Interstitial Cystitis (Painful Bladder Syndrome)

Interstitial Cystitis 3

Interstitial (in-tur-STISH-ul-sis-TIE-is) Cystitis (IC) or Painful Bladder Syndrome
IC or painful bladder syndrome is a chronic medical condition in which a person experiences constant bladder pressure and pain; sometimes, the pain is in the pelvic area. The pain levels can range from mild discomfort to severe pain.
The bladder is a hollow, muscular organ that stores urine. The bladder will expand to hold more liquid until it is full, sending a signal to the brain to communicate the need to urinate through the pelvic nerves. This is the reason most people will have the urge to urinate. However, for someone with interstitial cystitis, the signals can become jumbled – in which you will feel the need to urinate more often and with smaller volumes of urine than most people.
Interstitial cystitis most often affects women and can have a long-term impact on one’s quality of life. While no treatments will reliably remove interstitial cystitis, there are medications and therapies that may offer relief.

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Symptoms of Painful Bladder Syndrome

The signs of Painful Bladder Syndrome vary from person to person. If you have this condition, your symptoms may change over time, occasionally flaring in response to common triggers, such as sitting for extended periods, exercising, sexual activity, stress, or menstruating.

Interstitial cystitis signs and symptoms include:

  • Chronic pelvic pain
  • Pain during sexual intercourse
  • Pain or discomfort while the bladder fills, and relief as you urinate.
  • Persistent and urgent need to urinate
  • Pain in the pelvis or between the vagina and anus ( in women) or between the scrotum and anus in men ( perineum)
  • Frequent urination, often small amounts, throughout the entire day and night. People with severe IC urinate as much as 60 times a day.
Interstitial Cystitis

The severity of the symptoms caused by IC can vary based on the person, and others may experience periods where the symptoms disappear.

Although signs and symptoms of IC may look like chronic urinary tract infections, urine cultures are usually free from bacteria. However, symptoms may worsen if a person with interstitial cystitis gets a urinary tract infection.

You should see a doctor if you are experiencing chronic bladder pain or urinary urgency and frequency higher than normal.

What Causes IC or Painful Bladder Syndrome

It is unknown precisely what causes IC, but many factors can likely contribute to its development. For example, people with IC may also decide on the bladder’s protective lining (epithelium). A puncture in the epithelium may allow toxic substances in urine to irritate the bladder wall.

Other suggestions have not been proven but include factors such as autoimmune reaction, infection, allergy, or heredity.

Risk Factors


Gender: Women are diagnosed with interstitial cystitis more often than men. Men have nearly identical symptoms to those of interstitial cystitis. However, these symptoms are most often associated with prostate gland inflammation (prostatitis)

Age- Most individuals with interstitial cystitis are diagnosed during their 30s or older.

Chronic Pain Disorder: IC may be related to another pain disorder, such as fibromyalgia or irritable bowel syndrome.

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Complications

IC can result in several complications, including:

Reducing Bladder capacity– IC can lead to a thickening of the bladder wall that reduces the bladder capacity, meaning it would hold less urine.

Lower quality of life – Frequent need to urinate and pain caused by IC will interfere with your social activities, daily routine, and work.

Sexual intimacy – Frequent urination and pain can affect personal relationships and sexual intimacy.

Emotion issues: Chronic pain and interrupted sleep caused by IC can trigger emotional stress and depression.

Test and Diagnosis

To determine if you have IC or Painful Bladder Syndrome, the doctor may run a few of the following tests:

The doctor may request medical history or bladder dairy. Your doctor may ask you to describe your symptoms and may require that you keep a diary of the frequency in which you have to urinate, the volume of fluids you drink, and the volume of urine you pass.

Pelvic exam – During the pelvic exam, your doctor will examine your external genitals, including the vagina and cervix, and feel the abdomen to evaluate any internal pelvic organs. The doctor may also examine the anus and rectum.

Urine test- A sample of urine will be analyzed to check for urinary tract infection

Potassium sensitivity test – In this test, your doctor places two solutions – potassium chloride and water – into your bladder one at a time. You may be asked to rate on a scale of 0 to 5 the urgency and pain you feel after each solution is instilled. If you feel a noticeable difference in urgency and pain after the potassium solution than the water solution, the doctor may diagnose interstitial cystitis; individuals with normal bladder can not tell the difference between the two solutions.

