Interstitial cystitis (IC) is a chronic inflammation of the bladder wall. It can cause pain in the pelvic area and bladder, as well as an overactive bladder (urgent or frequent urination). It is often misdiagnosed as a urinary tract infection since, like a UTI, it irritates the bladder and has some of the same symptoms.
There is currently no cure for interstitial cystitis and the cause is unknown. However, there are a variety of treatments that can relieve the symptoms (e.g. pelvic pain, discomfort during sexual intercourse and urinary tract problems or functions). Symptoms can also disappear suddenly—such as after a change in diet, with treatment or for no reason—only to return weeks or months later. Treatment options vary depending on symptoms and patient response.
Oral Drugs for Interstitial Cystitis
Pentosan polysulfate sodium (Elmiron) is an FDA-approved medication shown to improve IC-related symptoms in about 30 percent of patients with the condition. Doctors are not certain how it works, but think the drug may offer a protective coating that helps repair damage in the bladder wall. PPS can take up to six months to work and has several side effects, including:
- Diarrhea and nausea
- Hair loss
- Abnormal liver function tests
- Mild blood thinning - PPS should not be used before surgery or taken in conjunction with anti-inflammatories (e.g. ibuprofen) or anticoagulants (e.g. heparin).
Pain medication can be used to relieve discomfort in the bladder and pelvic area. This includes over-the-counter drugs like aspirin and ibuprofen, as well as narcotic pain relievers.
Tricyclic antidepressants, such as amitriptyline, can relieve pain associated with interstitial cystitis. These drugs prevent the reabsorption of norepinephrine (a stress hormone) and serotonin (a neurotransmitter) so that the brain can block pain impulses. The medications may also relax the bladder, minimizing the intensity of bladder contractions and thereby lessening urination frequency. Side effects include drowsiness, sensitivity to sunlight, disorientation, increased heart rate, urinary retention and blurred vision.
Antihistamines, such as hydroxyzine pamoate, work by heading off the response that takes place during an allergic, inflammatory reaction. Calming the bladder's inflammation may reduce the frequency of urination, but these drugs can also cause physical exhaustion throughout the day.
Sedatives improve sleep, which can be disrupted by the urge to urinate at night or discomfort in the bladder.
Bladder Distention
Bladder distention is a procedure in which the bladder is filled to capacity with gas or liquid in order to look for damage in the bladder wall. The treatment is done under general anesthesia. Examining the bladder while it is stretched to capacity allows a physician to better see cracks or tears in the bladder lining.
In addition to a diagnostic tool, bladder distension can also provide some patients with relief from their symptoms. (This relief may be due to the fact that the procedure might allow the bladder to hold more urine before discomfort starts, or because it might throw off the pain signals in the nerves that run to the bladder.) Although bladder pain typically increases in the first 4 to 48 hours after treatment, these patients experience improvement within two to four weeks.
Bladder Wash or Bath (Instillation)
Washing the bladder for 10 to 15 minutes with a solution of dimethyl sulfoxide (DMSO), heparin, or lidocaine, may provide some relief. (The only solution that is currently FDA-approved for this procedure is DMSO). Instillation is done using a catheter inserted into the bladder and must be repeated with varying frequency, depending on the drug being used. Some patients are even able to administer their own treatment at home. Depending on the medication, it can take anywhere from eight to twelve weeks of treatment before patients experience noticeable results.
Bladder instillation can cause pain and irritation due to frequent catheterization. In addition, DMSO can have other side-effects, including:
- A garlic taste in the mouth and garlic odor on the breath
- Cataracts (a clouding of the eye), although this has only been seen in animals undergoing long-term treatment.
People who have DMSO treatment will need their blood monitored every six months to make sure their blood cells, kidneys and liver are not affected.
Diet
While there is no solid evidence that diet affects interstitial cystitis, some people experience increased pain and other symptoms after consuming certain items, including:
- Alcohol
- Aged cheeses
- Coffee
- Tomatoes and other acidic foods
- Spices
- Chocolate
- Caffeinated or citrus drinks
- Acidic foods
- Artificial sweeteners
Patients may benefit from an elimination diet, in which several foods are removed all at once and then added back one at a time. Monitoring symptoms carefully during this process can help determine whether the removal or addition of certain foods has any affect on their severity.
Other Treatments for Interstitial Cystitis
Physical therapy and biofeedback may relieve symptoms caused by tension in the pelvic floor (the muscle fibers and connective tissue located underneath the pelvis). In patients with interstitial cystitis, spasms of the muscles of the pelvic floor can cause pain. Physical therapy and biofeedback techniques teach a patient how to contract and relax the pelvic floor muscles to help decrease spasms. During biofeedback, electrodes are placed on the spasming muscles in the abdomen, pelvis, rectum, or vagina. Data is sent to a computer that examines the movement of the pelvic floor and muscles in the area. That data helps the therapist and patient understand which muscles are relaxing and contracting, and then a patient is given exercises that help strengthen -- and in some cases stretch -- those particular muscles. Over time, this can give individuals more control over their pelvic floor muscles and reduce the spasms that cause pain.
Bladder training may help people increase how long they can go before urinating. This is done using relaxation techniques and distraction to help a person hold onto the urine longer. The doctor may also suggest that the patient urinate on a set schedule, rather then when the urge occurs.
Interstitial Cystitis Surgery
Surgery is usually only considered after all other options have failed or when the pain is severe. But it is not always a sure thing, and symptoms may still persist. Although researchers are not certain why, it may be a sign of additional inflammation beyond the bladder. There are three different surgical approaches for CI:
Removing damaged areas: Ulcers on the bladder wall caused by interstitial cystitis can be removed with a scalpel or laser. This procedure is done under general anesthesia using a hollow tube inserted into the urethra (cystoscope). These procedures can cause bleeding or infection. In addition, laser treatment can burn a hole in the bowel.
Bladder enlargement: This procedure, also known as bladder augmentation, involves removing areas of the bladder damaged by interstitial cystitis. A piece of tissue removed from the large intestine is then used to make the bladder larger. This procedure may not help everyone and can have several side effects, including:
- Bladder infections
- Incontinence
- Needing a catheter to urinate
- Trouble absorbing nutrients from the shortened intestine.
Bladder removal: When interstitial cystitis has caused severe damage to the bladder wall, the entire bladder may be removed. During this surgery the flow of urine is rerouted (e.g. through the colon) into a bag either outside the body or inside the abdomen). If the tube leading to the bag is not kept clean, this procedure can lead to kidney infection. Some people may also experience phantom pain even after the bladder is removed.
References
Hanno P.M., Burks D.A., Clemens J.Q., Dmochowski R.R., et al. American Urology Association: Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. AUA. 2011.
Hanno P.M. Bladder Pain Syndrome (Interstitial Cystitis) and Related Disorders. Campbell-Walsh Urology, 10th. ed. 2011.
Metts J.F. Interstitial Cystitis: Urgency and Frequency Syndrome. American Family Physician. 2001; 64(7): 1199-1207.
Interstitial Cystitis/Painful Bladder Syndrome. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 2011.
Interstitial Cystitis. A.D.A.M. Medical Encyclopedia. 2012.
