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Interstitial Cystitis

Overview

Interstitial cystitis refers to the condition in which a patient feels pain in the region above or at the position of the urinary bladder. The urinary bladder is a part of your urinary tract that collects and stores urine and empties itself upon stimulation by nerves. In this disorder, there is some abnormality in this process, and a patient feels pain on passing urine, increased need to go to the toilet, or pain in the region above the urinary bladder or the pelvic floor. It is sometimes called bladder pain syndrome. No cause nor cure has been established. It is found to be associated with some other chronic conditions like irritable bowel syndrome and fibromyalgia. A person can have an improved life by following some lifestyle changes, medications, and procedures.   

Causes

The exact cause of the condition is still under research. Many theories have been proposed. Some studies postulate the idea of a defect in the bladder lining, which on exposure to some irritants, starts to cause pain. Other studies associate it with some allergic reaction or prior viral infection. It has been linked to stress, depression, anxiety, and panic. 

Epidemiology

According to the current studies, 2.7% to 6.5% of women suffer from interstitial cystitis in the United States. It affects whites more than blacks and females more than males. 

Risk Factors

Some factors may predispose you to increased chances of having interstitial cystitis.

·         Gender: Females are more commonly seen to have the disorder

·         Age: Most commonly affected age group is in the 30s

 

·         Concomitant chronic diseases: It has been found to co-occur in patients having fibromyalgia, irritable bowel syndrome, etc.

Signs And Symptoms

People have different severity of symptoms. Some may have more than others. The most common symptoms include;

·         Pain in the suprapubic region

·         Pain in the pelvic floor (between vagina and anus)

·         Burning sensation during urinating (dysuria).

·         Increased frequency and urge to urinate

·         Discomfort or pain in the lower abdomen

·         Painful sexual intercourse

·         Frequent awakening during the nighttime to urinate

 

·         Inability to start a urinary stream (hesitancy)

Diagnosis

If you feel the above symptoms, contact your healthcare provider. They will take your detailed history to assess your symptoms carefully and perform a clinical examination. There is no specific test to diagnose interstitial cystitis. Diagnosis is made based on clinical symptoms and exclusion of other possible diseases. Your doctor may advise you to undergo the following tests;

Urinalysis: The doctor may ask you to submit a sample of clean urine which will be checked in the lab for urinary nitrites, white blood cells (leukocytes), leukocyte esterase, and red blood cells to rule out infections and other causes.

Urine culture: This test is also performed on your urine sample. In this test, a causative organism is grown in the lab, and its susceptibility to antibiotics is assessed.

Imaging studies:  Your doctor may advise imaging studies like Ultrasound, CT scan, or MRI to check for structural abnormalities, cancers, and stones.

 

Cystoscopy: In this test, a flexible tube with a camera is inserted in your urethra to view the inside of your bladder. During this test, a sample of tissue can be excavated from the bladder to study in detail under the microscope in the lab. It is called a biopsy. Hunner's ulcers are found in 5–10% of people with IC during cystoscopy.

Differential Diagnosis

Some related disorders can produce alike symptoms;

·         Overactive bladder

·         Urinary tract infection (UTI)

·         Sexually transmitted infections

·         Prostatitis

·         Endometriosis in females

 

·         Bladder cancer

Treatment

The treatment of interstitial cystitis can be challenging. Some people may show only little improvement. The following guidelines have been proposed by the American Urological Association for the treatment of interstitial cystitis. The management guidelines range from conservative to invasive and include;

·         First-line treatments: These include education about the disease, self-care, stress management, bladder retraining, and diet modification by including and excluding some items in the diet. In some people, pain is triggered by some specific food items. They are advised to stop them. Examples include; coffee, tea, soda, chocolate, alcoholic beveragescitrus fruits, and artificial sweeteners. For bladder retraining, some people are guided to make a diary to record their routine of urination and avoid multiple unwanted toilet visits.

·         Second-line treatments: Medications and physical therapy fall in the second-line treatments. Some effective oral medications include amitriptyline, cimetidine or hydroxyzine, and pentosan polysulfate. some people may benefit from direct instillation of medicine in the bladder. These medicines include; DMSO, lidocaine, or heparin.

·         Third-line treatments: The next step includes treating Hunner’s lesions found in some patients. They can be treated by procedures like laser, fulguration, or triamcinolone injection and hydrodistention, distension of the bladder with water for a short duration, and low pressure.

·         Fourth-line treatments: In this step, manipulation with the nerves supplying the bladder is done to improve pain. it is called neuromodulation and involves the sacral or pudendal nerve.

·         Fifth-line treatments: Only some patients may benefit from the medicine cyclosporine A and injections of botulinum toxin.

 

·         Sixth-line treatments: These are the last resort and include surgical intervention. The procedures that can be helpful include;  urinary diversion, augmentation, or cystectomy.

Prognosis

Interstitial cystitis follows a chronic course associated with intermittent periods of exacerbations and remissions. It can severely affect a patient's quality of life and even lead to depression. 

Lifestyle Modifications

To cope with the disease, following lifestyle changes must be adopted to have a peaceful life.

·         Diet improvement: A person is advised to take a healthy balanced diet that must have vitamins, minerals, amino acids, antioxidants, etc., and avoid caffeine, alcohol, tobacco, spices, citrus, etc.

·         Urinary schedule: A diary should be maintained for urinary habits.

·         Hydration: Drink plenty of fluids, especially water. Drinking 8 glasses of water per day are recommended.

·         Stress management: Exercises and therapies should be initiated to manage stress.

·         Exercises: A person is advised to perform some form of exercise regularly. 

·         Sleep therapy:  Education must be given about sleep hygiene, and a regular sleep-wake schedule should be followed.

 

·         Psychological therapies: A person should undergo cognitive behavioral therapy or psychotherapy to control the symptoms of anxiety and depression and to learn to adapt to stress.