Interstitial cystitis

Description

Interstitial cystitis (in-tur-STISH-ul sis-TIE-tis) is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe pain. The condition is a part of a spectrum of diseases known as painful bladder syndrome.

The bladder is a hollow, muscular organ that stores urine. The bladder expands until it was full and then signals your brain that it is time to urinate, communicating through the pelvic nerves. This creates the need to urinate for most people.

With interstitial cystitis, these signals get mixed together until they feel the need to urinate more often and with smaller volumes of urine than most people.

Interstitial cystitis most often affects women and can have a lasting impact on the quality of life. Although there is no cure, medications and other therapies may offer relief.

Symptoms

The signs and symptoms of interstitial cystitis vary from person to person. If you have interstitial cystitis, your symptoms may also vary over time, periodically flaring in response to common triggers, such as menstruation, sitting for a long time, stress, exercise and sexual activity.

Interstitial cystitis signs and symptoms include:

  • Pain in the pelvis or between the vagina and anus in women
  • Pain between the scrotum and the anus (the perineum) in men
  • Chronic pelvic pain
  • A persistent, urgent need to urinate
  • Frequent urination, often of small amounts, throughout the day and night (up to 60 times a day)
  • Pain or discomfort while the bladder fills and relief after urinating
  • Pain during sex

Severity of symptoms is different for everyone, and some people can experience symptom-free periods.

Although the signs and symptoms of interstitial cystitis may resemble those of a chronic urinary tract infection, there is usually no infection. However, the symptoms may get worse if the person with interstitial cystitis is a urinary tract infection.

When to see a doctor

If you are experiencing chronic bladder pain or urinary urgency and frequency, contact your health care provider.

Causes

The exact cause of interstitial cystitis is not known, but it is very likely that many factors contribute. For example, people with interstitial cystitis may also have a defect in the protective lining (epithelium) of the bladder. A leak in the epithelium may allow toxic substances in the urine to irritate the bladder wall.

Other possible but not proven factors that contribute include an autoimmune reaction, heredity, infection, or allergy.

Risk factors

These factors are associated with an increased risk of interstitial cystitis:

  • Your sex. Women are diagnosed with interstitial cystitis more often than men. Symptoms in men can mimic the symptoms of interstitial cystitis, but are more often associated with inflammation of the prostate gland (prostatitis).
  • Of his age. Most people with interstitial cystitis are diagnosed during their 30 years of age or older.
  • Having a chronic pain disorder. Interstitial cystitis may be associated with other chronic pain disorder, such as irritable bowel syndrome or fibromyalgia.

Complications

Interstitial cystitis can result in a number of complications, including:

  • Reduction of the capacity of the bladder. Interstitial cystitis can cause stiffness of the wall of the bladder, allowing the bladder to hold less urine.
  • Lower quality of life. Frequent need to urinate and pain can interfere with social activities, work and other activities of daily living.
  • The Sexual intimacy of the problems. Frequent need to urinate and pain can strain personal relationships and sexual intimacy can suffer.
  • Emotional problems. The chronic pain and sleep disruption associated with interstitial cystitis can cause emotional stress and can lead to depression.

Interstitial cystitis

Diagnosis

The diagnosis of interstitial cystitis may include:

  • The clinical history and the bladder diary. Your doctor may ask you to describe your symptoms and keep a journal of the bladder, and recording the volume of fluids you drink and the volume of urine.
  • Pelvic exam. During a pelvic exam, the doctor will examine the external genitalia, the vagina, and the cervix of the uterus and feel the abdomen to determine their internal organs of the pelvis. Your doctor may also examine the anus and rectum.
  • Urine test. A sample of your urine is analyzed for signs of a urinary tract infection.
  • The cystoscopy. Your doctor inserts a thin tube with a small camera (cystoscope) through the urethra, showing the lining of the bladder. Your provider may also inject fluid into the bladder to measure the ability of the bladder. Your doctor may perform this procedure, known as a procedure, after having been injected with a numbing medicine so that you feel more comfortable.
  • The biopsy. During cystoscopy under anesthesia, the doctor may remove a sample of tissue (biopsy) of the bladder and the urethra to examine under a microscope. This is to detect bladder cancer and other rare causes of pain in the bladder.
  • Cytology of the urine . Your provider collects a urine sample, and examine the cells to help rule out cancer.
  • Potassium sensitivity test. Your provider places (inspire) two solutions of water and chloride of potassium in your bladder, one at a time. You are asked to rate on a scale of 0 to 5, the pain and the urgency that you feel after each solution is implemented. If you feel significantly more pain or urgency with the potassium in the solution with the water, your healthcare provider can diagnose interstitial cystitis. The people with typical bladders can't tell the difference between the two solutions.

