Interstitial Cystitis

Interstitial cystitis is a chronic condition resulting in recurring discomfort or pain in the bladder (Read about "The Urinary System") and the surrounding pelvic region. According to the National Kidney and Urologic Diseases Information Clearinghouse, the symptoms of interstitial cystitis or IC vary from case to case and even in the same individual, but they include:

• mild discomfort, pressure, or tenderness in the bladder and surrounding pelvic area
• intense pain in the bladder and surrounding pelvic area
• an urgent need to urinate (urgency) and or a frequent need to urinate (frequency)
• pain that changes in intensity as the bladder fills with urine or as it empties

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says interstitial cystitis is far more common in women than in men. Of the more than 700,000 Americans estimated to have IC, 90 percent are women. Many women with IC find that their symptoms get worse during menstruation.

Causes of IC

In IC, the bladder wall may be irritated and become scarred or stiff. Glomerulations (pinpoint bleeding caused by recurrent irritation) may appear on the bladder wall. Some people with IC find that their bladders cannot hold much urine, which increases the frequency of urination, sometimes up to 60 times a day. Also, people with IC often experience pain during sexual intercourse.

NIDDK says some of the symptoms of IC are similar to those of other diseases and disorders, including urinary tract infections (Read about "Urinary Tract Infections") and endometriosis in women (Read about "Endometriosis") and, in men, chronic bacterial and nonbacterial prostatitis (Read about "The Prostate"). IC's symptoms can also mimic those of bladder cancer (Read about "Bladder Cancer"), bladder inflammation or infection caused by radiation to the pelvic area, eosinophilic and tuberculous cystitis, kidney stones (Read about "Kidney Stones"), neurological disorders, sexually transmitted diseases and low-count bacteria in the urine.

However, even though some of the symptoms of IC resemble those of bacterial infection (Read about "Microorganisms"), medical tests often reveal no bacteria in the urine of patients with IC. Furthermore, patients with IC do not respond to antibiotic therapy, as do patients who have, for example, urinary tract infections.

The National Institutes of Health are looking into potential causes of IC. One theory being studied is that IC is an autoimmune response following a bladder infection. Another theory is that bacteria may be present in bladder cells but it's not detectable through routine urine tests. Researchers are also looking into heredity as a contributing factor.

Diagnosing IC

Because IC symptoms can be indicative of other conditions, and because there is no definitive test to identify IC, doctors must rule out other conditions before considering a diagnosis of IC.

According to NIDDK, diagnostic tests that help identify or rule out other conditions include urinalysis, urine culture, cystoscopy, biopsy of the bladder wall (Read about "Endoscopy" "Biopsy"), urine cytology and, in men, laboratory examination of prostate secretions. (Read about "Laboratory Testing") For example, if white and red blood cells and bacteria in the urine indicate an infection of the urinary tract, it can be treated with an antibiotic. If, on the other hand, urine is sterile for weeks or months while symptoms persist, the doctor may consider a diagnosis of IC. If other causes are ruled out, the most important test to confirm IC is a cystoscopy under anesthesia.

Treatment options

If IC is diagnosed, factors that influence treatment options include bladder size and whether mast cells are present in the tissue of the bladder wall. (For a definition of mast cells and other terms associated with the immune system see "The Immune System" and "Immune System Glossary") Mast cells may be a sign of an allergic or autoimmune reaction. (Read about "Allergies") Right now, most treatment options aim to reduce symptoms.

The National Kidney and Urologic Diseases Information Clearinghouse says options include

• bladder distention to increase bladder capacity
• bladder instillation, also called a bladder wash or bath
• oral medication, including analgesics
• surgery, in severe cases

Some patients also report feeling better when they eliminate potentially irritating foods such as spices, tomatoes, alcohol, and acidic foods, from their diet.

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