Interstitial cystitis (painful bladder syndrome)

Definition and facts

What is the interstitial cystitis?

Interstitial cystitis, also known as painful bladder syndrome, is a long-lasting or chronic condition that causes painful urinary symptoms. Symptoms can vary from person to person. For example, some people may experience mild discomfort, pressure, or tenderness in the pelvic area, while others may experience severe pain in the bladder or struggle with urinary urgency (the sudden need to urinate) or urinary frequency (the need to urinate). urinating more often).

Health care professionals diagnose interstitial cystitis by ruling out other conditions with similar symptoms.

Researchers do not know the exact cause of this condition. Some think it could be the result of conditions that cause inflammation in various organs and parts of the body.

Severe symptoms of interstitial cystitis can affect a patient’s quality of life. The patient may feel that they cannot exercise or leave the house because they have to go to the bathroom too often, or maybe their relationship is suffering because sexual intercourse is painful.

Working with health care professionals, such as a urologist or urogynecologist, along with a pain specialist, may help improve symptoms of interstitial cystitis.

Illustration of the urinary tract and pelvis.
Interstitial cystitis can cause pain in the bladder and pelvic area.

How common is interstitial cystitis?

Interstitial cystitis is common. In the United States, the condition can affect between 3 and 8 million women, and between 1 and 4 million men. 1

Who is most likely to develop interstitial cystitis?

Interstitial cystitis can occur at any age, including childhood, but it is more common in adult women and men. About two women for every man are affected. 1 However, more men may be affected by interstitial cystitis than researchers initially thought.

Some research suggests that women are more likely to develop the condition if they have a history of sexual abuse or physical trauma. two

What other health problems do people with interstitial cystitis have?

Many women with interstitial cystitis are more likely to develop other conditions, such as irritable bowel syndrome , fibromyalgia, and chronic fatigue syndrome . 3 Allergies and some autoimmune diseases are also associated with interstitial cystitis. 4

Vulvodynia, a chronic pain in the vulva that often produces a burning or stinging sensation, or roughness, is commonly associated with interstitial cystitis. 2 Vulvodynia has symptoms that coincide with those of interstitial cystitis.

What are the complications of interstitial cystitis?

Symptoms of interstitial cystitis, such as urgency, frequency, and pain, can force the patient to decrease their physical and social activity and negatively affect their quality of life.

Women with pelvic pain or vulvodynia often experience pain during sex, which can spoil their relationships and their self-image. Men may also experience pelvic pain that causes discomfort or pain during sexual intercourse. Sometimes sexual activity can increase bladder pain attacks, also known as symptom flares.

Sexual complications can cause people to avoid more intimacy, possibly causing depression and feelings of guilt. To the Like many people dealing with chronic pain, people with interstitial cystitis are more likely to struggle with sleep loss (in English) because of the frequent need to urinate, and anxiety and depression (in English) . 5

Generally, clinical tests such as pelvic exams and Pap tests are painful for women with symptoms of interstitial cystitis, especially those who may have pelvic floor muscle spasms; however, these tests should not be avoided. Women should consult with health care professionals about how to make pelvic exams and Pap tests more comfortable, and how often they should be done.

Bibliography

[1] What is interstitial cystitis? 4 to 12 million may have IC. Interstitial Cystitis Association website. www.ichelp.org/about-ic/what-is-interstitial-cystitis/4-to-12-million-may-have-ic (en inglés). Updated February 18, 2015. Accessed June 14, 2017.

[2] Mayson BE, Teichman JM. The relationship between sexual abuse and interstitial cystitis/painful bladder syndrome. Current Urology Reports. 2009;10(6):441–447.

[3] Nickel JC, Tripp DA, Pontari M, et al. Interstitial cystitis/painful bladder syndrome and associated medical conditions with an emphasis on irritable bowel syndrome, fibromyalgia and chronic fatigue syndrome. The Journal of Urology. 2010;184(4):1358–1363.

[4] Ruutu M, Leppilahti M, and Sairanen J. Epidemiology. In: Nordling J, Wyndaele JJ, van de Merwe JP, Bouchelouche P, Cervigni M, Fall M, eds. Bladder Pain Syndrome: A Guide for Clinicians. New York, NY: Springer US; 2013:11–19.

[5] Chuang YC, Weng SF, Hsu YW, Huang CL, Wu MP. Increased risks of healthcare-seeking behaviors of anxiety, depression and insomnia among patients with bladder pain syndrome/interstitial cystitis: a nationwide population-based study. International Urology and Nephrology. 2015;47(2):275–281.

Symptoms and causes

What are the symptoms of interstitial cystitis?

People with interstitial cystitis often have discomfort, pressure, tenderness, or pain in the bladder, lower abdomen, and pelvic area. Symptoms vary from person to person, they can be mild or strong and even change in each person as time passes.

