Interstitial cystitis is a non-infectious cystitis, the (suprapubic, pelvis and abdomen) causes pain, frequent urination and urinary urgency incontinence. Diagnosis is made by history and exclusion of other diseases clinically and by cystoscopy and biopsy. Under the therapy is better for most patients, but a cure is rare. The treatment varies, including dietary measures, bladder training, pentosan, analgesics, antidepressants and intravesical treatments.
(See also overview of micturition.)
Interstitial cystitis is a non-infectious cystitis, the (suprapubic, pelvis and abdomen) causes pain, frequent urination and urinary urgency incontinence. Diagnosis is made by history and exclusion of other diseases clinically and by cystoscopy and biopsy. Under the therapy is better for most patients, but a cure is rare. The treatment varies, including dietary measures, bladder training, pentosan, analgesics, antidepressants and intravesical treatments. (See also overview of micturition.) The incidence of interstitial cystitis is unknown; but the error appears to be more common than previously thought and may other clinical syndromes underlying (z. B. chronic pelvic pain). Whites are affected more often and 90% of cases occur in women. The cause is unknown, but the pathophysiology can possibly related to the loss of protective urothelial mucin and the consequent penetration of Harnkalium and other substances into the bladder wall, with the activation of the sensory nerves and damage of the smooth muscle in context. Mast cells may mediate this process, but its role is unclear. Symptoms and complaints initially runs interstitial cystitis asymptomatic; but when it comes over the years to damage the bladder wall, symptoms and worse. Suprapubic and pelvic pressure or pain often associated with frequent urination (up to 60 times a day) or urination. These symptoms worsen with bladder filling and disappear when the patient urinate; in some patients the symptoms of ovulation, menstruation, seasonal allergies, physical or emotional stress or during intercourse be worse. Foods high in potassium content (eg. As citrus fruits, chocolate, caffeinated beverages, tomatoes) can trigger an exacerbation. Tobacco, alcohol and spicy foods may worsen the symptoms. If the bladder wall converted scarred, bladder compliance and capacity to take off, from which urinary urgency and frequent urination or result deteriorate. Diagnosis Clinical Investigation cystoscopy with possible biopsy The diagnosis is suspected because of symptoms after other more common disorders were excluded by investigations (HWI, PID, chronic prostatitis or Prostatodynia, diverticulitis). A cystoscopy is necessary and sometimes a benign bladder ulcer is detected (Hunnersches ulcer). A bladder cancer, especially a carcinoma in situ, must be excluded by biopsy. The assessment of symptoms using a standardized scale or during intravesical potassium chloride administration (potassium sensitivity test) can improve the diagnostic accuracy, but not part of the routine. Therapy change of Lebenssstils bladder training medication (eg. As sodium pentosan polysulfate, tricyclic antidepressants, NSAID, Dimethylsulfoxidinstillation) The last resort is surgery lifestyle change Up to 90% of patients experienced by the treatment an improvement but a cure is rare. To treat the exclusion of noxious tobacco, alcohol, food should be high in potassium and spicy food gehören.Wahl the treatment Besides lifestyle changes bladder training, medication, intravesical therapies and surgical procedures are used as needed. Stress reduction and biofeedback (to strengthen the pelvic floor muscles, z. B. with Kegel exercises) can help. None of the treatments alone has proven to be effective, but a combination of ? 2 nonsurgical treatments is recommended before a surgical procedure considered wird.Medikamentöse therapies The drug most commonly used is sodium pentosan polysulfate, a heparin-like molecule similar to urothelial glycosaminoglycan; a dose of 100 mg p.o. 3 times a day, the protective bubble surface can recover. Palliatives are perceived only after 2-4 months. Intravesical instillation (n. D. Ed .: and electrophoresis, electro-Motifdrugapplication, EMDA) of 15 ml of a solution of 100 mg of pentosan or 40,000 I.U. Heparin plus 80 mg lidocaine and 3 ml of sodium bicarbonate can be successful in patients who do not respond to oral therapy. Tricyclic antidepressants (eg., Imipramine 25-50 mg daily) and NSAIDs in standard doses the pain can relieve. Antihistamines (z. B. hydroxyzine 10-50 mg 1 time before going to bed), the mast cells directly inhibit or by inhibiting allergic triggers. Dimethyl sulfoxide, instilled via a catheter into the bladder and left there for 15 minutes, can reduce substance P and promote Mastzellgranulation. 50 ml every 1-2 weeks 6-8 weeks, if need be repeated relieve up to half of the patients symptoms. Intravesical instillation of BCG, and hyaluronic acid is currently untersucht.Chirurgische and other processes, some people get help hydrodistention the bladder, endoscopic resection of Hunner’s ulcer and sacral nerve stimulation. Surgical therapy (Blasenteilresektion, bladder expansion, and neobladder urinary diversion) is the last resort for patients with unbearable pain that respond to any other treatment. The output is not predictable; in some patients the symptoms persist. Conclusion Interstitial cystitis is a non-infectious cystitis which tends to cause chronic pelvic pain and frequent urination. Diagnosis requires the exclusion of other causes for the symptoms (eg. As urinary tract infections, pelvic inflammatory disease, chronic prostatitis or Prostatodynia, diverticulitis), cystoscopy and biopsy. Healing is rare, but in up to 90% of patients, the condition improved with treatment. Treatments include changes in diet, bladder training and medications (eg. As sodium pentosan polysulfate, tricyclic antidepressants, NSAID, Dimethylsulfoxidinstillation). Surgery is the last alternative in patients with intolerable pain in whom other therapies have failed.