What is interstitial cystitis?
Interstitial cystitis (IC), also known as painful bladder syndrome (PBS), is a chronic bladder condition that can cause discomfort or pain in the bladder and pelvic region. This condition can affect men, women, and children. However, interstitial cystitis is much more common in women. It is estimated that as many as 12 out of every 100 women could have early symptoms of painful bladder syndrome, according to the CDC.
Though the symptoms of painful bladder syndrome oftentimes resemble symptoms of a bacterial infection, test results do not indicate that IC/PBS is caused by bacterial infection. This is further confirmed by the fact that patients with this condition do not respond to antibiotics.
Currently, the cause of interstitial cystitis is unknown. However, some researchers suspect that IC/PBS could be a bladder manifestation of an inflammatory or neurologic condition, such as fibromyalgia.
Symptoms of Interstitial Cystitis
The prevalence of symptoms associated with interstitial cystitis can vary widely. Common IC symptoms include:
- Suprapubic pelvic pain (above the pubic bone on the abdomen)
- Perineal pain (between the vagina and anus)
- Chronic pelvic pain
- Pain during sexual intercourse
- Frequent urge to urinate
- Urinating throughout the day and night, usually in small amounts.
Are you struggling with these symptoms? Schedule an appointment online with Arizona Associates for Women’s Health.
The symptoms associated with interstitial cystitis can vary greatly from patient to patient. Some women may frequently feel the need to urinate, while experiencing no pain at all. Other women may feel pain when exercising or having sex, but have no urinary issues. If you’re experiencing any of the above symptoms – or related symptoms – let your physician know.
Diagnosing Painful Bladder Syndrome
Your gynecologist at Arizona Associates for Women’s health may use one of the following tests to diagnose interstitial cystitis:
- Bladder diary. You will be asked to record the amount of water you drink and urine that you pass. An unusual relationship between these two figures could inform your physician about your condition.
- Pelvic Exam. A standard pelvic exam, like the one that is a part of your regular health screening, allows your physician to evaluate your organs for any abnormalities.
- Potassium Sensitivity Test. In this test, two different solutions, one of water and one of potassium chloride, are placed in the bladder. You will be asked to rate your pain and feelings of urgency after each solution. Typically, patients with IC experience pain or urgency with the potassium chloride solution, while patients with healthy bladders cannot tell a difference.
- Urinalysis. This test is performed to rule out a urinary tract infection.
- Cystoscopy. A cystoscope is a tiny tube, equipped with a camera, which goes through the urethra. Your gynecologist may perform a cystoscopy to see your bladder’s lining. The bladder may also be filled with a liquid or gas during a cystoscopy. (Anesthesia is administered for this procedure.) This can help rule out other causes of bladder pain.
- Biopsy. Lastly, a biopsy (which is taken during cystoscopy) may be used to determine if bladder cancer or other rare diseases are the cause of your pain.
Treating IC/PBS
Presently, there is no cure for interstitial cystitis. Because researchers have not yet discovered the underlying causes, current treatment options focus on pain and symptoms. Below, you’ll find information about common treatment options for painful bladder syndrome and interstitial cystitis. Ask your primary care physician for more information.
Oral Medications
As the least invasive treatment option, an oral medication may help relieve the pain and discomfort associated with IC. A few common oral medications are:
- Non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen, for pain relief.
- Tricyclic antidepressants can help relax the bladder and reduce the intensity of bladder contractions.
- Some antihistamines, such as loratadine (which is commonly used for treating allergy symptoms) may also be used to reduce the frequency and urgency of urination.
- Pentosan is the only FDA-approved drug that is specifically designed for the treatment of interstitial cystitis. Though the precise chemistry behind this drug is not fully understood, some scientists believe that it could play a role in the restoration of the bladder’s inner wall. Unfortunately, pentosan is slow working. Pain-relief typically only follows after two to four months of use, and a decrease in urinary frequency requires about six months of use in most patients.
Bladder Distension
Patients who felt their urge to urinate lessen after a diagnostic cystoscopy may undergo additional bladder distension sessions. During this process, the bladder is filled with gas or liquid and then emptied. Distension could help by increasing bladder capacity.
Transcutaneous Electrical Nerve Stimulation (TENS)
Transcutaneous Electrical Nerve Stimulation (TENS) is a treatment method that reduces pelvic pain and frequency urges by administering mild pulses of electricity to the pelvic region. Wires may be placed outside the body – on the lower back or just above the pubic region – or in the vagina. Patients who respond well to TENS may choose to have an electrical nerve-stimulating device implanted beneath the skin. These implantable devices feature a wire near the tailbone, which stimulates the sacral nerves.
Bladder-Instilled Medications
Some patients achieve the most pain relief by having medications instilled directly into the bladder. These medications may help reduce inflammation; in some cases they may even prevent muscle contractions that cause the frequent urge to urinate. The medication is typically mixed with an anesthetic and administered via catheter. After 10 to 15 minutes, the patient expels the medication by urinating. These treatments are usually administered once a week for six to eight weeks, after which they are only given as needed.
Surgical Options
As a last resort, surgery is an option for treating interstitial cystitis. However, surgical treatment for IC/PBS is rare. Typically, for a candidate to be considered eligible for surgery, she must have severe bladder pain and only be capable of holding a very small amount of urine.
- In a bladder augmentation procedure, a portion of the bladder is removed and replaced with a piece of tissue from the colon.
- In fulguration – a minimally invasive procedure – painful bladder ulcers (Hunner’s ulcers) are burned off.
- In resection, ulcers are surgically removed from the bladder. Resection can be performed in a minimally invasive fashion, as well.
- In extremely rare cases, the bladder may be removed entirely. This is known as a cystectomy. After the bladder has been removed, ureters (which carry urine from the kidneys to the bladder) are rerouted to an artificial bladder or a piece of the colon, which opens onto the skin of the abdomen.
For more information about interstitial cystitis, painful bladder syndrome, and your treatment options at Arizona Associates for Women’s Health, please contact us by calling 480-257-2700.