Treatment

There is not a single treatment that removes the signs and symptoms of interstitial cystitis, and there is not a treatment that works for everyone. You may need to try various treatments or combinations of treatments, before finding a method that relieves their symptoms.

Physical therapy

Working with a physical therapist can relieve the pelvic pain associated with muscle pain, restrictive connective tissue or muscle alterations in the floor of the pelvis.

Oral medications

Certain medications that you take by mouth (oral medication) can improve the signs and symptoms of interstitial cystitis:

  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), to relieve the pain.
  • Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax the bladder and block the pain.
  • Antihistamines, such as loratadine (Claritin, and others), which can reduce the frequency and urgency and relieve other symptoms.
  • Pentosan polysulfate sodium (Elmiron),which is approved by the Food and Drug Administration specifically for the treatment of interstitial cystitis. How it works is unknown, but you can restore the internal surface of the bladder, which protects the bladder wall from substances in the urine that could irritate it. It can take two to four months before you begin to feel relief from the pain and up to six months to experience a decrease in urinary frequency. Macular eye disease has been associated with the use of this drug in some people. Before you start this treatment, you may need a comprehensive eye exam. You may also need additional eye exams to monitor diseases of the eyes as you continue the therapy.

Pentosan polysulfate sodium (Elmiron), which is approved by the Food and Drug Administration specifically for the treatment of interstitial cystitis. How it works is unknown, but you can restore the internal surface of the bladder, which protects the bladder wall from substances in the urine that could irritate it. It can take two to four months before you begin to feel relief from the pain and up to six months to experience a decrease in urinary frequency.

Macular eye disease has been associated with the use of this drug in some people. Before you start this treatment, you may need a comprehensive eye exam. You may also need additional eye exams to monitor diseases of the eyes as you continue the therapy.

Nerve stimulation

Nerve stimulation techniques include:

  • Transcutaneous electrical nerve stimulation (TENS).With TENS, mild electrical impulses to relieve pelvic pain and, in some cases, to reduce the frequency of urination. TENS may increase blood flow to the bladder. This can strengthen the muscles that help control the bladder or trigger the release of chemicals that block pain. Electric Cables placed in the lower part of the back or just above the pubic area to deliver electrical impulses — the length of time and frequency of the therapy depends on what works best for you.
  • Sacral nerve stimulation.Your sacral nerves are a main link between the spinal cord and the nerves of the bladder. Stimulation of these nerves can reduce urinary urgency associated with interstitial cystitis. With the stimulation of the sacral nerve, a thin wire is placed near the sacral nerves send electrical impulses to the bladder, similar to a pacemaker for the heart. If the procedure decreases the symptoms may be permanent of a surgically implanted device. This procedure does not handle the pain of interstitial cystitis, but it can help to relieve some of the symptoms of urinary frequency and urgency.

Transcutaneous electrical nerve stimulation (TENS). With TENS, mild electrical impulses to relieve pelvic pain and, in some cases, to reduce the frequency of urination. TENS may increase blood flow to the bladder. This can strengthen the muscles that help control the bladder or trigger the release of chemicals that block pain.

Electric Cables placed in the lower part of the back or just above the pubic area to deliver electrical impulses — the length of time and frequency of the therapy depends on what works best for you.

