symptoms.
Other tests that may help a physician diagnose IC include:
- Culture for prostate secretions;
- Cystocscopy with hydrodistention;
- Potassium sensitivity test.
There are no standard, successful treatments for IC. There is no cure for IC. The primary goals of IC treatments are to ease the symptoms and improve the patient’s quality of life. The physician will usually begin by suggesting that the patient attempt lifestyle changes such as dietary management, behavioral therapies (such as urinating on a schedule), and stress management.
Lifestyle. Lifestyle factors can affect the IC patient. Certain foods or beverages can exacerbate symptoms of IC. Some of these items include:
- Citrus fruits and other fruits (such as apples , bananas, and tomatoes) and certain vegetables (such as onions).
To identify culprit foods, physicians recommend that patients keep a food diary that associates foods eaten with any symptoms that a patient may experience. In addition, physicians recommend that patients become involved in self-care through stress reduction and behavioral exercises.
Bladder distension. For bladder distension, the patient is placed under anesthesia. The physician then expands the bladder beyond its capacity by filling it with water through a catheter, drains the bladder, and may refill and drain a second time.
Medications. If the initial bladder distension does not relieve symptoms, the physician may prescribe a number of medications, including:
- Pentosan polysulfate (Elmiron);
- Tricyclic antidepressants; and
Intravesical therapy with dimethyl sulfoxide (DMSO; Rimso-50). During intravesical therapy, also called bladder wash or lavage, the physician inserts a catheter through the urethra into the bladder and fills the bladder with the medication DMSO. The physician performs the procedure once a week for 6 weeks. The treatment lasts for approximately 6 months and can be repeated.
Transcutaneous electrical nerve stimulation (TENS). In TENS, wires fitted with electrodes placed on the lower back or pubic area or devices placed in the vagina in women or the rectum in men deliver mild electrical impulses to the nerves. The physician instructs the patient how to control the pulses, and the pulses can be delivered from a few minutes to 2 hours twice each day.
Interstim Implant. For the Interstim Implant, two small wire electrodes are placed in the nerves in the sacrum and a modulator adjusts the current.
Surgery. Considered to be the last-resort therapy, and also considered to be a rare approach to treating IC, surgery has shown little success in alleviating the pain and urinary difficulties associated with IC. Bladder removal, known as cystectomy, has become the most common procedure performed for IC patients.