Interstitial cystitis is a painful urologic condition that affects men and women.
Interstitial Cystitis (IC) or chronic pelvic pain is a chronic inflammatory condition of the bladder and/or pelvic region that affects millions of men, women and children. While most commonly found in women, it can affect people of any age, race or gender. Symptoms associated with this condition include pain, painful urination, urinary frequency, urinary urgency, and painful intercourse. Other symptoms might include muscle and joint pain, migraines, allergies and gastrointestinal problems.
Unfortunately, many IC sufferers have difficulty obtaining a diagnosis since symptoms are similar to other urologic conditions. Nonetheless, the effect of IC on an individual’s quality of life should never be underestimated. IC symptoms can be debilitating and may cause the patient to experience feelings of helplessness and despair. Thankfully, there is an improved understanding and awareness of pelvic pain by the medical community and the public at large.
What causes interstitial cystitis?
There are many theories as to the cause of interstitial cystitis. One prominent theory relates to the cells that line the inside of the bladder. The internal lining of the bladder is protected from toxins in the urine by a layer of protein called Glycosaminoglycan. For persons with interstitial cystitis, this protective layer may be broken down, which allows toxins to irritate the bladder wall. The bladder may then become inflamed, tender, and fail to store urine well.
Another theory is that IC is an autoimmune response following a bladder infection. Still others believe that bacteria may be present in bladder cells that are not detectable through a routine urine test. Some scientists have also suggested that certain substances in the urine may be irritating to people with IC. Unfortunately, no specific substance – unique to people with IC – has been isolated. Researchers are beginning to explore the possibility that heredity may also play a part in some forms of IC.
Interstitial cystitis symptoms
Early in the disease process, IC symptoms can closely resemble those of a bladder infection, making it difficult to diagnose. It can also mimic other urologic health concerns. interstitial cystitis symptoms can include:
- Pain in the lower abdomen.
- Frequent urination during day and night.
- Urgent urination.
- Pain associated with sexual relations.
- Vulvar pain and may experience pain in the perineum (women).
- Pain as the bladder fills with some relief after urination.
- Increased pain during menstruation
- Pain and inflammation of the prostate (men).
- Painful ejaculation.
The symptoms of IC do not go away on their own, but may persist and worsen. Generally, symptoms tend to get worse within the first 5 years and then level off. Patients with IC typically experience a period of symptom flare, or intensification, followed by periods of remission.
How is chronic pelvic pain diagnosed?
Because pelvic pain symptoms are similar to those of other disorders, doctors must first rule out other conditions before diagnosing interstitial cystitis. Here are some of the diagnostic steps that may be taken during an office visit:
- Review of personal medical history.
- Review of symptoms.
- Physical examination.
- Urinalysis – A urine analysis / culture may not show abnormalities. However, a small amount of red blood cells may be found in the urine (hematuria).
- Prostatic fluid may be cultured (men),
- Cystoscopy – Performed under general anesthesia, this procedure is used to evaluate the patient’s bladder health. Initially, the bladder is stretched with water, allowing the provider better visualization of the bladder wall. Next, a small, telescopic fiber-optic camera, or scope, is inserted through the urethra into the bladder. At this point, the urologist can examine the bladder epithelium. During the examination, they may detect bladder wall inflammation, a thick, stiff bladder wall, or Hunner’s ulcers. Glomerulations (tiny hemorrhages that can be signs of IC) may also be revealed while the bladder is stretched to capacity. These hemorrhages may be present in up to 95% of IC cases.
- Biopsy of the bladder – Tissue samples are removed and analyzed to distinguish between ulcers and possible cancer. Testing will also help evaluate the presence of mast cells, which are sometimes seen in abundance in IC-affected bladders. Some IC sufferers do not have epithelial glomerulations or ulcers.
Interstitial cystitis treatment options
Unfortunately, there is no known cure for chronic pelvic pain; the goal of treatment is to relieve symptoms. However, there are options to lessen the severity of the condition. Many individuals are helped by applying one or a combinations of treatment options. Treatments can include:
- Oral medications
- Bladder instillation
- Dietary changes to avoid irritants
- Bladder training to reduce urinary frequency
- TENS unit for pain control
If you are suffering with unexplained, chronic pelvic pain, contact Urology Austin to schedule an appointment with one of our urologists.