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Interstitial cystitis

Interstitial cystitis is a long-term (chronic) problem in which pain, pressure, or burning is present in the bladder. It is also called painful bladder syndrome.

Alternative Names

Cystitis - interstitial; IC

Causes, incidence, and risk factors

The bladder is a hollow organ with a thin layer of muscle that stores urine. When your bladder fills up with urine, it sends a signal to your brain, telling the muscles to squeeze. In most people, these signals are not sent until your bladder is almost full. If you have interstitial cystitis, the signal to empty your bladder is sent more often or when your bladder is not very full.

The condition most often occurs between ages 30 to 40, although it has been reported in younger people.

Women are 10 times more likely to have IC than men.

The exact cause of this condition is unknown.

Symptoms

Symptoms of IC are chronic. They have a tendency to come and go with periods of lesser or worse severity. Common symptoms include:

  • Bladder pressure or discomfort (mild or severe)
  • Urge to urinate often
  • Burning pain in the pelvic area
  • Pain during intercourse

Many people who have long-term interstitial cystitis are also depressed because of the pain and changes to their lifestyle.

Signs and tests

Your doctor will look for other causes of your symptoms. These include:

  • Sexually transmitted infections
  • Bladder cancer
  • Bladder infections

Tests are performed on your urine look for infection or cells that suggest cancer inside the bladder. During a cystoscopy, the doctor uses a special tube with a small camera on the end to look inside your bladder. A sample or biopsy of the lining of your bladder may be taken.

Tests at your doctor's office may also be done to show how much urine must be in the bladder before you feel the need to urinate.

Treatment

There is no cure for IC, and there are no standard treatments. Treatment is based on trial and error until you find relief. Results vary from person to person.

DIET AND LIFESTYLE CHANGES

Some patients find that making changes in their diet can help control symptoms. Try to avoid foods and beverages that can cause bladder irritation. Stop eating certain foods, one at a time, to see if your symptoms get better. Reduce or stop consuming caffeine, chocolate, carbonated beverages, citrus drinks, and foods with high levels of vitamin C.

Other foods that the Interstitial Cystitis Association lists as possibly causing bladder irritation are:

  • Aged cheeses
  • Alcohol
  • Artificial sweeteners
  • Fava and lima beans
  • Meats that are cured, processed, smoked, canned, aged, or that contain nitrites
  • Most fruits except blueberries, honeydew melon, and pears
  • Nuts except almonds, cashews, and pine nuts
  • Onions
  • Rye bread
  • Seasonings that contain MSG
  • Sour cream
  • Sourdough bread
  • Soy
  • Tea
  • Tofu
  • Tomatoes
  • Yogurt

You and your doctor should discuss methods you can use for bladder training, such as training yourself to urinate at specific times or using biofeedback to relieve pelvic floor muscle spasms.

MEDICINE AND PROCEDURES

Combination therapy may include medicines such as:

  • Pentosan polysulfate sodium, the only medication taken by mouth that is approved for treating IC
  • Tricyclic antidepressants such as amitriptyline to relieve pain and urinary frequency
  • Vistaril (hydroxyzine pamoate), an antihistamine that causes sedation and helps reduce urinary frequency

Other therapies include:

  • Over-filling the bladder with fluid while under general anesthesia , called bladder hydrodistention
  • Medicines placed directly into the bladder, including dimethyl sulfoxide (DMS), heparin, or lidocaine
  • Bladder removal (cystectomy) for extremely difficult cases

Support Groups

Some people may benefit from taking part in interstitial cystitis support groups .

Expectations (prognosis)

Treatment results vary. Some people respond well to simple treatments and dietary changes. Others may require extensive treatments or surgery.

Calling your health care provider

Call your health care provider if you have symptoms of interstitial cystitis. Be sure to mention that you suspect this disorder. It is not well recognized or easily diagnosed.

References

Hanno PM. Painful bladder syndrome/interstitial cystitis and related disorders. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Saunders Elsevier;2011:chap 12.

Lentz GM. Urogynecology: Physiology of micturition, voiding dysfunction, urinary incontinence, urinary tract infections, and painful bladder syndrome. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 21.

Cody JD, Nabi G, Dublin N, McClinton S, Neal DE, Pickard R, Yong SM. Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy. Cochrane Database Syst Rev. 2012;2:CD003306. DOI: 10.1002/14651858.CD003306.pub2.

French LM, Bhambore N. Interstitial cystitis/painful bladder syndrome. Am Fam Physician. 2011;83(10):1175-1181.

Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. The Journal of Urology. 2011;185:2162-2170.

Updated: 5/22/2013

Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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