Interstitial Cystitis

Last week, we talked about the symptoms and some of the causes of bladder irritation. Today we will focus on a condition that causes long-term bladder irritation symptoms called interstitial cystitis. This condition is common and may affect up to 12 million people in the US. Symptoms can vary but some people have severe symptoms that significantly impact their quality of life.

Interstitial cystitis (IC) is also called bladder pain syndrome. It is a chronic condition that causes symptoms of bladder irritation, including pain and pressure in the pelvis (especially as the bladder fills), urinary frequency and urgency, and pain when urinating.

• Defects in the protective lining of the bladder
• Allergies or problems with mast cells (which cause allergic symptoms)
• Autoimmune diseases
• Chronic inflammation in the body – Which can result from a variety of causes.
• Problems within blood vessels
• Abnormal substances in the urine, including consistently high protein levels.

• IC is more common in women. In the US, IC affects between 3-8 million women, and between 1-4 million men.
• IC is more common in people aged 30 or older.
• It is also more common in people who have another condition that causes chronic pain.

• Diary of diet and symptoms – I discussed this last week.
• Urinalysis – To look for red and white blood cells, protein, certain germs, etc.
• Urine culture – To determine what, if any, bacteria is present in your urine.
• Cystoscopy – Use of a thin lighted tube to look at the inside of your bladder, done in the office without anesthesia.
• Biopsy – Taking a tissue sample of your bladder wall and urethra (the tube leading form the bladder to the outside).
• Cystoscopy with hydrodistention – This is usually done under anesthesia. The cystoscopy is done while filling your bladder as big as possible with water. This may reveal cracks or ulcers in the bladder lining that might not show up when it is less full.

• Dietary changes – Last week, I talked about food and drink triggers for bladder irritation. Those things can cause more severe symptoms for people with IC. Look at last week’s tip for the list.
• Exercise/physical activity – Such as walking, bicycling, Yoga, or Tai Chi.
• Reducing stress – Try relaxation exercises. If you have very high stress levels, you may want to talk to a mental health professional to help.
• Physical therapy – This may include pelvic floor exercises.
• Bladder retraining – To help you hold more urine in the bladder.
• Oral medication – Might include OTC antacids, low dose amitriptyline, hydroxyzine.
• Medication instilled directly into the bladder
• Bladder stretching with hydrodistention (filling with water)
• Nerve stimulation
• Botox injection into the bladder muscle – done through a cystoscope.
• Surgery – Only recommended for severe and refractory cases.