Interstitial cystitis (IC)
What is interstitial cystitis?
Interstitial cystitis is a term used to describe one of a group of Painful Bladder Syndromes.
Vary between individuals and within an affected person, and include:
- Urinary urgency (day and night).
- Urinary frequency; sometimes more than 20x/day.
- Pressure and pain in the lower abdomen and pelvis (increases as the bladder fills and decreases as the bladder empties).
- Reduced bladder capacity.
- Dyspareunia (painful intercourse).
What causes Interstitial cystitis?
No one actually knows what causes interstitial cystitis. It is likely to be multifactorial (caused by several different things). There is no evidence that it is caused by bacterial or viral infections.
Theories of causation include:
- A defect on the epithelium (protective lining) of the bladder.
- An unidentified inflammatory process.
- An autoimmune disease.
- Hereditary factors.
Making a diagnosis of interstitial cystitis
Diagnosis involves exclusion of other bladder, lower abdominal or pelvic pathology
The following may facilitate making the diagnosis:
- History of complaint.
- Bladder diary.
- Abdominal and pelvic examination.
- Potassium sensitivity test.
- Bladder biopsy.
Cystoscopy in diagnosing interstitial cystitis
Cystoscopy in the operating theatre allows for bladder hydrodistension
Petechial haemorrhages from the urothelium (bladder epithelium) during or following hydrodistension.
Hunner’s lesion or “ulcer” is a distinctive inflammatory lesion. It is not actually an ulcer. The lesion typically presents as a well defined, reddened mucosal area within the bladder with small vessels radiating towards a central scar.
Bladder biopsy allows a tissue specimen to be obtained for histological analysis.
Other conditions that are found more commonly in patients with IC include:
- Irritable bowel syndrome.
- Food intolerance.
- Inflammatory bowel disease.
- Auto-immune disorders.
- Sjogren’s syndrome.
- Multiple allergies.
How is interstitial cystitis treated?
No simple treatment exists to ameliorate all the symptoms of interstitial cystitis. No single treatment works for everyone.
Patients often need to try a variety of treatments to find those that work for them.
Modification of diet
Most (but not all) people with IC find that certain foods exacerbate their symptoms. Generally, all foods high in acidity are not well tolerated. The foods and drinks that seem to produce the highest incidence of symptom worsening include:
- Caffeinated Tea and Coffee (decaffeinated may be tolerated)
- Carbonated Drinks
- Cranberry Juice
- Spicy Foods
- Chocolate (contains caffeine)
- Fruit – particularly berry fruits i.e. Strawberries /Tomatoes /Onions
Every person has different tolerances to foods that will irritate their bladder. The amount of food consumed before bladder irritation starts can also vary from one person to another.
The simplest way to find out whether any foods bother your bladder is to try an ‘elimination’ diet. You stop eating all of the foods that could irritate your bladder for 1-2 weeks. If you bladder symptoms improve while you are on the diet, this suggests that at least one of the foods was irritating your bladder. You can then sequentially introduce the foods that had been ceased until you find out which ones irritate your bladder.
Physical therapy & biofeedback
Rational: Spasms of the pelvic floor muscles can cause lower abdominal and pelvic pain.
Physiotherapists teach pelvic floor exercises to help you relax your pelvic floor muscles.
Oral therapies for IC include:
- Pain killers (analgesia)
- A semi-synthetic polysulphated xylan
Semi-synthetic polysulphated xylan
It is not known exactly how the semi-synthetic polysulphated xylan works and it must be taken continuously for pain relief to persist. Cessation of the drug results in a resumption of pain.
The recommended dose is 100 mg three times daily (every 8 hours). It is best taken at least one hour before or two hours after meals so that food does not delay its’ absorption.
It has anticoagulant activity, thus it can cause bleeding. If used in combination with other anticoagulants (such as heparin and warfarin) the risk of bleeding may increase.
- Hyaluronic acid.
- Dimethylsulphuric acid.
(Medications instilled into the bladder)
- Anti-cholinergic agents.
- Chondroitin sulphate.
- Local anaesthetics.
- Bladder anti-spasmodic
Hydrodistension is usually done during cystoscopy. It involves overfilling the bladder with water, usually beyond the functional bladder capacity, and leaving the bladder on a stretch for a period of time ranging between 5-15 minutes.
Hydrodistension can be repeated as a treatment only if it produces a noted, beneficial reduction in symptoms that lasts for a period of time.
Transcutaneous electrical nerve stimulation (TENS)
- Mild electrical pulses may relieve pelvic pain and, in some cases, reduce urinary frequency.
Sacral nerve stimulation
- A thin wire placed near the sacral nerves delivers electrical impulses to the bladder. This may reduce pain, urinary frequency and urgency.
Bladder surgery is not often used in IC. It is usually reserved for patients that have failed to respond to other therapies:
- Involves diathermy of the ulcers.
- Involves cutting through the ulcers.
- Very rarely used.
- Involves the replacement of part of the bladder with a piece of colon.
- Associated with many complications and no improvement in bladder pain.