Cystoscopy – The doctor will insert a thin tube with a miniature camera (cystoscope) via the urethra, allowing the doctor to see the bladder’s lining. Your doctor may also inject liquid into the bladder to measure your bladder capacity, called a hydrodistention. Your doctor may perform a cystoscopy with an anesthetic medication to make you more comfortable.

Biopsy – During a cystoscopy and you are under anesthesia; your doctor may take a sample of the bladder tissue (biopsy) and the urethra for examination under a microscope. A biopsy would also check for other conditions.

Treatments and Medications

No simple treatment option can eliminate the signs and symptoms of IC and one treatment. It may be necessary to try various types of treatment or combinations before your doctors find an approach that relieves your symptoms.

Working with a physical therapist can address pelvic pain caused by muscle tenderness, restrictive connective tissue, or muscle abnormalities in the pelvic floor.

Oral Medications

Oral drugs that may improve the signs and symptoms of IC include the following:

Nonsteroidal anti-inflammatory drugs relieve pain, such as ibuprofen (Advil, Motrin IB) or Aleve or Naproxen.

Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), can assist in relaxing the bladder and block pain.

Antihistamines, similar to loratadine (Claritin, others0 may reduce urinary urgency and frequency and relieve other symptoms.

The Food and Drug Administration approved Pentosan (Elmiron) to treat interstitial cystitis. The method that works is not known, but it may restore the inner lining of the bladder as well as protect the bladder wall from a substance in urine that could irritate. It can take two to four months before you can start to feel relief in pain and up to six months to have a decrease in urinary frequency.


Transcutaneous electrical nerve stimulation (Tens). With TENS, mild electrical vibrations relieve pelvic pain and, in some situations, reduce urinary frequency. TENS can help to increase blood flow to the bladder and strengthen muscles to help control the bladder or trigger the rise of substances that block pain. Electrical wires positioned on the lower back above the pubic area deliver these electrical pulses, and the frequency and length of time depend on the best therapy that works for you.

Sacral nerve stimulation: Your sacral nerves are a primary link between the spinal cord and nerves in your bladder. Inciting these nerves may reduce urinary urgency associated with interstitial cystitis. Sacral nerve stimulation uses a thin wire placed near the sacral nerves to deliver electrical impulses to your bladder, which are similar to the functionality of a pacemaker for the heart. If the procedure decreases the symptoms, it may make sense to have a device surgically implanted for permanent use.

Bladder distention

Some people notice a momentary improvement in symptoms after undergoing cystoscopy

with bladder distention. Bladder distention is the stretching of the bladder with water or gas. The system may be repeated as a treatment if the response lasts a long time.

Medications are instilled into the bladder.

In bladder instillation, your doctor places the prescription medication dimethyl sulfoxide into your bladder through a thin, flexible (rinmos-50) into your bladder through a thin, flexible tube (catheter) inserted through the urethra. The solution seldom is mixed with other medications, such as a local anesthetic, and remains to sin your bladder for 15 minutes; You urinate to expel the solution.

You might receive dimethyl sulfide – also called DMSO- treatment weekly for six to eight weeks and then have maintenance treatment as needed – such as every couple of weeks for up to one year.

A newer bladder installation method uses a solution containing the medications lidocaine, sodium bicarbonate, and either pentosan or heparin.

Surgery

Doctors seldom use surgery to treat IC because removing part of or all of the bladders does not relieve pain and can lead to additional complications. People with severe pain or those whose bladders can hold only a minuscule volume of urine are possible candidates for surgery, but usually only after other treatment options have not been effective; surgical options include the following:

Fulguration – This is a minimally invasive method involved in the insertion of instruments through the urethra to burn off ulcers that may be causing IC

Resection – is a minimally invasive surgery that involves the insertion of instruments through the urethra to out of around any ulcers.

Bladder augmentation is this procedure; surgeons remove the infected portion of the bladder and replace it with a piece of the colon. However, the pain remains, and some people must empty their bladders with a catheter many times a day.