WHAT IS INTERSTITIAL CYSTITIS?

Overview of Disease
Interstitial cystitis is a chronic pelvic pain condition characterized by pain or pressure perceived to be related to the urinary bladder and urgent/frequent urination.

LIVING WITH Interstitial Cystitis

Learn more what it's like to live with interstitial cystitis
SYMPTOMS

Symptoms of interstitial cystitis can vary greatly between individuals. In addition to pelvic pain and urinary urgency, common symptoms include:

  • Suprapubic pain
  • Painful intercourse
  • Urethral burning
  • Waking with the need to urinate at night
  • Low back, hip, groin, or tailbone pain
DIAGNOSIS

Interstitial cystitis is a diagnosis of exclusion, given in the absence of any identifiable cause of symptoms. Often a urine culture is run to rule out a urinary tract infection, and a cystoscopy may be conducted (though is not required for diagnosis) to check the bladder for ulcers or cancer. In past decades, a potassium sensitivity test was often used, but this test is not conclusive of interstitial cystitis and the American Urological Association specifically recommends not using it. There is no specific diagnostic test that can identify interstitial cystitis, and the condition may be diagnosed by symptoms alone.  

CAUSES AND RISK FACTORS

The cause of interstitial cystitis is not fully known at this time. Approximately 10% of patients have visible damage to the bladder lining, known as Hunner’s lesions, that contribute to symptoms. Researchers have noted a genetic link with interstitial cystitis, as family members or twins are more likely to have interstitial cystitis than the general population alone. More than 90% of patients with interstitial cystitis also have pelvic floor dysfunction, which can cause or exacerbate any of the symptoms of interstitial cystitis.  

There has also been correlation between interstitial cystitis and a history of urinary tract infections, other pain conditions like fibromyalgia and migraines, autoimmune disease, and bladder trauma.

Other factors that are believed to worsen an individual’s interstitial cystitis include:

  • Stress or other strong negative emotions
  • Sexual activity
  • Menstruation
  • Urinating or trying to hold urine in for too long
  • Dehydration
  • Exercise
  • Sudden or bumpy movements
  • Tight clothing
  • Sitting for too long
TREATMENT OPTIONS

There are a number of treatment options for individuals with interstitial cystitis. The American Urological Association has Interstitial Cystitis Guidelines, which they recommend patients follow in order, starting with those that have been proven to be the most safe and effective.

First Line of Treatment:

  • Education about the condition
  • Behavioral modifications, including changes in diet
  • Stress relief

Second Line of Treatment:

  • Oral medications, including amitriptyline, cimetidine, hydroxyzine, or pentosan polysulfate.
  • Pelvic floor physical therapy
  • Pain management
  • Bladder instillations of Heparin, Lidocaine, or a combination of the two

Third Line of Treatment:

  • Cystoscopy under anesthesia with short-duration, low-pressure hydrodistension
  • Fulguration of Hunner’s lesions (if present)

Fourth Line of Treatment:

  • Intra-bladder Botox (BTX-A)
  • Trial of neurostimulation

Fifth Line of Treatment

  • Cyclosporine A

Sixth Line of Treatment:

  • Surgery

Not to be Done:

  • Long-term antibiotics in the absence of a proven infection
  • Potassium-sensitivity test
  • Bacillus Calmette-Guerine (BCG) Instillations
  • Resinferatoxin Instillations
  • High pressure and long-duration hydrodistention
  • Long-term oral steroids
COMPLEMENTARY THERAPIES

Complementary therapies for interstitial cystitis range from physical therapy and lifestyle changes to mind-body medicine and energy medicine. Much like western medicine, complementary medicine is often a trial and error process; however, several methods have shown promise in helping treat it.

Physical Therapy:

  • bladder training
  • bowel training
  • strengthening and stretching the pelvic floor to control pelvic floor spasms

Complementary Therapy:

  • guided imagery
  • biofeedback
  • mindfulness meditation
  • yoga/pilates and other gentle exercise
  • acupuncture
  • acupressure
  • reiki
  • reflexology
  • tai chi

Other complementary and alternative treatment options are available, including stress reduction techniques, dietary supplements, and stretching routines.

DIET & NUTRITION

Many patients with interstitial cystitis notice their symptoms are flared or triggered by certain foods or drinks. While there is no set diet for interstitial cystitis, identifying and eliminating food triggers can substantially improve symptoms for diet-sensitive patients. The most commonly agreed upon lifestyle change is to stop smoking, as it can cause an increase in any painful condition and cause bladder cancer.

Diet and nutrition are more complex to figure out and should be dealt with on a case to case basis, usually with the help of a nutritionist; however, nutrition is thought to play a role in helping or hurting interstitial cystitis.

Eliminating foods that cause your body inflammation may help reduce pain, as well as reducing foods that irritate your bladder. Common trigger foods for patients with interstitial cystitis include:

  • Caffeine (including chocolate)
  • Carbonated drinks
  • Spicy foods
  • Acidic foods
  • Alcohol
  • Artificial sweeteners
  • MSG (monosodium glutamate)

Keeping a food diary can help you determine other foods that may increase your amount of interstitial cystitis pain or frequency/urgency may help determine the best diet for your specific case.

 

To find a more thorough information regarding IC and dietary changes, please visit: https://www.ichelp.org/living-with-ic/interstitial-cystitis-and-diet/

INTERSTITIAL CYSTITIS EXPERT

Learn a little more with Interstitial cystitis expert Nicole Cozean

Disclaimer: The educational information provided is not a substitute for medical advice. Always consult your primary care physician for diagnosis, treatment, and individual guidelines.