Interstitial cystitis (IC) is a disease that manifests as recurrent pain or discomfort in the bladder and the region of the pelvis that surrounds the bladder. The symptoms are usually different for every patient and one patient can have different symptoms with each flare up. Approximately 1 million people are affected by the condition – mostly women.
How severe the symptoms are may be different for each person as well. Some people with IC do have periods where it goes away as if in remission. Because of the differing symptoms and the fact that the symptoms are often more severe in some people than in others, it is thought that IC is actually several diseases.
It may help to understand better how the bladder functions in order to fully understand what interstitial cystitis is. The bladder is a hollow organ in which the urine is stored until you are ready to empty your bladder.
When the bladder is full, signals are sent to the brain using the pelvic nerves indicating that it is time to empty. This is what produces the urge to urinate. With IC, these signals are confused and the patient may feel the need to urinate more often but smaller volumes of urine are actually emptied from the bladder.
Having interstitial cystitis can cause a number of complications:
- It can make the walls of the bladder become stiffer, resulting in smaller capacity of the bladder.
- Pain and the increased need to urinate can inhibit work, social activities, and other things in the patient’s daily life.
- The constant need to urinate along with the pain can sometimes lead to emotional issues that can eventually lead to depression. Depression can worsen symptoms of any disease, including interstitial cystitis.
Interstitial cystitis is sometimes called IC. It is more simply referred to as painful bladder syndrome (PBS). Scientists who research this condition also call it bladder pain syndrome (BPS). Depending on the symptoms a patient has, doctors may use the term IC/PBS. They normally do this for all cases of urinary pain that aren’t connected to any other issue like an infection of kidney stones.
There is really known definitive cause of interstitial cystitis. Much research is done and focuses mostly on the lining of the bladder (the epithelium). This layer is there to protect the wall of the bladder from toxins in the urine. According to the research, in 70 percent of patients with IC this lining contains leaks. This suggests that these leaks may be allowing substances like chemicals from beverages or food that are in the urine to enter the bladder. These substances may irritate the bladder wall, triggering the IC.
The lining of the bladder wall is made up of protective substances. Researchers who study IC also believe that some people with the condition may have lower levels of these substances. This can be another reason for the damage to the wall of the bladder found in so many cases of IC.
A substance called antiproliferative factor (APF) has also been discovered that may block the normal production of the cells that make up the lining of the bladder. Nearly all of the time that APF is found in the urine it is with people who have interstitial cystitis.
There is another theory that suggests that IC is an autoimmune disorder or that infection may be the cause of the symptoms and the bladder damage.
As mentioned earlier, the symptoms of interstitial cystitis may differ from patient to patient. Someone with IC may also discover that his or her symptoms change with time. The symptoms can come on or become worse with certain physical or emotional triggers like menstruation, allergies, sexual activity, or anxiety and stress.
The symptoms of IC include:
- The continuous and pressing need to urinate.
- Urinating frequently in small amounts. Those who have severe cases of IC may urinate as much as 60 times in a day.
- Pelvic pain. In women the pain is between the vagina and the anus and in men it is between the scrotum and the anus.
- Pelvic pain during intercourse.
- Constant pain in the pelvis.
Some patients may have only the pain and others the urination symptoms. It is most common to have both the pain and the frequent urination.
Pain from interstitial cystitis can get worse if there is a urinary tract infection.
There are a few factors that can put people at a higher risk of interstitial cystitis:
- Sex – Women are diagnosed with IC considerably more often than men or children of either gender. Men can have similar symptoms that are normally associated with prostatitis.
- Age – This disease most often occurs between the ages of 30 and 40.
- Other chronic conditions – People who suffer from other chronic conditions like irritable bowel syndrome and fibromyalgia may be more prone to IC, however there is no known connection between these conditions.
Any preventative measures that can be taken against a recurrence of interstitial cystitis are based on the theory that it is caused by the damage done to the bladder wall. The advice is to avoid any continuing irritation of the bladder. One way to do this is by boosting the immune system:
- Visit an integrative internist. These doctors focus on your overall health and the concept of preventing disease as well as treating chronic illnesses. This type of doctor will do an in-depth study of your health history. This is important since IC can occur after another serious illness like fatigue, stress, or some type of infection that may have required antibiotics.
- This doctor can give you suggestions for boosting your immune system. These doctors practice both traditional and alternative medicine and can give advice regarding the proper vitamins and other supplements to take for the immune system. Probiotics are often recommended.
- Diet is especially important. If you eat the types of food that support gastrointestinal health, this can lead to a stronger immune system. This type of diet should include plenty of proteins, vegetables, and foods that are high in fiber. Organic food is better that non-organic and processed foods.
Another way to prevent IC is to keep the pH level in the body balanced.
- You should have the pH in your body tested regularly. “Potential of Hydrogen” is the amount of acidity or alkalinity in any solution. By testing the body’s pH you will know if you are more alkaline or more acidic. If the pH is not balanced properly, the body is considered to be toxic. The cells in a body that is toxic are not capable of absorbing the nutrients from food or oxygen.
- Eat the foods that will provide a healthy pH balance. The foods you eat should be 75 percent alkaline and 25 percent acidic. Too much acidic food can make the entire body too acidic, which can cause inflammation, irritation, lower energy, weak immune systems, and interstitial cystitis.
