Interstitial cystitis (IC) is a condition that causes both bladder pain or discomfort as well as the need to frequently pass urine. IC is most commonly diagnosed in women.
The condition is also known as painful bladder syndrome (PBS) when there is no abnormality in the bladder. Bladder Pain Syndrome is often used to encompass both IC and PBS.
What are the causes of interstitial cystitis?
The causes of IC are not fully understood. Bacterial and viral infections have been ruled out as a cause, and it is thought that it may be down to a defective bladder lining. In a normal bladder, the lining should protect the bladder wall from the toxic nature of the urine passing through it. It has been discovered that about 70% of people with IC have a leaky protective lining in their bladder which may allow the urine to aggravate the bladder wall. In severe cases, the inflammation of the bladder wall can cause it to scar and become stiff, which prevents it from expanding when urine enters. Some women can develop cracks in their bladder lining, ulcers or bleeding, which can be painful and lead to the need to urine frequently and urgently.
There is also a noticeable increase of histamine produced by the body due to the inflammation process and an increased number of nerve cells in the bladder wall. An autoimmune response may also cause IC to develop in some people, which is when the body produces antibodies that fight against another part of the body.
How can interstitial cystitis be treated?
As the causes of interstitial cystitis (IC) are not yet known, current treatments are aimed instead at relieving its symptoms. As more is discovered about IC, more potential treatments will emerge. In the meantime, the majority of sufferers are likely to feel better after trying one or more of the following treatments:
Diet
Alcohol, tomatoes, spices, chocolate, caffeine, citrus drinks, artificial sweeteners, acidic foods and tobacco can aggravate your bladder. Try removing these foods from your daily diet for a couple of weeks to a month. It is then worth reintroducing one food at a time to see if it makes your symptoms worse.
Bladder distension
This is when a doctor fills up your bladder with fluid, whilst you are under anaesthetic, to stretch the wall of your bladder. Although it is a common treatment for IC, with about one in three patients noticing a positive effect, doctors are unsure why it helps symptoms. It could be interfering with pain signals sent by nerves in the bladder. It is not, however, a full-proof treatment and some people even claim that their pain is worse after the procedure. We can offer this treatment.
Medications
- Amitriptyline or Gabapentin nerve medications can be used to block the pain and reduce bladder spasms. Due to the side effects of these medications, a lower dose is recommended with a gradual increase if needed.
- Oral antihistamines or H2 antagonists have also helped many patients with their bladder symptoms. These treatments normally work better if the cause of inflammation is allergy based.
- Pentosane polysulfate is another medication that can be used for the treatment of IC. This will help protect the lining of your bladder from the toxicity of your urine. Around 40% of patients claim to notice a positive improvement in their IC symptoms after taking this medication. This drug is, however, expensive and may not be readily available.
Bladder instillation
Bladder instillations can be given every week or two for one or two months. The doctor will insert a catheter into your bladder and then fill it up with liquid medicine that is meant to help the bladder wall. You are then expected to hold the liquid in your bladder for a few seconds up to 15 minutes and then it is drained. The treatment will be repeated as needed.
Further treatments of interstitial cystitis
While many of these treatments work for sufferers of IC, there is also a large number of people who do not react positively to them. There are currently some alternative treatments being assessed, such as a botulinum toxin bladder injection and sacral nerve stimulation. Many people need strong pain medication or referral to a multidisciplinary pain clinic. A small number of sufferers do not respond to any treatment at all and have to undergo surgery in order to get some relief. Surgery should only ever be considered as an option if all available treatments have failed and the pain is disabling.
