Interstitial cystitis (painful bladder syndrome)

If you’re plagued with recurring pain or pressure in your pelvis and feel a frequent urge to pee, you may suspect another UTI (urinary tract infection) but you could actually have interstitial cystitis (IC), a chronic inflammation of the bladder. Some doctors have started calling it bladder pain syndrome (PBS). With IC/PBS, the bladder may be irritated or inflamed and become scarred or stiff; a stiff bladder cannot expand when urine fills it. While some IC/PBS symptoms are similar to a bacterial bladder infection, medical tests will not find bacteria and antibiotic treatment doesn’t help.

Interstitial cystitis causes The causes of IC/PBS are not yet fully understood. It’s possible that a defect in the lining of the bladder, which normally protects the bladder wall from the toxic effects of urine, might cause IC by letting urine irritate the bladder wall. Often sufferers of IC/PBS have other conditions such as fibromyalgia and irritable bowel syndrome (IBS), leading scientists to hypothesize that IC/PBS may be part of a more general condition inflaming various organs, including the bladder. Heredity may also play a part in some cases.

Interstitial cystitis symptoms These vary but may include mild discomfort, tenderness, pressure or intense pain in the pelvic or bladder area. If you have IC/PBS you may feel like you need to urinate urgently or frequently or both but you may only pass a small amount of urine each time. As your bladder fills, the pain may worsen and symptoms may be more severe when you’re under stress, during your period or when you’re having sex.

Interstitial cystitis diagnosis/tests For a diagnosis of IC/PBS, you must have pain related to the bladder accompanied by frequent and/or urgent urination and no other disease that could be causing your symptoms, such as a UTI. There is no one test to identify IC/PBS so your doctor will start by ruling out other bladder disorders, such as urinary tract infections (UTIs), kidney stones, endometriosis, sexually transmitted infections (STIs) or bladder cancer. She may order a urine sample to check for bacteria. You may be referred to an urologist for a cystoscopy (which uses a thin instrument with a light on it to see inside the bladder and urethra); or a biopsy of the bladder wall and urethra may be done during the cystoscopy to get a tissue sample of the bladder to rule out bladder cancer. A distention of the bladder under anesthesia which involves stretching the bladder to its capacity by filling it with a liquid or gas is also sometimes used to diagnose IC/PBS.

Interstitial cystitis treatment There’s no cure yet for IC/PBS but treatments may help relieve symptoms. Talk to your doctor about which combination of treatments is best for you.

• Bladder distention After this diagnostic procedure (see above) people often report an improvement in symptoms.

• Bladder instillation Also called a bladder wash or bath, this procedure involves filling the bladder with a solution that is held for varying amounts of time, such as 10 to 15 minutes, before being emptied. The drug dimethyl sulfoxide may be passed through a catheter into the bladder during weekly treatments to reduce inflammation and block pain.

• Medications Pain relievers, such as ibuprofen and aspirin may help treat mild discomfort. Other medications, such as antidepressants, antihistamines and Pentosan Polysulfate Sodium (Elmiron), which protects the lining of the bladder wall from urine, may also improve symptoms.

• Electrical nerve stimulation Electrical pulses can stimulate the nerves of the bladder through the skin in a method called transcutaneous electrical nerve stimulation (TENS), through wires on the lower back or above the pubic area or special devices inserted into the vagina. TENS may help increase blood flow to the bladder and strengthen pelvic muscles, relieving pelvic pain.

• Bladder training You can learn to train your bladder to urinate less often by going to the bathroom at scheduled times and using relaxation techniques.

• Lifestyle changes Some IC/PBS sufferers find that eliminating certain foods, such as tomatoes, chocolate, caffeine, alcohol and acidic foods may help. Exercising may relieve symptoms and quitting smoking — a major cause of bladder cancer — is also recommended.

Interstitial cystitis prevention Since doctors do not know the cause of interstitial cystitis, there is no known way to prevent it. If you already have the condition, quitting smoking, avoiding trigger foods and beverages may minimize your risk of a flare-up.

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