Interstitial cystitis

Interstitial cystitis (IC) is a long-term (chronic) problem in which pain, pressure, or burning is present in the bladder. It is often associated with urinary frequency or urgency. It is also called painful bladder syndrome.

Causes

The bladder is a hollow organ that stores urine. It has a thin layer of muscle inside it. When your bladder fills up with urine, it sends a signal to your brain, telling the muscles to squeeze. Under normal conditions, these signals are not painful. If you have interstitial cystitis, the signals from the bladder are painful and may occur even when the bladder is not full.

The condition most often occurs between ages 20 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. Symptoms tend to come and go with periods of lesser or worse severity. Common symptoms include:

• Bladder pressure or discomfort (mild to severe)
• Urge to urinate often

  Urge to urinate often

  Frequent urination means needing to urinate more often than usual. Urgent urination is a sudden, strong need to urinate. This causes a discomfort i...

  

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• Burning pain in the pelvic area
• Pain during intercourse

Many people who have long-term IC may also have other conditions such as endometriosis, fibromyalgia, irritable bowel syndrome, other chronic pain syndromes, anxiety, or depression.

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Exams and Tests

Your health care provider will look for other causes of your symptoms. These include:

• Sexually transmitted infections
• Bladder cancer

  Bladder cancer

  Bladder cancer is a cancer that starts in the bladder. The bladder is the body part that holds and releases urine. It is in the center of the lower...

  

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• Bladder infections
• Kidney or ureteral stones

  Kidney or ureteral stones

  A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.

  

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Tests are done on your urine to look for infection or cells that suggest cancer inside the bladder. During a cystoscopy, the provider 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 provider's office may also be done to show how well your bladder fills and how well it empties.

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 people 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 spicy or acidic foods (such as those 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
• Acidic fruits (except blueberries, honeydew melon, and pears, which are OK.)
• 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 provider should discuss methods you can use for bladder training. These may include training yourself to urinate at specific times or using pelvic floor physical therapy and biofeedback to relieve pelvic floor muscle tension and spasms.

MEDICINES AND PROCEDURES

Combination therapy may include medicines such as:

• Pentosan polysulfate sodium, the only medicine taken by mouth that is approved for treating IC
• Tricyclic antidepressants, such as amitriptyline, to relieve pain and urinary frequency
• Hydroxyzine (Vistaril), an antihistamine that can help reduce inflammation. It can cause sedation as a side effect

Other therapies include:

• Over-filling the bladder with fluid while under general anesthesia, called bladder hydrodistention

  General anesthesia

  General anesthesia is treatment with certain medicines that puts you into a deep sleep-like state so you do not feel pain during surgery. After you ...

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• Medicines placed directly into the bladder, including dimethyl sulfoxide (DMSO), heparin, or lidocaine
• Neuromodulation
• Bladder removal (cystectomy) for extremely difficult cases, which is rarely done

Support Groups

More information and support for people with interstitial cystitis and their families can be found at:

Interstitial Cystitis Association: www.ichelp.org/get-involved/join-the-ic-community/ and others.

Outlook (Prognosis)

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

When to Contact a Medical Professional

Contact your provider if you have symptoms of IC. Be sure to mention that you suspect this disorder. It is not always easily recognized or diagnosed. It is often confused with having repeated urinary tract infection.