Interstitial Cystitis (Painful Bladder Syndrome)

Interstitial cystitis (IC) is an inflamed or irritated bladder wall. It is also known as painful bladder syndrome and frequency-urgency-dysuria syndrome. It affects men and women of all racial and ethnic backgrounds and ages, but is more common in women.

IC is a chronic disorder that can lead to scarring and stiffening of the bladder. As a result, the bladder can’t hold as much urine as it did in the past.

The most common symptoms of interstitial cystitis (IC) are:

• Frequent and sometimes painful urination, as often as 40, 50, or 60 times a day.
• Urge to urinate.
• Feelings of pressure, pain, and tenderness around the bladder, pelvis, and the area between the anus and vagina or anus and scrotum (perineum).
• Pain during sex.
• In men, discomfort or pain in the penis and scrotum.
• In women, symptoms may worsen around their period.

Symptoms of IC vary from person to person, may come and go, and can change over time. Common triggers that worsen symptoms include sitting for a long time, stress, exercise, and sexual activity. Although symptoms of IC may resemble those of a chronic urinary tract infection (UTI), there’s usually no infection. However, symptoms may worsen if a person with IC gets a UTI.

The cause of IC is unknown. Certain foods can make IC symptoms worse. These include:

• Citrus fruits
• Tomatoes
• Chocolate
• Coffee
• Potassium-rich foods
• Alcoholic beverages
• Caffeinated beverages
• Spicy foods
• Some carbonated beverages

Conditions that can possibly lead to IC include genetic and immune disorders, recurrent bacterial infections, allergy, and pelvic floor dysfunction. People with IC may also have a defect in the protective lining (epithelium) of the bladder. A leak in the epithelium may allow toxic substances in urine to irritate the bladder wall.

• Gender. Women are diagnosed with IC more often than men. Symptoms in men may mimic IC, but they’re more often associated with an inflammation of the prostate gland (prostatitis).
• Age. Most people with IC are diagnosed during their 30s or older.
• Having a chronic pain disorder. IC may be associated with other chronic pain disorders, such as irritable bowel syndrome or fibromyalgia.

Symptoms of IC closely resemble those of other urinary disorders, so tests may be needed to rule out other problems.

1. Medical History. Tell your health care provider about your symptoms, how long you’ve had them, and how they affect your everyday living. Bring a list of your over-the-counter and prescription drugs. Tell your provider about any past and current health problems and about your diet, including how much and what kinds of liquids you drink during the day and night. You may be asked to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass.

2. Physical Exam. A health provider will often feel your abdomen, the organs in your pelvis, and your rectum, to see what may be causing your symptoms.

3. Urinalysis. A sample of your urine is taken. Lab tests look for certain cells and chemicals, including red and white blood cells, bacteria, or too much protein. A urine cytology test looks for cancer cells.

4. Cystoscopy. A hollow tube called a cystoscope is inserted into the urethra (the tube that carries urine out of the body) and then into the bladder. The lens in the cystoscope allows a doctor to examine the bladder lining. Cystoscopy may be used to look for cancer cells in the bladder, particularly if cancer cells are found with urinalysis.

IC can be hard to treat and has no cure. Treatments are aimed at easing symptoms, and may include:

1. Medication. Medication may be taken by mouth (oral) or placed directly into the bladder by a catheter (bladder instillations). Oral drugs can include:

• Tricyclic antidepressants (such as amitriptyline or imipramine (Tofranil)), which relax the bladder and interfere with the release of neurochemicals that can cause bladder pain and inflammation.
• Elmiron (Pentosan polysulfate sodium), the only oral drug approved by the FDA specifically for interstitial cystitis. This drug improves the bladder lining, making it less leaky and therefore less inflamed and painful.
• Antihistamines (such as loratadine (Claritin)), which interfere with the release of histamine. These help relieve bladder inflammation and pain, urinary frequency, and nighttime voiding.
• Painkillers (NSAIDS such as aspirin, naproxen sodium, and ibuprofen; and acetaminophen), which can help relieve mild to moderate pain.

2. Bladder training. You urinate at specific times and use relaxation techniques and distractions to help keep to the schedule. Over time, you try to lengthen the time between the scheduled voids.

3. Bladder over-distention. This method (also called bladder distention) increases bladder capacity. It also interferes with pain signals sent by the nerve cells in the bladder. Water is used to stretch the bladder. Botulinum toxin A (Botox) may be injected into the bladder wall. This treatment option could lead to being unable to empty your bladder completely when you urinate. You may need to self-catheterize (inserting a tube into your own bladder to drain urine) after this treatment.

4. Bladder cocktails. The bladder is filled with a solution that is held for a period of time, then voided out.

5. Transcutaneous electrical nerve stimulation (TENS). Mild, electric pulses enter the body for minutes to hours, two or more times per day. The pulses are sent through wires placed on the lower back, or through special devices put into the vagina in women or into the rectum in men. For some people, TENS eases bladder pain and urinary frequency and urgency.

6. Sacral neuromodulation (SNS). Your sacral nerves are a primary link between the spinal cord and nerves in your bladder. SNS delivers electrical impulses to the bladder and stimulates the sacral nerve, which may reduce urinary urgency associated with IC. This procedure doesn’t manage pain from IC, but may help to relieve some symptoms of urinary frequency and urgency.

• Dietary changes.  Diet has not been proven to affect IC, but some believe that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder inflammation. Avoiding them may help to decrease some symptoms.
• Smoking cessation.  Many people with IC find that smoking makes their symptoms worse.
• Exercise.  Exercise may help ease or temporarily stop symptoms of IC.
• Stress reduction.  There is no proof that stress causes IC, but stress can worsen IC symptoms.
• Clothing changes.  Wear loose clothing, and avoid belts or clothes that put pressure on your abdomen.