Symptoms may include a combination of:

Urgency

Urgency is the sensation that the person feels that they need to urinate at that very moment. A strong urge is normal if you have not urinated for a few hours or if you have been drinking a lot of fluids. The person with interstitial cystitis may feel pain or burning, along with an urgent need to urinate before the bladder has had time to fill.

Frequency

The frequency is urinating more often than the person thinks he should need, given the amount of fluid he is drinking. Most people urinate four to seven times a day. Drinking large amounts of fluid can cause more frequent urination. Taking blood pressure medications called diuretics, or water pills, can also cause more frequent urination. Some people with interstitial cystitis have a strong and painful urge to urinate many times a day.

Pain

As the bladder begins to fill, the person may experience pain, as well as discomfort, that worsens until they urinate. The pain usually improves for a time once the bladder is emptied. People with interstitial cystitis rarely have constant pain in the bladder. The pain can go away for weeks or months and then come back. Sometimes people with interstitial cystitis refer to a bladder pain attack as a flare-up of symptoms.

Some people may feel pain without urgency or frequency. This pain can come from a spasm in the pelvic floor muscles, the group of muscles that attach to the pelvic bones and support the bladder, bowel, and uterus or prostate. During sexual intercourse, this pain caused by spasm in the pelvic floor muscles may get worse.

What Causes Interstitial Cystitis?

Researchers are working to understand the causes of interstitial cystitis and find effective treatments. Although the exact cause of interstitial cystitis is unknown, it may be determined that certain events or factors initiate or trigger flare-ups of symptoms; These flare-ups can make interstitial cystitis feel worse. Some people have reported that their symptom flare-ups occur when 6

  • are stressed, or feel certain emotions, such as anger or sadness
  • have sex
  • have a menstrual cycle
  • have a urinary tract infection
  • urinate or hold urine for too long
  • skip meals or are dehydrated
  • feel the changes of the seasons or the weather
  • have allergies
  • experience abrupt or jerky movements
  • take certain medications or forget to take their medications
  • wear tight underwear and pants
  • use laundry detergents with certain chemicals or bathe in pools treated with certain chemicals
  • use certain brands of toilet paper
  • do certain physical activities, such as pushing or lifting heavy objects
  • stand for a long time
  • they do a Pap test
  • take antidepressants , sinus medications, or pain relievers

The patient should consult with their healthcare professional regarding the management of symptom flare-ups. If you know what triggers your symptoms, you may want to avoid them. However, if factors that affect your health, such as having sex, a Pap test, or certain medications, cause flare-ups of symptoms, you should see your healthcare professional right away.

You may also want to learn more about which foods and drinks could trigger flare-ups .

Bibliography

[6] Sutcliffe S, Bradley CS, Clemens JQ. Urological chronic pelvic pain syndrome flares and their impact: qualitative analysis in the MAPP network. International Urogynecology Journal. 2015;26(7):1047–1060.

Diagnosis

How do healthcare professionals diagnose interstitial cystitis?

To diagnose interstitial cystitis, healthcare professionals use the patient’s medical history, a physical exam, and laboratory tests.

The healthcare professional will ask if the patient has a history of health problems  related to interstitial cystitis. They will also ask about symptoms  and other factors to help find the cause of bladder problems.

For patients with symptoms of interstitial cystitis, your healthcare professional may also do a pelvic exam. During the pelvic exam, the healthcare professional will examine the patient’s pelvic floor muscles to determine if any of her pain symptoms are related to pelvic floor muscle spasm.

For men, your healthcare professional may do a digital rectal exam  to check for prostate problems and to check your pelvic floor muscles.

Doctors diagnose interstitial cystitis based on:

What tests do doctors use to diagnose interstitial cystitis?

A healthcare professional may use the following tests to examine the inside of the urethra and bladder, and even take a tissue sample from inside the bladder. The healthcare professional will use tests to rule out certain diseases and conditions, such as urinary tract infections and bladder cancer. If the patient’s test results are normal and all other diseases and conditions are ruled out, the doctor might diagnose interstitial cystitis.

Urinalysis and urine culture (urine culture)

The doctor’s office may give the patient a container to take to the bathroom. A healthcare professional will give you directions on how to collect the urine in the container. The presence of white blood cells, red blood cells, and bacteria in the urine could indicate a urinary tract infection, which can be treated with an antibiotic.

Cystoscopy

Doctors can use cystoscopy  to examine the inside of the urethra and bladder. Doctors use a cystoscope, a tube-like instrument, to check for ulcers, cancer, inflammation, redness, and signs of infection in the bladder. The tip of this long, thin instrument glides smoothly through the urethra into the bladder.