Test and Diagnosis
Since the symptoms of interstitial cystitis are so similar to those of things like urinary tract infections, bladder cancer, endometriosis in women, and prostatitis in men, the first thing that doctors will usually do is tests to rule those things out. The diagnosis of IC is generally based on pain in the bladder combined with frequent urination and the absence of other diseases that have the same symptoms.
To rule out the other diseases, a doctor may do a urinalysis to look for the presence of bacteria; a culture of prostate secretions to determine if there is a prostate infection; or an exam to rule out bladder cancer that consists of taking a sample of the bladder and urethra for biopsy.
The doctor will also perform a complete pelvic exam and what is known as a potassium sensitivity test. In this test a solution of water and one of potassium chloride are placed into the bladder one at a time. The patient is asked to rate his or her pain and need to urinate after the placement of each solution. If the pain and urgency is significantly higher with the potassium chloride, the doctor may diagnose IC.
There is no one treatment that works for interstitial cystitis in every patient. There are a number of treatments, including medications that can offer some relief but what works for one patient may not work for the next. This often results in trying several treatments before hitting on the one that is successful.
Herbal and Home Remedies
Besides following the dietary advice given in the section on Prevention, there are some other home remedies and herbal treatments that my help with interstitial cystitis.
1. Supplements and herbs
- Calcium Citrate – Taking a calcium citrate supplement adds alkaline to urine. This can reduce the bladder irritation.
- Gotu kola – This herb stimulates the production of the substances that make up the lining of the bladder.
- Buchu – This is a diuretic and antiseptic for the bladder and should be taken as a tea.
- Cornsilk – This also has diuretic properties and should be made into a tea.
- Horsetail – This herb has properties that heal tissue as well as acting as a diuretic.
When used correctly, supplements and herbal treatments don’t usually have any side effects and can be purchased for reasonable prices at drug stores or health food stores.
2. Bladder training – This involves teaching yourself to urinate according to the time on the clock rather than when you feel the need. Start at certain intervals, like every 30 minutes whether you feel the need to or not. You can gradually up the time by 30-minute increments. This technique can help you reduce the frequency of urination.
3. Loose clothing – Don’t wear anything that put pressure on your stomach.
There is only one prescription drug approved as a treatment for interstitial cystitis. This drug is Elmiron and it is not entirely understood how it works, but it is thought that the drug may restore the inner lining of the bladder. It can take anywhere from two to six months for you to notice a decrease in the frequency of urination. There are some minor side effects, which include slight gastrointestinal issues, and hair loss that stops when you are through taking the drug.
There are other oral medications that may help:
- Non-steroidal anti-inflammatory drugs like ibuprofen can relieve the pain.
- Antihistamines may sometimes help with the urgency to urinate.
- Tricyclic antidepressants can aid with relaxing the bladder to block pain.
Any minor side effects of these drugs can be found on the labels.
Surgery and Non-Surgical Options
There are some non-surgical procedures that can be done to help relieve the pain of interstitial cystitis:
- Electrical Nerve Stimulation – With the use of special devices either attached to the skin by wires or inserted into the vagina, electrical pulses can be sent to stimulate the nerves that go the bladder. This is known as transcutaneous electrical nerve stimulation (TENS) and is used to treat chronic pain for many conditions. It is thought that the electrical pulses enhance the blood flow to the bladder as well as make the pelvic muscles stronger that control the bladder. This treatment may also signal the body to release substances that block pain.This procedure is not very costly and takes about three to four months to produce results. Most insurance providers cover the procedure.
- Bladder Instillation – This procedure is also called a bladder wash and involves filling the bladder with a solution of a prescription medication called dimethyl sulfoxide. A local anesthetic is sometimes mixed with the solution. The solution is left in the bladder for about 15 minutes and then it is expelled when the patient urinates. This treatment can reduce inflammation and may even stop the muscle contractions responsible for pain as well as urgency and frequency of urination.This procedure has one side effect and it is not serious. It can cause a garlicky taste in the mouth and odor on the skin for several hours. Most insurance providers cover the procedure.
Interstitial cystitis is very rarely treated with surgery because the procedures do not necessarily relieve pain. Some of the procedures are very invasive and most of them can have complications. Surgery is usually only the option when all other treatments have failed.
The options for surgery include:
- Bladder augmentation – The damaged portion of the bladder is removed and replaced with a section from the colon. This makes the bladder larger. The pain usually remains. Women may often need to use a catheter to empty the bladder several times a day. The IC can also reoccur on the section of the colon that was used to make the bladder larger.
- Cystectomy – This is a removal of the entire bladder. There are several different methods used to reroute the urine when this is done, one of which involves attaching the ureters to a piece of the colon and cutting an opening in the abdomen so that the urine can empty into a bag outside the body.
- Fulguration – This procedure uses lasers to burn away ulcers in the bladder that may be causing the IC.
- Resection – This is similar to fulguration, but the ulcers are cut out rather than burned with a laser.
Fulguration and resection don’t always work and have been known to make symptoms worse.
A cystectomy or bladder augmentation can cost between $6,500 and $11,000. The other procedures are less invasive and cost less.