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Interstitial cystitis
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VOL 114 / NO 6 / DECEMBER 2003 / POSTGRADUATE MEDICINE
You feel discomfort and pain in the area of your bladder and pelvis. You have to urinate much more often than other people, even on days when you don't drink that much water; sometimes you feel you won't make it to the bathroom in time. Your doctor tells you that you have interstitial cystitis, a disease that affects between 450,000 and 700,000 people in the United States. An often misunderstood condition that is easily confused with other diseases, it wasn't recognized by doctors until about 20 years ago.
What is interstitial cystitis?
An inflammation of the bladder wall, interstitial cystitis is thought to result from the breakdown of a layer of protein that normally protects the bladder lining from toxins in urine. The toxins irritate the bladder wall, which bleeds and can become scarred and stiff. At this stage, the bladder can't expand normally and can't hold as much urine as it used to.
What causes interstitial cystitis?
One of the reasons interstitial cystitis is so frustrating is that no one knows what causes it. We do know that it isn't caused by an infection with any known bacteria and doesn't commonly run in families.
What are the symptoms?
Symptoms vary from person to person and may change over time. They include the frequent urge to urinate, the need to urinate immediately, and mild to severe pain, pressure, or tenderness in the area of the bladder that may change as the bladder fills or empties. Some people with this disorder urinate up to 60 times a day. For women, symptoms may worsen during menstruation and may include pain during sexual intercourse. Pregnancy can make the symptoms worse or better. For men, pain may occur in the area of the prostate.
Who is most likely to have interstitial cystitis?
About 90% of the people in the United States who have the condition are women. Interstitial cystitis mainly affects people over age 40, but it can affect younger adults and even children.
How is it diagnosed?
Interstitial cystitis is often misdiagnosed as a urinary tract infection or another condition. To make sure the symptoms aren't due to another disorder, the doctor may conduct several tests, such as a urinalysis or, in men, an examination of prostate fluid. An examination of the bladder called cystoscopy is done to check for pinpoint bleeding and star-shaped sores called Hunner's ulcers and to see how much fluid or gas the bladder can hold. In some cases, the doctor takes a tissue sample from the bladder. Because cystoscopy can be painful for people with interstitial cystitis, it is done under anesthesia.
How is it treated?
There is no cure for interstitial cystitis, but particular procedures, drugs, and lifestyle changes can help many people find relief from their symptoms. Some people choose to have a procedure called bladder distention, in which their bladder is stretched to allow it to hold more urine at a time. Others undergo a bladder instillation (also called a bladder wash or bath), in which the bladder is filled with a solution that is held for 10 to 15 minutes before being emptied. Still others find relief with a process called transcutaneous electrical nerve stimulation (TENS), in which mild electric impulses are applied to the bladder area.
Other treatments that work for some people include taking certain drugs, giving up smoking, doing exercises at home that gently stretch the bladder, or sticking to a urination schedule. Although there is no proof that diet influences interstitial cystitis, some people believe that it helps to avoid alcohol, tomatoes and other high-acid foods, spices, chocolate, citrus beverages, caffeine, and artificial sweeteners.
If none of these treatments work for you, your doctor may recommend surgery to remove scarred tissue, make the bladder bigger, or, in rare cases, remove the entire bladder.
This information is not a substitute for medical treatment.
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