The chronic condition of interstitial cystitis (IC) causes bladder pain, urgency, and frequency. It affects more women than men, and it can interfere with daily activities. In addition to a defect in the bladder lining, an abnormal immune response, or a genetic predisposition, IC may have an unknown cause. Although there is no cure for IC, treatments can help manage its symptoms.
A bladder is a muscular organ that stores urine until it is time for it to be released. The bladder lining, or epithelium, protects the bladder from urine's substances. People with IC may have damaged or leaky epitheliums, causing urine to irritate the bladder wall and cause inflammation. As a result, the bladder may become overactive, sensitive, and painful due to this inflammation.
The reason why the epithelium becomes defective is not clear, but some possible factors include:
Infection or injury to the bladder
Autoimmune reaction, where the body’s immune system attacks its own tissues
Genetic factors, where some people inherit a tendency to develop IC
Hormonal changes, such as those during menstruation, pregnancy, or menopause
Stress or trauma, which may affect the nervous system and the bladder
The symptoms of IC vary from person to person, and they may change over time. Some common symptoms include:
Bladder pain or pressure, which may worsen as the bladder fills up or during urination
Urinary urgency, which is the strong and sudden need to urinate
Urinary frequency, which is the need to urinate more often than normal, sometimes up to 60 times a day
Nocturia, which is the need to urinate at night, disrupting sleep
Dysuria, which is pain or burning during urination
Hematuria, which is blood in the urine
Dyspareunia, which is pain during sexual intercourse
Some people with IC may also experience other symptoms, such as:
Pelvic pain or discomfort
Lower back pain or discomfort
Fatigue or tiredness
Depression or anxiety
Reduced quality of life
Diagnoses for IC are usually made based on symptoms, medical history, and physical examination, since there are no definitive tests. In order to rule out other conditions that may cause similar symptoms, such as bladder cancer, kidney stones, or endometriosis, some tests may be performed, including:
Urinalysis, which is the analysis of urine for signs of infection, blood, or other abnormalities
Urine culture, which is the growth of urine in a laboratory to identify any bacteria or fungi
Cystoscopy, which is the insertion of a thin tube with a camera and light into the bladder through the urethra to examine the bladder wall and take tissue samples if needed
Urodynamics, which are tests that measure the pressure, flow, and volume of urine in the bladder and the urethra
Potassium sensitivity test, which is the instillation of a potassium solution into the bladder to see if it causes pain or urgency, indicating a leaky epithelium
IC is treated by relieving symptoms and improving bladder function. Treatment varies based on severity of symptoms, response to previous treatments, and the patient's preferences.
Medications, such as:
Pentosan polysulfate sodium, which is a drug that may help repair the epithelium and reduce inflammation
Amitriptyline, which is an antidepressant that may help relax the bladder and block pain
Hydroxyzine, which is an antihistamine that may help reduce inflammation and allergy-like reactions
Ibuprofen, which is a nonsteroidal anti-inflammatory drug that may help reduce pain and inflammation
Bladder instillations, which are the insertion of a liquid solution into the bladder through a catheter to coat and soothe the bladder wall. The solution may contain different ingredients, such as:
Dimethyl sulfoxide (DMSO), which is a solvent that may have anti-inflammatory and analgesic effects
Heparin, which is a blood thinner that may help restore the epithelium and prevent scarring
Lidocaine, which is a local anesthetic that may help numb the bladder and reduce pain
Bladder distension, which is the stretching of the bladder with water or gas under anesthesia to increase the bladder capacity and reduce the frequency and urgency of urination
Bladder training, which is a behavioral therapy that involves following a schedule of urination and gradually increasing the time between urinations to improve the bladder control and reduce the urgency
Physical therapy, which is a therapy that involves exercises and massage to relax the pelvic floor muscles and reduce the pain and spasms
Neuromodulation, which is a therapy that involves stimulating the nerves that control the bladder with electrical impulses to improve the bladder function and reduce the pain
Surgery, which is a last resort option that involves removing part or all of the bladder or creating a new bladder from a piece of intestine. Surgery may have serious risks and complications, and it may not cure the symptoms of IC.
There is no known way to prevent IC, but some lifestyle changes may help reduce the symptoms and improve the quality of life. These include:
Avoiding or limiting foods and drinks that may irritate the bladder, such as spicy, acidic, or caffeinated foods and drinks
Drinking enough water to stay hydrated and dilute the urine
Quitting smoking, as smoking may worsen the bladder inflammation and increase the risk of bladder cancer
Managing stress, as stress may trigger or worsen the symptoms of IC
Practicing good hygiene, as hygiene may prevent infections that may aggravate the bladder
Seeking support, as support from family, friends, or professionals may help cope with the emotional and social impact of IC
Interstitial cystitis is a chronic and painful condition that affects the bladder and the quality of life. There is no cure for IC, but treatments can help manage the symptoms and improve the bladder function.
