Alphabetical List of Conditions Treated / Interstitial Cystitis/Painful Bladder Syndrome
Interstitial Cystitis/Painful Bladder Syndrome
Overview. Interstitial cystitis (IC) is a chronic inflammatory bladder condition that can cause constant or occasional discomfort, with symptoms running the gamut from mild to severe. Although it can feel like a bacterial infection, no infectious organism is found in people with IC, and treatment with antibiotics is ineffective. Symptoms may include frequent urination, urinary urgency (the sudden, compelling need to empty the bladder), and pain in the pelvic region. The discomfort can be felt as pressure or tenderness, mild irritation or intense pain. Many IC patients complain that their symptoms worsen with certain foods or drinks, or when they are under physical or mental stress. For women, the pain can intensify during the menstrual cycle. For both men and women, pain during or after sexual activity is common.
Incidence. The varying types of symptoms and degrees of severity have led many experts to conclude that IC may actually be several diseases, and to use the umbrella term painful bladder syndrome (PBS) to cover cases of urinary pain not caused by infection, urinary stones, or other known culprits. Because of this, precise numbers are hard to come by, but the National Institute of Diabetes and Digestive and Kidney Diseases estimates that 1.3 million Americans have IC/PBS, most of them women – although it is possible that many men who are diagnosed with conditions such as prostatitis actually have IC/PBS.
Cause. While the cause of IC remains unknown, it is thought by many to be related to a breakdown in the bladder’s natural lining (epithelium), enabling toxins from the urine to penetrate into the bladder and resulting in inflammation, irritation, and a diminished ability to hold urine. Because IC and conditions such as fibromyalgia and irritable bowel syndrome often go together, some believe that the bladder symptoms may be part of a larger inflammatory condition. Researchers are also learning more about a substance found almost exclusively in the urine of people with IC, anti-proliferative factor (APF), which appears to interfere with the normal growth of the cells lining the inside of the bladder wall.
Diagnosis. The diagnosis of IC is difficult, and many patients see several doctors or are misdiagnosed before the disease is correctly pinpointed. No test has proved definitive, and there is disagreement over how the diagnosis should be made. A medical history, physical exam and urinalysis are always part of the process, as are tests to rule out other treatable conditions that could be causing the symptoms, such as urinary tract infections, bladder cancer, and chronic prostatitis or chronic pelvic pain syndrome in men. A bladder distension is often an important part of the diagnostic testing, and some patients report that it improves symptoms.
Treatment. Although there is no cure, there are a variety of treatments and lifestyle approaches that can reduce IC symptoms. These include biophysical techniques such as dietary restrictions, bladder retraining, transcutaneous electrical nerve stimulation (TENS), medications and surgery. Changing the diet can help – for some, that means reducing consumption of potassium- and acid-rich foods, spices and beverages that contribute to bladder irritation and inflammation. TENS delivers mild electrical pulses through the skin to stimulate the bladder nerves; this can relieve symptoms by increasing blood flow to the bladder, strengthening pelvic muscles, or changing the pain response. Two treatments have been approved by the U.S. Food and Drug Administration for the treatment of IC. The oral medication pentosan polysulfate (Elmiron) is designed to restore the protective coating of the bladder lining, and may also decrease inflammation. Dimethyl sulfoxide (DMSO) is inserted into the bladder through a catheter, usually at several weekly intervals, to block inflammation, reduce pain, and eliminate the “free radicals” that can damage tissue. Given the likelihood that there are several causes of IC, treatments tend to be individualized.
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