interstitial cystitis

Interstitial cystitis (IC) is probably a neuro-inflammatory condition of the bladder wall. The symptoms of IC include pelvic pain, pressure or discomfort related to the bladder. These are typically associated with urinary frequency and urgency in the absence of infection or other pathology. IC is also called trigonitis, urethral syndrome, chronic pelvic pain syndrome (CPPS), bladder pain syndrome (BPS) and/or painful bladder syndrome (PBS).


Who is affected by IC?

There are an estimated 3-8 million IC sufferers in the US today and it can affect women, men and children of any age and race. However, 90% of all IC patients are women. Many researchers believe that this is an underestimation because many patients remain misdiagnosed or undiagnosed. Current studies indicate that the average age of onset is 40 and 25% of women with IC are under the age of 30.


Why is interstitial cystitis so challenging to diagnose?

Many people with IC have difficulty obtaining a diagnosis because the cause of IC is unknown. There is no foolproof test to diagnose IC and it remains primarily a diagnosis of exclusion. It takes an average of five to seven years to obtain a diagnosis of IC, and sometimes even longer. IC can have a devastating impact financially and on quality of life.


What are the symptoms of IC?

Symptoms can range from mild to severe and can differ from patient to patient.

  • Frequency – day and/or nighttime frequency of urination (up to 60 times a day in severe cases). In early or very mild cases, frequency may be the only symptom.
  • Urgency – the sensation of having to urinate immediately, which may also be accompanied by pain, pressure, or spasms.
  • Pain – in the lower abdominal, urethral, or vaginal area. Pain can also be present with sexual intercourse.
  • Many early cases present with possible urinary tract infections or “cystitis”.  Urine cultures are negative and patients are not responsive to antibiotics.

 

getting started

  1. Prepare to discuss this problem with your physician by paying special attention to:
    • Conditions and events that lead to your frequency, urgency, bladder pain/problems or pelvic pain
    • How long have you been having problems or symptoms
    • The strategies you use (or have used) to cope with your frequency, urgency, or pain

  2. Make sure you obtain records from your primary care provider and/or urologist prior to your visit.


  3. Once you have taken the first step in speaking with your physician, the next step is a thorough evaluation by a physician specializing in interstitial cystitis in women. This evaluation may include:
    • Patient history
    • Physical examination
    • Urologic assessment
      • Urinalysis and urine culture — to rule out bacterial infection
      • Post void residual urine — measured after urination
      • Cystoscopy — a small telescope that looks in the bladder
      • Urodynamics — a series of tests, performed in the office, to determine the characteristics of storing and emptying fluid

 

The diagnosis for IC is made by ruling out other conditions that have symptoms resembling IC. Once all of the initial evaluation is complete, an individualized treatment plan will be developed to meet your specific condition.

treatment options

Current available treatments:

There are no uniformly effective treatments for IC. The standard of care is a multimodal approach, using trial and error, until the physician and patient find a combination therapy that is both well-tolerated and effective for each individual patient.

The key to treating IC is treating the patient as an individual.

With a thorough assessment, we are able to offer several treatment options which include the following:

Self-help measures:

  • Diet modification: eliminate caffeine, alcohol, acidic or spicy foods, foods high in potassium
  • Bladder retraining
  • Relaxation therapy, visualization, etc.
  • Self-hypnosis
  • Gentle, non-jarring exercises/stretching
  • Wearing comfortable, non-binding clothing, shoes, hosiery and underwear


Alternative therapies (referral):

  • Acupuncture
  • Chinese herbal therapies
  • Biofeedback
  • Visualization
  • Chiropractic therapy
  • Homeopathy
  • Massage


Medical treatments:

  • Physical therapy – Working on relaxation and release of overly tight, highly toned muscles that results in fewer spasms, less pain, and in some instances, increased bladder capacity. The goal of IC therapy is to relax and release the pelvic muscles. Therefore Kegel exercises are not recommended for IC patients.

 

  • Non-prescription therapies:
    • Cysta-Q and Prosta-Q
    • Algonot
    • Desert harvest freeze dried aloe vera
    • Prelief (acid reducer)

 

  • Drug therapy:
    • Elmiron
    • Antihistamines
    • Tricyclic antidepressants
    • Medications to treat neuropathic pain
    • Analgesics
    • Non-steroidal anti-inflammatory medications (NSAIDs)
    • Antispasmodics or urinary anesthetics
    • Anticholinergics/OAB drugs
    • Urinary alkalinizing agents
    • Muscle relaxants

 

  • Intravesical therapy (bladder instillations) – Medications introduced directly into the bladder—these medications can be utilized as a bladder “cocktail” in combination with one another
    • DMSO (dimethyl sulfoxide), Rimso-50
    • Heparin
    • Lidocaine (short acting anesthetic) and/or Marcaine (long acting anesthetic)
    • Sodium bicarbonate
    • Steroids
    • Antibiotics

 

  • Surgical options:
    • Hydrodistention