Interstitial cystitis

Overview

Interstitial cystitis (IC), also known as bladder pain syndrome (BPS), is a chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain. The discomfort ranges from mild to severe and is often associated with urinary frequency and urgency. Unlike urinary tract infections (UTIs), IC does not typically involve an infection, and standard antibiotics are ineffective. It predominantly affects women but can also occur in men. IC can significantly impair quality of life due to chronic pain and its impact on daily functioning.

Causes

The exact cause of interstitial cystitis is unknown, but several factors are believed to contribute to its development:

• Defective bladder lining: Damage to the protective lining of the bladder (urothelium) may allow irritants in the urine to penetrate and inflame the bladder wall.

• Autoimmune response: Some researchers suspect the immune system may mistakenly attack the bladder.

• Nerve dysfunction: Abnormal signaling between the bladder and brain may increase pain perception and urgency.

• Inflammation or allergic response: Chronic inflammation or mast cell activation in the bladder wall may play a role.

• Infection or trauma: A history of UTIs, pelvic surgery, or bladder trauma may trigger IC symptoms in susceptible individuals.

Symptoms

Symptoms of interstitial cystitis can vary widely between individuals and may fluctuate in intensity. Common symptoms include:

• Chronic pelvic pain or pressure: Centered around the bladder area, often worsening as the bladder fills.

• Urinary frequency: Needing to urinate more often than normal, including multiple times overnight (nocturia).

• Urgency: A persistent, urgent need to urinate, even when the bladder is not full.

• Pain during urination: Discomfort or burning while urinating without the presence of infection.

• Pain during intercourse: Dyspareunia, especially common in female patients with IC.

• Flare-ups: Periods of worsening symptoms, often triggered by stress, certain foods, or menstruation.

Diagnosis

Diagnosing interstitial cystitis can be challenging, as its symptoms overlap with other urinary or gynecological conditions. There is no single definitive test, so diagnosis is often based on exclusion:

• Medical history and symptom review: A detailed assessment of urinary and pelvic symptoms.

• Urinalysis and urine culture: To rule out urinary tract infections or hematuria.

• Cystoscopy: An endoscopic procedure to inspect the bladder for inflammation, ulcers (Hunner's lesions), or other abnormalities.

• Bladder hydrodistension: Stretching the bladder under anesthesia may reveal glomerulations (pinpoint hemorrhages) associated with IC.

• Pelvic exam: To exclude gynecological causes of pelvic pain in women.

Treatment

There is no known cure for interstitial cystitis, but many patients find symptom relief through a combination of therapies:

• Dietary modifications: Avoiding trigger foods such as caffeine, alcohol, spicy foods, and acidic fruits.

• Bladder training: Scheduled voiding and gradual bladder stretching can reduce urgency and frequency.

• Oral medications: Pentosan polysulfate sodium (PPS), antihistamines, tricyclic antidepressants, and pain relievers may be prescribed.

• Intravesical therapy: Bladder instillations of medication to soothe the bladder lining.

• Physical therapy: Pelvic floor therapy to address muscle tension or dysfunction contributing to pelvic pain.

• Neuromodulation: Electrical stimulation of nerves to modify pain signals in refractory cases.

• Surgery: Reserved for severe cases that do not respond to conservative treatments.

Prognosis

The course of interstitial cystitis varies among individuals. While it is a chronic condition, many people experience periods of remission or symptom improvement with proper management. Treatment can significantly reduce discomfort and improve quality of life. However, flare-ups are common and may require ongoing adjustments to therapy. Early diagnosis and a personalized, multidisciplinary approach offer the best outcomes for symptom control and functional recovery.