Cystitis - interstitial

Definition

Interstitial cystitis is chronic (long-term) inflammation of the bladder wall.

Alternative Names

Cystitis - interstitial; IC

Causes

Interstitial cystitis (IC) is a painful condition caused by inflammation of the tissues of the bladder wall. The cause is unknown. The condition is usually diagnosed by ruling out other conditions (such as sexually transmitted disease, bladder cancer, and bladder infections).

IC is frequently misdiagnosed as a urinary tract infection, and patients often go years without a correct diagnosis. On average, there is about a 4-year delay between the time the first symptoms occur and the diagnosis is made.

More than 700,000 Americans have IC. The condition generally occurs around age 30 to 40, although it has been reported in younger people. Women are 10 times more likely to have IC than men.

Symptoms

• Urinary frequency (up to 60 times a day in severe cases)
• Urinary urgency
• Urinary discomfort
• Pain during intercourse
• Pelvic pain

Exams and Tests

Diagnosis is made by ruling out other causes. Urine analysis, urine culture, and urine cytology tests are essential.

Usually, cystoscopy (endoscopy of bladder) and bladder biopsy are performed. The characteristic finding of interstitial cystitis during cystoscopy is pinpoint bleeding in the lining of the bladder or ulcers on the bladder wall. 

In IC, the bladder does not hold as much urine as a normal bladder typically does.

A procedure called video urodynamics can reveal how much urine needs to be in the bladder before the patient feels the need to urinate.

Treatment

There is no cure for IC, nor are there any standard or consistently effective treatments. Results vary from individual to individual. As long as the cause is unknown, treatment is based on trial and error until relief is found.

Elmiron is the only medication taken by mouth that is specifically approved for the treatment of IC. This medicine coats the bladder like Pepto-Bismol coats the stomach.

Other medicines may include:

• Tricyclic antidepressants such as Elavil (amitriptyline) may relieve pain and urinary frequency
• Vistaril (hydroxyzine pamoate), an antihistamine that causes sedation helps reduce urinary frequency
• Opioid painkillers for severe pain

Other therapies include:

• Instilled medications - medicines are placed directly into the bladder. Medicines that are given this way include dimethyl sulfoxide (DMS), heparin, Clorpactin, lidocaine, doxorubicin, or bacillus Calmette-Guerin (BCG) vaccine.
• Surgery, ranging from cystoscopic manipulation to bladder removal (cystectomy)
• Bladder hydrodistention (filling bladder with fluid)
• Bladder training (using relaxation techniques to train the bladder to go only at specific times)
• Physical therapy and biofeedback (may help relieve pelvic floor muscle spasms)

Diet modification

Some patients find that changes in their diet can help control symptoms. The idea is to avoid foods and beverages that can cause bladder irritation. Below are some of the foods that the Interstitial Cystitis Association says may cause bladder irritation.

• Aged cheeses
• Sour Cream
• Yogurt
• Chocolate
• Onions
• Tofu
• Soy
• Fava and lima beans
• Tomatoes
• Most fruits except blueberries, honeydew melon, and pears
• Rye bread
• Sourdough bread
• Meats that are cured, processed, smoked, canned, aged, or that contain nitrites
• Nuts except almonds, cashews, and pine nuts
• Alcohol
• Citrus juices
• Coffee
• Tea
• Cranberry juice (Note: Although cranberry juice is often recommended for urinary tract infections, it can make IC symptoms worse)
• Seasonings that contain MSG
• Artificial sweeteners

Experts suggest that you do not stop eating all these foods at one time. Instead, try eliminating one at a time to see if that helps relieve symptoms.

Support Groups

For additional information and support, see interstitial cystitis support groups.

Outlook (Prognosis)

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

Possible Complications

• Chronic (long-term) pain that may cause a change in lifestyle
• Emotional trauma
• High costs associated with frequent medical visits
• Chronic depression
• Side effects of treatments (depending on the treatment)

When to Contact a Medical Professional

Call your health care provider if you have symptoms suggestive of interstitial cystitis. Be sure to mention that you suspect this disorder. It is not well-recognized nor is it easily diagnosed.

Nickel JC. Interstitial cystitis: a chronic pelvic pain syndrome. Med Clin North Am. 2004; 88(2): 467-81, xii.

Mattox TF. Interstitial cystitis in adolescents and children: a review.  J Pediatr Adolesc Gynecol. 2004; 17(1): 7-11.

Metts JF. Interstitial Cystitis: Urgency and Frequency Syndrome. Am Fam Physician. 2001 Oct 1;64(7):1199-206.

Walsh PC. Campbell's Urology. 8th ed. St. Louis, Mo: WB Saunders; 2002:631-660.