Interstitial Cystitis: Symptoms and Treatment

Interstitial cystitis is a painful bladder condition that causes inflammation of the bladder wall.

Interstitial cystitis (IC) is a recurring problem of the bladder, the storage reservoir for urine. IC patients typically suffer from long-term inflammation of the bladder wall. Most cases of interstitial cystitis are marked by a pattern that fluctuates between periods of remission and flare-ups (worsening of the symptoms). The chronically inflamed bladder wall eventually becomes stiff and scarred. As a result, the bladder cannot enlarge properly when it is refilling. This may considerably reduce the storage area of the bladder.

Types of Interstitial Cystitis

IC can be either ulcerative (severe form) or non-ulcerative. In case, ulcers are visible on the bladder wall, then it is known as ulcerative IC. The incidence rate of ulcerative IC is low; 1 in 10 IC patients suffer from ulcerative IC. On the other hand, patients affected with non-ulcerative IC show development of glomerulations, bladder hemorrhages that are typically marked by mild bleeding due to ruptured blood vessels. In both types of IC, bladder capacity decreases, but in ulcerative IC, the bladder storage area reduces significantly.

Symptoms

It is observed that 9 in 10 people diagnosed with IC are females. Some of the most common symptoms of this chronic bladder ailment are given below:

Bladder Pain
In this condition, the lining of the bladder wall is damaged considerably. As a result, the bladder wall is exposed to toxic urine components, causing burning sensation all the time.

Pelvic Pain
“Pelvic region aches and pains”, Well, this is the most common complaint reported by IC patients. As urinary bladder is situated in the pelvic region, IC patients often experience pelvic pain that may worsen during urination. The intensity of pelvic may vary, nevertheless it is chronic. One may also feel pelvic pressure when the bladder is refilling. In some cases, the pain affects the entire abdominal region. In men, there is discomfort in the scrotum and penis; in women, pain is experienced between the anus and vagina.

Frequent Urination
The inflamed and sore bladder is unable to hold urine for long periods of time. Hence, the patient has a tendency to urinate frequently. Patients diagnosed with IC commonly show urinary urgency due to diminished bladder storage capacity. IC can lead to as many as 60 trips to the toilet for urination. The urination frequency can be more than 8 times at night.

Painful Urination
The stored urine moving out of the inflamed bladder is likely to cause discomfort. The inner bladder wall is sore, hence passing the urine can trigger sudden pain.

Hematuria
Hematuria, which means blood in urine, may also occur in IC patients. It is indicating that the ulcers or the glomerulations formed on the inner bladder wall are bleeding. Hematuria may be visible to the naked eye or detected in urinalysis.

Painful Intercourse
Sexual activity takes a back seat in IC patients. Having intercourse causes discomfort for people affected with this chronic bladder condition. Majority of males diagnosed with IC have reported pain during ejaculation and erectile dysfunction. In fact, IC flare-ups are common after sexual intercourse. Women with IC suffer from chronic vulvar pain, that also has a long term impact on their sexual life.

Factors that Worsen IC Symptoms

Interstitial cystitis that is prevalent in women, flares-up during menstruation. The symptoms aggravate during their periods. Sexual intercourse can also exacerbate IC symptoms. IC patients will have a hard time dealing with their condition, in case they get diagnosed for UTI. High impact exercises such as jogging, running, rope jumping and jumping jack can also aggravate IC symptoms. Stress and even sitting for long periods of time can contribute to worsening of IC symptoms.

Treatment

Medications
Oral medications that can provide relief from IC symptoms are as follows:

Elmiron
In order to improve pain associated with IC, doctor often prescribe Elmiron. This is the only prescription drug that has got FDA consent for the treatment of bladder conditions such as interstitial cystitis. Basically, Elmiron creates a thin layer of protective coating over the bladder wall, thus preventing its exposure to urine. This helps to reduce bladder discomfort and pelvic pain. Although, Elmiron is helpful to treat IC, it does not provide immediate relief and may take around 2 months to improve pain. Also, the drug is not free from side effects and hence, the patient’s health needs to be monitored by regularly taking blood tests to check for any issues that may develop.

NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are also found to be helpful to reduce bladder discomfort.

Analgesics
Drugs such as pyridium and prodium are urinary tract analgesics and may contribute to reduce urinary burning and urgency.

Antidepressants
Tricyclic antidepressants in low doses helps to block the nerve pain signals from reaching the brain, thereby providing relief from chronic bladder pain. Amitriptyline, also known as Elavil is one such antidepressant that often works to reduce chronic pain.

Non-Surgical Treatment

If oral medications fail to provide relief to the patient, then non-surgical procedures are used. These procedures are, in most cases, effective and help reduce pain and increase the capacity of the bladder. The following non-surgical procedures are performed:

Bladder Instillations
Bladder instillation or bladder wash is a procedure that involves filling the bladder with a therapeutic solution using a catheter (a narrow tube). A rescue solution which is a mixture of lidocaine, heparin and a topical anesthetic is the most commonly prescribed solution to fill the bladder. The solution is held for some time, ranging from a few seconds to several minutes, before allowing it to drain through the catheter. This method of treatment gives desirable results, as it reduces pain and anxiety of the patient to a great extent. For the treatment to be effective and to achieve long-lasting relief, the procedure needs to be performed several times.

Hydrodistention (Stretching of Bladder)
In this procedure, water is filled in the bladder. As a result, the bladder expands considerably, which can be quite painful. Hence, general anesthesia is administered to the patient before starting this procedure. This form of treatment can help improve IC symptoms and increase bladder capacity.

Bladder Training
In order to control the urge to urinate and reduce urinary frequency, bladder training from a physiotherapist may be helpful. It involves pre-planning the visits to the washroom, which means urinating only at certain times of the day. Another aspect of this technique involves holding the urine for a few minutes, despite feeling the urge to urinate. Slowly, one should try and keep on increasing this delayed urination time, until one can comfortably control the urgent need to urinate for 2-3 hours.

Exercise
In order to alleviate urinary symptoms and for better bladder control, the doctor may suggest few pelvic floor exercises. These  exercises for interstitial cystitis help to strengthen the muscles that play a key role in controlling urine flow.

Surgical Treatment

Surgical procedures are used, when IC patients do not respond to conservative treatment. If the pain does not recede, doctors recommend surgery. However, patients should discuss all the possible risks and complications with the doctor prior to the surgery. The following bladder surgeries may relieve IC symptoms:

Augmentation
This involves enlarging the bladder by introducing a section of the colon in the bladder. In this procedure, a small tissue of the colon is removed and joined to the bladder in such a way that the size of bladder increases. Firstly, the procedure removes inflamed, ulcerated, and scarred sections of the bladder. The bladder is then augmented using the intestinal tissue.

Fulguration
In this procedure, high voltage electric current is passed through the ulcerous tissue of the bladder to destroy it. The high frequency current is generated using a needle shaped electrode and introduced into the urethra to target the ulceration in the bladder. The procedure also involves burning off the adjoining nerves of the ulcer that are sending pain signals to the brain. This in turn, helps to reduce bladder pain and inflammation.

Cystectomy
In this procedure the bladder is completely removed to get rid of IC symptoms. Once the doctor removes the bladder, different methods are used to provide a new route for urine output.

Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.