Sacral nerve stimulation. Your sacral nerves are a main link between the spinal cord and the nerves of the bladder. Stimulation of these nerves can reduce urinary urgency associated with interstitial cystitis.

With the stimulation of the sacral nerve, a thin wire is placed near the sacral nerves send electrical impulses to the bladder, similar to a pacemaker for the heart. If the procedure decreases the symptoms may be permanent of a surgically implanted device. This procedure does not handle the pain of interstitial cystitis, but it can help to relieve some of the symptoms of urinary frequency and urgency.

Distension of the bladder

Some people notice a temporary improvement in symptoms after the cystoscopy with bladder distention. Distension of the bladder, is the stretching of the bladder with water. If you have the long-term improvement, the procedure can be repeated.

Botulinum toxin (Botox) can be injected into the wall of the bladder during bladder distension. But, this treatment option can lead to not being able to empty the bladder completely when you urinate. You may need to self-catheterize — be able to insert a tube in his own bladder to drain the urine after this treatment.

Drugs introduced into the bladder

In the instillation of the bladder, your provider places of the prescription medication of dimethyl sulfoxide (Rimso-50) in the bladder through a thin, flexible tube (catheter) that is inserted through the urethra.

Sometimes the solution is mixed with other drugs, such as a local anesthetic, and remains in the bladder for about 15 minutes. Urination to expel the solution.

You could receive dimethyl sulfoxide — also called DMSO — treatment weekly for six to eight weeks, and then have maintenance treatments as needed — just like every couple of weeks, up to a year.

Another approach to the instillation of the bladder using a solution that contains the drugs lidocaine, sodium bicarbonate, and any of pentosan or heparin.

Surgery

Doctors rarely is surgery used for the treatment of interstitial cystitis due to removal of the bladder does not relieve the pain and can lead to other complications.

People with severe pain or those whose bladders can have only very small volumes of urine are potential candidates for surgery, but usually only after other treatments fail and your symptoms affect the quality of life. Surgical options include:

  • Fulguration . This minimally invasive method consists in the insertion of instruments through the urethra to burn ulcers that may be present with interstitial cystitis.
  • The resection. This is another minimally invasive method that involves the insertion of instruments through the urethra to cut around any of the ulcers.
  • Bladder augmentation. In this procedure, a surgeon increases the capacity of the bladder by the application of a patch of bowel into the bladder. However, this is done only in very specific and rare cases. The procedure does not eliminate the pain and some people need to empty the bladder with a catheter several times a day.

Self-care

Some people with interstitial cystitis find the relief of the symptoms of these strategies:

  • Changes in the diet.The elimination or reduction of the foods in your diet that irritate the bladder may help to relieve the discomfort of interstitial cystitis. Common bladder irritants known as the "four Cs" — includes: soft drinks, caffeine in all its forms (like chocolate), citrus products and foods that contain high concentrations of vitamin C. Consider the possibility of avoiding similar foods, such as tomatoes, pickles, alcohol, and spices. Artificial sweeteners may aggravate symptoms in some people. If you think that certain foods can irritate the bladder, try eliminating it from your diet. Reintroduce them one at a time, and pay attention to that, in your case, to make the symptoms worse.
  • The training of the bladder.Bladder training consists of timed voiding — go to the bathroom, according to the clock rather than waiting for the need to go. She starts off by urinating at certain time intervals, for example every half hour, if you have to go or not. Then gradually wait longer between visits to the bathroom. During the training of the bladder, you can learn to control urinary urges through the use of relaxation techniques, such as breathing slowly and deeply, or distracting yourself with another activity.

Changes in the diet. The elimination or reduction of the foods in your diet that irritate the bladder may help to relieve the discomfort of interstitial cystitis.

Common bladder irritants known as the "four Cs" — includes: soft drinks, caffeine in all its forms (like chocolate), citrus products and foods that contain high concentrations of vitamin C. Consider the possibility of avoiding similar foods, such as tomatoes, pickles, alcohol, and spices. Artificial sweeteners may aggravate symptoms in some people.

