Interstitial Cystitis

Interstitial Cystitis



Definition of Interstitial Cystitis

Also known by the name of Bladder Pain Syndrome (BPS), Interstitial Cystitis (IC) is an inflammatory condition affecting submucosal and muscular layers of bladder.

Bladder is a hollow balloon like organ that stores urine from kidneys until it can be expelled. Walls of bladder have muscles that relax as bladder fills and contracts to empty it. Inside walls are lined with cells that protect contact of urine with muscles. Inflammation caused due to Interstitial Cystitis results in damage of this lining and stiffening of bladder.  This inability of the bladder  to empty the urine out leads to the collection of urine inside and result in bladder enlargement.  Sometimes pinpoint spots of bleeding are visible in lining and in some cases there are ulcers or sores called Hunner’s Patches.

Generally the symptoms of Interstitial Cystitis go away on their own, however they recur after an average period of eight months.

 

Cause of Interstitial Cystitis

No one knows for sure what causes Interstitial Cystitis because it varies from person to person. Beside this fact there are several explanations for the condition that are as follows.

 

  • There are several theories for proposing the cause of Interstitial Cystitis. These theories include the following.

    • Autoimmune Theory: According to this theory, IC is an autoimmune response in which body attacks its own organs and tissues.

    • Nerve Theory: This theory states that some inherent  negative changes may occur inside the neurons that  leads to the denervation of muscles.

    • Mast Cell Theory: According to this theory, overproduction of Histamine or other potential harmful chemicals by Mast Cells (Cells that respond to the allergic reactions).

    • Adherence Theory: Increased adherence results in allowing irritating substance in urine to penetrate into bladder i.e break down of bladder lining.

    • Infection Theory

  • Majority of Interstitial Cystitis patients struggle with damaged Urothelial lining (Bladder Lining).

  • Some genetic subtypes are linked to the disorder i.e. as follows.

    • Antiproliferative factor secreted by bladders of IC patient that inhibits bladder cell proliferation causing bladder lining.

    • PAND is a genetic subtypes that is associated with several disorders in which one of them is Interstitial Cystitis.

 

Signs and Symptoms of Interstitial Cystitis

Signs and symptoms of Interstitial Cystitis are commonly misdiagnosed as common bladder infection (Cystitis) or Urinary Tract Infection UTI. Interstitial cystitis is not caused due to bacterial infection hence antibiotics are an ineffective treatment for it. Symptoms of Interstitial Cystitis may attribute to following conditions in men and women.

  • In men: Prostatitis and Epididymitis.

  • In women: Endometriosis and Uterine Fibroids.

 

Symptoms of Interstitial Cystitis are as follows.

  • Suprapubic pain

  • Urinary frequency

  • Painful sexual intercourse

  • Nocturia (waking at night to urinate)

  • Painful urination that has following features:

    • Pain that worsens with bladder filling and improve with urination.

    • Pain that worsens due to certain food or drink.

    • Burning sensation in Urethra when urinating condition known as Dysuria.

  • Urinary Hesitancy i.e. needs to wait for the stream to begin.

  • Interstitial Cystitis patients that have Hunner’s Ulcer suffer from discomfort only in their Urethra while other has pain in entire Pelvis.  

Risk Factors for Interstitial Cystitis

Interstitial Cystitis is a common condition and anyone can develop it. The risk factors that are associated with Interstitial Cystitis are as follows.

  • Sex:

Women are commonly more diagnosed with IC (interstitial cystitis) than men. Men have identical symptoms to those of IC/BPS but normally they are in association with Prostatitis. It was believed to be the condition of menopausal women.

  • Age:

The general range of IC in population is from 1 in 100000 to 5.1 in 1000. The growing numbers of men and women are diagnosed with the conditions in their 30s.

  • Associated Disorders:

People suffering from other chronic conditions that have same etiology as that of Interstitial Cystitis are at higher risk to IC/BPS. These conditions include the following.

  • Irritable bowel syndrome (IBS)

  • Fibromyalgia

  • Chronic Fatigue Syndrome

Diagnosis of Interstitial Cystitis

Diagnosis of IC/BPS is exclusion as well as a review of clinical symptoms. The diagnosis of patient includes the following steps.

  • Patient history

  • Physical examination

  • Laboratory tests

These steps help in assessing and documentation of symptoms of IC/BPS and also other disorders.

In 2009 Japanese researchers identified a urinary marker to be used for early diagnosis. It is called Phenylacetylglutamine.

Prevention from Interstitial Cystitis

For repeated bladder infections like Interstitial Cystitis doctors recommend some preventive self measure measures. These methods of prevention are as follows.

  • Drinking plenty of fluids especially water is a very preventive measure.

  • If you feel the urge to urinate then do not delay it.

  • Wipe from front to back after bowel movement to prevent bacteria in the anal region spreading to vagina and urethra.

  • It is best to take showers than bathing in tubs.

  • Empty your bladder after intercourse.

  • Avoid using deodorants sprays or any other products in genital areas as they cause irritation in urethra and bladder.

Treatment of Interstitial Cystitis

According to American Urological Association the guidelines for treatment of IC/BPS ranging from conservative to invasive treatments are as follows.

  • First line treatment;includes patient’s education, diet modification and stress management.

  • Second line treatment includes physical therapies, oral medications and bladder instillations.

  • Third line treatment includes treatment of Hunner’s ulcers and hydrodistention.

  • Fourth line treatment includes Neuromodulation

  • Fifth line treatment Cyclosporine A, Botulinum Toxin

  • Sixth line treatment surgical intervention such as Cystectomy and urinary diversion.

Some of the treatments of IC/BPS in detail are as follows.

BLADDER DISTENSION:

Bladder distension is also known as Hydrodistention, is a procedure that stretches bladder capacity giving short term pain relief. Bladder rupture or Sepsis may be associated with high pressure hydrodistention.

BLADDER INSTILLATIONS:

It is one of the main forms of IC/BPS treatment. This treatment approach directly contacts medication with bladder. It also includes low systemic side effects due to poor absorption of medications. DMSO (Dimethyl Sulfoxide ) is the only approved bladder instillation for IC/BPS.

MEDICATIONS:

Amitriptyline has been effective in reduction of symptoms such as Pelvic pain and Nocturia. Calcineurin Inhibitor Cyclosporine A has been deemed important for treatment of IC/BPS because of its immunosuppressive properties.

SURGERY:

Surgical intervention for IC/BPS is used rarely as a treatment for last resort. Patients who choose surgical intervention continue to experience pain after surgery. Some of the typical surgical procedures of IC/Bps include the following.

  • Bladder augmentation

  • Urinary diversion

  • Transurethral fulguration

  • Resections of ulcers

  • Cystectomy