Illustration of a cystoscopy.  The cross section shows the cystoscope inserted into the urethra.  Fluid flows from a bag through the cystoscope to fill the bladder.  The cross section shows the uterus, vagina, anus, and rectum.
Your doctor may perform a cystoscopy to diagnose interstitial cystitis.

Treatment

How do doctors treat interstitial cystitis?

Researchers haven’t found a treatment for interstitial cystitis that works for everyone. Doctors use current treatments to relieve symptoms for each person individually.

The healthcare professional will work with each patient to find a treatment plan that meets their needs. The plan may include:

  • Changes in lifestyle
  • bladder training
  • physiotherapy
  • medicines
  • bladder procedures

Some treatments may work better than others. The patient may also need to use a combination of these treatments to alleviate their symptoms.

The healthcare professional may ask the patient to fill out a form, called a symptom scale, with questions about how they are feeling. The symptom scale could allow the healthcare professional to better understand how the patient responds to treatment.

The patient may need to try a number of different treatments before finding one that works for them. Symptoms may go away with treatment, with a change in diet, or for no apparent reason. Even when symptoms go away, they can return after days, weeks, months, or even years. Researchers do not know why. Over time, the patient and the doctor should be able to find a treatment that gives them some relief and helps them cope with interstitial cystitis.

Changes in lifestyle

Change eating habits. Some people with interstitial cystitis find that certain foods or drinks trigger their symptoms. Others do not find a relationship between symptoms and what they eat. However, the patient should make sure they drink enough water to stay hydrated and consult with a healthcare professional about how much fluids to drink to prevent dehydration based on their health, level of physical activity, and where they live. . Additional information about diet, diet, and nutrition and how they relate to interstitial cystitis .

Give up smoking. Some people find that smoking makes their symptoms of interstitial cystitis worse. Researchers don’t know for sure how tobacco affects interstitial cystitis. However, smoking is a major cause of bladder cancer . If the patient smokes, one of the best things he can do for his bladder and general health is to stop smoking.

If the patient smokes or uses other tobacco products, they should stop. You can ask for help so you don’t have to do it alone. You can start by calling the National Smoking Cessation Line at 1-800-QUITNOW or 1-800-784-8669. You can get tips on how to quit smoking at Smokefree.gov .

Stress reduction Researchers do not believe that stress causes interstitial cystitis; however, stress can trigger flare-ups of painful symptoms in some people with this disorder. If the person is feeling stressed, they should try relaxation techniques  and other activities that may calm them down, such as:

  • observe nature around you
  • listen to soft music
  • perceive smells around you
  • savor every bite of a special food
  • breathe gently

Stay physically active. If you have interstitial cystitis, you might think that the last thing you want to do is be physically active. However, many people find that easy activities like walking or gentle stretching exercises  help relieve symptoms.

Seek support. Having the emotional support of family, friends, and others with interstitial cystitis is a very important part of helping you cope. Patients who learn about the disorder and become involved in their own care do better than those who do not.

Bladder training

Bladder training can help the bladder hold more urine. Generally, people with bladder pain get into the habit of going to the bathroom as soon as they feel the need to urinate to avoid the pain or urge. Then they feel the urge to urinate again before the bladder is really full. The body can get used to urinating frequently. Bladder training helps the bladder hold more urine before the body prompts it to urinate.

The patient should keep a bladder diary to keep track of how he is doing (PDF, 117.53 KB) . You should start by noting when you urinate. For example, you may have to go to the bathroom every 40 minutes. You should try to wait a few more minutes and gradually stretch the time between one urination and another. This can be easier if the person is well hydrated. Learn more about the importance of getting enough fluids in your diet .

If the patient’s bladder hurts, he should urinate. You may find that the first need to go to the bathroom disappears if you ignore it. You need to find ways to relax  or distract yourself when the first urge strikes.

After a week or two, the patient may be able to extend the time up to 50 to 60 minutes, and they may notice that the urge to urinate does not return as soon.

Physiotherapy

If the patient has symptoms of interstitial cystitis or pelvic floor muscle spasms, the doctor may suggest that they work with a physical therapist who specializes in pelvic floor problems. The physical therapist will work to stretch the tight pelvic floor muscles and help keep them relaxed.

Medicines

To help control mild bladder pain, the doctor may suggest that the patient take over-the-counter pain relievers (pain relievers), such as:

The patient should consult with the doctor if he thinks he needs a stronger pain reliever. If you have severe pain, your doctor may need to prescribe narcotic pain relievers or pain relievers such as acetaminophen with codeine or longer-acting narcotics.

However, in some people, certain antidepressants , sinus medications, and pain relievers can trigger flare-ups of symptoms. The person should check with their healthcare professional if these medications make their interstitial cystitis worse.

