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Interstitial cystitis (IC), or painful bladder syndrome (PBS), is a chronic bladder condition (long-term bladder pain) characterized by inflammation. It causes discomfort and pressure in the bladder region. It also causes urinary tract symptoms that last for 6+ weeks.
Even though there is no actual infection present, it may feel like an infection, but remember, it is not one.
Interstitial cystitis is often diagnosed through the exclusion of other conditions that could cause similar symptoms, which can result in a delay in diagnosis. It can be a frustrating and debilitating condition, but early diagnosis and proper management can help improve quality of life.
Causes of Interstitial Cystitis
1. Urothelial dysfunction
This theory suggests that damage to the bladder’s lining (urothelium), specifically the glycosaminoglycan (GAG) layer, can lead to increased permeability and irritation, resulting in the symptoms of IC.
2. Mast cell dysfunction
Mast cells are immune cells that play a role in inflammation and allergy. In interstitial cystitis, it is thought that mast cells in the bladder wall may become overactive, releasing histamine and other inflammatory molecules, which can contribute to bladder inflammation and pain.
3. Vascular malformations
Bladder wall biopsies in some patients with interstitial cystitis have revealed glomerulations, or pinpoint bleeding sites on the bladder wall, which suggest that there may be blood vessel abnormalities in the bladder.
4. Neurogenic inflammation/edema
The bladder has a complex network of nerve fibers that regulate its function. In interstitial cystitis, it is thought that nerve damage or dysfunction can lead to increased sensitivity to pain and inflammation in the bladder.
5. Autoimmune or immune-mediated process
Some researchers believe that interstitial cystitis may be an autoimmune condition, where the immune system attacks healthy tissue in the bladder, leading to inflammation and damage.
6. Increase in sensory afferent fibers
There may be an increase in the number of sensory nerve fibers in the bladder wall, which can lead to increased sensitivity to pain and other sensations.
In some patients, there may be an increase in the amount of fibrous tissue in the bladder wall, which can contribute to bladder dysfunction and pain.
8. Increase in gray matter volume
Some imaging studies have suggested that there may be an increase in the volume of gray matter in the brains of patients with IC, which may be related to increased sensitivity to pain.
Symptoms of Interstitial Cystitis
Interstitial cystitis is a chronic condition that is not accompanied by any symptoms in the beginning, but with time, as the bladder wall is damaged, the patient experiences bladder or suprapubic region pain along with urinary symptoms such as frequent urination (as much as 60 times a day), nocturia, and urgency.
Some professionals explain that interstitial cystitis symptoms may worsen in those who are ovulating, menstruating, dealing with stress, or suffering from allergies.
The pain associated with interstitial cystitis may range from mild discomfort to severe, debilitating pain and can be intermittent or constant. There may be other symptoms that come with IC, such as pain during sexual intercourse for women and pain after ejaculation for men. (4)(2)
Treatment for Interstitial Cystitis
Interstitial cystitis is a medical condition that causes bladder pain and discomfort. When lifestyle changes do not work, your doctor may suggest prescription drugs.
There are two types of drugs used for IC treatment – oral and intravesical drugs (drugs that are positioned straight into the bladder). The most commonly used drug is pentosan.
Dimethyl sulfoxide (DMSO) is another drug that can be placed into the bladder through a catheter, and it can help block swelling and decrease pain sensation. Hydroxyzine is an antihistamine that can help relieve symptoms of interstitial cystitis.
Amitriptyline is an antidepressant that can also improve IC/BPS. Heparin is similar to pentosan and is placed into the bladder with a catheter. Surgery is the last resort for patients with intolerable pain that doesn’t improve with other treatments. (5)
Testing for Interstitial Cystitis
Before a diagnosis of interstitial cystitis is established, other potential conditions that could cause similar symptoms must be ruled out.
A thorough workup is necessary, which may involve multiple specialists, including urologists, gynecologists, and pain management specialists.
The investigations that may be carried out as part of the workup for interstitial cystitis can include:
- Blood tests: Blood tests may be performed to check for underlying conditions that could be causing symptoms, such as diabetes.
- Diabetic tests: Testing for diabetes may include checking blood glucose levels and measuring hemoglobin A1c (HbA1c), a measure of blood sugar control over time.
- Urinalysis: A urine sample may be tested using a dipstick to check for the presence of blood, bacteria, or other abnormalities. Microscopy and culture and sensitivity testing may also be performed to detect infections.
- Sexual health screening: Depending on the patient’s sexual history and symptoms, screening for sexually transmitted infections (STIs) such as chlamydia or herpes may be performed.
- Urodynamic studies: Urodynamic studies are tests that measure the function of the urinary system, including the bladder and urethra. These tests can help identify abnormalities in bladder function and rule out other conditions that can cause similar symptoms.
- Cystoscopy: Cystoscopy is a procedure that involves using a thin tube with a camera to examine the inside of the bladder. This can help identify any abnormalities in the bladder lining, such as inflammation or ulcers.
Once other conditions have been ruled out, a diagnosis of interstitial cystitis may be established based on the patient’s symptoms, medical history, and physical examination.
However, because there is no definitive test for interstitial cystitis, arriving at a diagnosis can be challenging, and it may take time to find the most appropriate management strategy for each individual patient. (1)
Complications of Interstitial Cystitis
Interstitial cystitis is a chronic condition that can have a significant impact on a person’s quality of life. Some of the complications associated with interstitial cystitis include:
- Urinary tract infections
- Sexual dysfunction: The pain and discomfort associated with interstitial cystitis can also lead to sexual dysfunction, including pain during intercourse or decreased sexual desire.
- Emotional and psychological distress
- Sleep disturbances
- Reduced quality of life: The combination of pain, urinary dysfunction, and emotional distress can significantly impact a person’s quality of life, making it difficult to work, socialize, or enjoy leisure activities.
- Bladder damage: In some cases, the chronic inflammation associated with IC can lead to bladder damage, including scarring and reduced bladder capacity.
It’s important to note that not everyone with IC will experience all of these complications, and the severity of symptoms can vary from person to person.
However, seeking timely diagnosis and appropriate management can help minimize the risk of complications and improve quality of life. (1)
When to See a Doctor
If you are experiencing symptoms of IC/PBS, it is important to see a doctor to receive a proper diagnosis and appropriate treatment.
Here are some specific signs that indicate it’s time to see a doctor:
- Urinary symptoms: Frequent, urgent, or painful urination and blood in the urine are common symptoms of IC/PBS.
- Pain or discomfort: Pain or discomfort in the bladder, pelvic area, or urethra is also a common symptom of IC/PBS.
- Impact on daily life: If your symptoms are affecting your daily life, such as interfering with work or social activities, you should see a doctor.
- Family history: If you have a family history of IC/PBS, you may be at increased risk for the condition and should discuss your concerns with a doctor.
It’s important to seek medical attention if you suspect that you may have IC/PBS, as early diagnosis and treatment can help manage the symptoms and improve quality of life. (4)
Interstitial cystitis (IC) is a chronic bladder condition characterized by frequent urination and bladder pain and pressure. It is often diagnosed through the exclusion of other conditions and can be difficult to treat.
Some common treatments include medication, dietary changes, physical therapy, and nerve stimulation. However, the effectiveness of these treatments can vary from person to person.
Support groups and counseling can also be helpful in managing the emotional and psychological impacts of interstitial cystitis.