If you think that certain foods can irritate the bladder, try eliminating it from your diet. Reintroduce them one at a time, and pay attention to that, in your case, to make the symptoms worse.

The training of the bladder. Bladder training consists of timed voiding — go to the bathroom, according to the clock rather than waiting for the need to go. She starts off by urinating at certain time intervals, for example every half hour, if you have to go or not. Then gradually wait longer between visits to the bathroom.

During the training of the bladder, you can learn to control urinary urges through the use of relaxation techniques, such as breathing slowly and deeply, or distracting yourself with another activity.

These self-care steps may also help:

  • Wear loose-fitting clothing. Avoid belts or clothes that put pressure on your abdomen.
  • Reduce stress. Try methods such as visualization, and biofeedback.
  • If you smoke, stop. Smoking may worsen any painful condition, and the habit of smoking contributes to bladder cancer.
  • Exercise. Easy stretching exercises can help reduce the symptoms of interstitial cystitis.

Alternative medicine

Two complementary and alternative therapies show promise in the treatment of interstitial cystitis:

  • Guided imagery. This type of therapy is used for the direct visualization and suggestions for use of visualization to help imagine the healing, with the hope that the body follows the mind suggestions.
  • Acupuncture. During an acupuncture session, a practitioner of numerous places of thin needles into the skin at specific points on the body. According to traditional Chinese medicine, precisely placed acupuncture needles to relieve pain and other symptoms by rebalancing the flow of the vital energy. Western physicians tend to believe that acupuncture stimulates the activity of the body's natural painkillers.

These treatments have not been well studied for interstitial cystitis, so make sure to discuss the use of these therapies with your healthcare provider.

Coping and support

Interstitial cystitis can affect your quality of life. The support of family and friends is important, but because the disease is a urinary problem, you can find the topic difficult to discuss.

Seek the support of a health care provider who is concerned about their quality of life as well as your condition. Find someone who will work with you to help alleviate your urinary frequency, urgency, and bladder pain.

You could also benefit from joining a support group. A support group can provide a sympathetic hearing and useful information. Ask your service provider to obtain information about support groups or see the Interstitial Cystitis Association on the web.

Preparing for your appointment

You may be asked to keep a journal of the bladder for a couple of days to record the information, such as the frequency of urination and how much and what types of liquids you drink.

For more tests, you may be referred to a specialist in urinary disorders (urologist) or urinary disorders in women (urogynecologist).

What you can do

To get the most out of your visit to your health care provider prepare in advance:

  • Write down any symptoms you are experiencing. Include all the symptoms, even if you don't think that is related.
  • Make a list of all the medications, vitamins, or other supplements that you take . Many over-the-counter supplements can irritate the urinary tract. Also keep in mind the dosage and how often you should take your medication or supplements.
  • Have a family member or a close friend to go with you. You can give a lot of information in your visit, and it can be difficult to remember everything.
  • Take a notepad or electronic device with you. The use is to note important information during your visit.
  • Prepare a list of questions to ask. The list of your most important questions first, in case time runs out.

For interstitial cystitis, some basic questions to ask include:

  • Is that my symptoms eventually go away?
  • What kinds of tests might I need?
  • Going to change my diet to help with my symptoms?
  • Could the medications that I take to be aggravating my condition?
  • There are medications that help relieve my symptoms?
  • I'm going to need surgery?

Make sure that you understand what your doctor tells you to. Do not hesitate to ask your provider to repeat information or to ask questions of clarification.

What to expect from your provider

Be prepared to answer the questions of your provider, such as:

  • How often you feel the urge to urinate with little or no warning?
  • Do you feel the need to urinate immediately after you have urinated?
  • Have you ever urinating less than two hours after you finished urinating?
  • Do you wake up in the night to urinate?
  • Do you have burning or pain in the bladder?
  • Do you feel pain in the abdomen or in the pelvis?
  • She is currently sexually active?
  • How much of their symptoms, bother you?
Symptoms and treatment of Interstitial cystitis