What is Interstitial Cystitis (IC)?
Interstitial Cystitis (IC) is a chronic condition where the protective lining of the bladder develops abnormal changes. These abnormal changes can lead to urinary frequency and urgency, burning with urination, pain with sex, and pain/pressure in the bladder and/or pelvic area. These symptoms tend to worsen over time if left untreated.
IC affects both men and women, but it is more common in females. One study suggests 1 out of every 8 women may be suffering from IC. It is estimated that more than 1.3 million Americans have IC, but many more may be undiagnosed.
The exact cause of IC is unknown, but there is research that reveals several theories. It is not known if the changes in the bladder lining cause the symptoms or if there is an underlining disorder that causes the changes in the bladder lining. Due to the changes in the bladder lining the bladder nerves and nerves to other surrounding organs (pelvis, abdomen and hips) become highly sensitive. The symptoms of IC may begin on their own or there may be an event which triggers symptoms to start such as a urinary tract infection, vaginitis, trauma or surgery.
What are the symptoms of IC?
IC is a disorder that has multiple symptoms associated with it. Many patients have a combination of symptoms that can vary from day to day. They may also develop flares where symptoms are more pronounced for a period of time. The most common symptoms of IC are:
- Urinary frequency: Urinary frequency is when a woman has an increased amount of urination. Patients with IC may have an increased need to urinate during the day or night. Patients with IC may urinate more than 8-10 times per day and more than 1-2 times at night.
- Urinary urgency: Urinary urgency is the need for immediate urination and cannot be ignored. This urgency may cause discomfort or pain. It also may cause the feeling to urinate again after emptying your bladder.
- Pelvic pain, discomfort, or pressure: The pelvic pain, discomfort, or pressure of IC is commonly felt in the lower pelvis above the pelvic bone. The pain may increase when the bladder is full and may be relieved by urination. Many patients with IC also experience pelvic pain during sex.
How is IC diagnosed?
The diagnosis of IC can often be difficult because the exact cause of IC is unknown and the symptoms of IC mimic other disorders. It is not unusual for a patient to have seen 3-4 different healthcare providers and or spent 3-4 years before an accurate diagnosis is made. There is no one test that can identify IC. Diagnosing IC is made by inquiring about symptoms, physical exam, questionnaires and excluding other causes of the symptoms.
A combination of the following may help aid in your diagnosis:
- Health history and physical exam: The healthcare provider will inquire about your symptoms and do a physical exam to aid in finding the source of your pelvic pain.
- Pain and Urgency/Frequency Questionnaire (PUF): The PUF Questionnaire was developed to evaluate the symptoms of IC and aid healthcare providers in making a diagnosis. A score over 10 indicates that a diagnosis of IC is more likely.
- Intravesical Anesthetic Challenge Test: The test allows the healthcare provider to determine if the bladder is the source of your pain. A small catheter is inserted into your bladder and a solution with an anesthetic is instilled.
- Potassium Sensitivity Test (PST): The PST test is being used less frequently to diagnosis IC. It may be helpful in distinguishing bladder pain from other sources in patients who have vague symptoms. During the PST a small catheter is inserted into the bladder and 2 different solutions are instilled into the bladder and the patient is asked questions about how the solutions affect their symptoms. 70% of patients who have IC will have a positive PST test.
How is IC treated?
There currently is no cure for IC but the symptoms can be treated. The treatment for IC involves a combination of different therapies ranging from lifestyle changes to medications. Many patients receiving treatment for IC have a significant reduction or remission of symptoms.
Lifestyle Changes: These may include diet changes, exercise, stress reducing techniques, and bladder training
Physical therapy, specifically pelvic floor physical therapy can aid in reducing pelvic pain. It is important to have a specially trained physical therapist in women’s health/pelvic floor.
There are medications designed to repair the bladder lining and medications designed to decrease nerve pain, these include:
- Elmiron: Elmiron is an oral medication designed to repair the bladder lining. It is taken 3 times per day and may take up to 3 months to show improvement. Elmiron is a long term medication.
- Bladder instillations: These are a mixture of heparin and lidocaine that are instilled into the bladder via catheter. The medication works on repairing the bladder wall and decreasing nerve sensitivity. The bladder instillations tend to work quickly and are done weekly for 9 weeks.
- Amitriptyline (Elavil): This medication is an antidepressant that is typically used to treat people with chronic pain. The dose used to treat chronic pain is significantly lower than the dose used to treat depression. The exact mechanism of action is unknown.