Long-term use of pain relievers can be dangerous. The doctor should be consulted on how to safely manage chronic or long-term pain, possibly with the help of a pain specialist – that is, a doctor who diagnoses, treats, and manages pain. The person may also want to inquire about alternatives to pain relievers or supplemental pain relievers .

If lifestyle changes, bladder training, physical therapy, and pain relievers don’t do enough to relieve the symptoms of interstitial cystitis, your doctor may prescribe other medications, such as:

All medications, even over-the-counter ones, have side effects. You should always check with your doctor before using any medication or supplement for more than a few days.

A woman with medicines in her hand and a glass of water
If lifestyle changes, physical activity, and over-the-counter pain medications don’t do enough to relieve the symptoms of interstitial cystitis, your doctor may prescribe other medications.

Bladder instillation

Some people with interstitial cystitis find relief after a treatment in which the doctor places a small amount of liquid medicine into the bladder, known as bladder instillation or bladder flushing or bathing. The doctor slides a tube (catheter) into the patient’s bladder and slowly adds a liquid that soothes the irritation of the bladder wall. The liquid may be a compound called dimethylsulfoxide (DMSO) or a solution that contains heparin, steroids, and a topical anesthetic, such as short-acting lidocaine , or long-acting marcain.

The patient will be asked to hold the fluid in the bladder for about 15 minutes and then release it. The patient can receive this treatment once a week or every two weeks for 1 to 2 months. The patient may not feel improvement until the third or fourth treatment.

Bladder stretch

Your doctor may use a procedure known as a bladder stretch, or hydrodistention, to treat bladder pain, even if only for a short time. Bladder stretching occurs when the doctor fills the bladder with water to stretch it. It is done under local or general anesthesia to help tolerate the procedure.

Some people feel temporary relief from symptoms after this treatment. Researchers aren’t exactly sure why stretching the bladder helps some people. Stretching can temporarily block pain signals sent by nerves in the bladder.

Sometimes pain symptoms can be temporarily worse 4 to 48 hours after bladder stretching. However, pain levels should return to their previous level or improve within 2 to 4 weeks.

Surgery

Most people with interstitial cystitis do not require surgery. If all other options have been tried and the pain is still excruciating, the patient and doctor might consider surgery to either:

  • enlarging the bladder, a procedure known as bladder augmentation,
  • removing the bladder, which is known as a cystectomy, or
  • diverting the normal flow of urine, known as a urinary diversion .

The patient should talk with the doctor and his family about the possible benefits and side effects of bladder surgery. Surgery does not cure the pain of interstitial cystitis in all cases.

Food, diet and nutrition

Can what the patient eats or drinks alleviate or prevent interstitial cystitis?

No research has consistently linked certain foods or beverages to interstitial cystitis. However, some research strongly suggests a relationship between diet and symptoms. Eating a healthy diet and staying hydrated are important for general health, including bladder health.

A man packing apples into a bag at the supermarket.
No research has linked certain foods or beverages to interstitial cystitis, although healthy eating is important for overall health, including bladder health.

However, some people with interstitial cystitis find that certain foods or drinks trigger their symptoms. Coffee, sodas, alcohol, tomatoes, spicy and spicy foods, chocolate, caffeinated drinks, juices and citrus drinks, MSG (monosodium glutamate), and foods high in acid can trigger or worsen the symptoms of interstitial cystitis. Some people also find that their symptoms get worse after eating or drinking products with artificial sweeteners, or sweeteners that are not found naturally in food and beverages.

Learning which foods trigger or worsen symptoms may take a bit of effort. The patient should keep a food diary and note the times that he or she feels pain in the bladder. For example, the diary could show that symptom flare-ups always occur after eating tomatoes or oranges. If the patient finds that certain foods make his symptoms worse, his healthcare professional and dietitian can help him avoid them with an eating plan. Find an expert for advice on how to use the nutrition and ingredient information on food labels. The patient can use this information to help him avoid eating or drinking things that cause bladder pain.

By stopping certain foods and drinks, and then incorporating them one at a time back into what they normally eat and drink, it can help you determine which foods or drinks, if any, affect their symptoms. The patient should consult with a health care professional about the amount of fluids to drink to prevent dehydration based on their health, level of physical activity, and where they live. Water is the best liquid for bladder health.

Some doctors recommend taking an antacid with food. This medicine reduces the amount of acid that enters the urine.

Clinical trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research on many diseases and conditions.

What are clinical trials? Are They Right For You?

Clinical trials are part of clinical research and are at the core of all medical advancements. Clinical trials look for new ways to prevent, detect, or treat diseases. Researchers also use clinical trials to look at other aspects of health care, such as improving the quality of life for people with chronic diseases. Find out if clinical trials are right for you .

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Source Agency: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)