Definition Interstitial cystitis is a term that refers to a type of chronic inflammation of the bladder of unknown cause.
What is going on in the body? This condition occurs primarily in adult women. It results in chronic inflammation of the bladder. The cause is currently unknown, but many theories have been proposed. The issue is further clouded by the fact that the condition may represent a set of symptoms rather than a single condition.
What are the signs and symptoms of the condition? A primary symptom of this condition is pain in the bladder or lower abdomen. Bladder or lower belly pain is often relieved temporarily by urinating. Another common symptom is the urgent need to urinate. Often, people will have to empty their bladder every 2 hours during the day. They will also have to get up several times during the night to urinate. Blood may be seen in the urine.
What are the causes and risks of the condition? The cause of this condition is unknown. Therefore, the risk factors for developing the condition are also unknown. Certain foods may make symptoms worse. These include chocolate, caffeine and citric acid.
Women diagnosed with this condition often have higher rates of several other conditions. These include:
vulvodynia, or diffuse burning of the vaginal lips
fibromyalgia, a disorder causing pain in the muscles
inflammatory bowel disease, a disorder causing diarrhoea and cramping
systemic lupus erythematosus, a condition in which a person's immune system attacks his or her own body, affecting the skin, joints, and other body organs
What can be done to prevent the condition? There are no proven ways to prevent this condition.
How is the condition diagnosed? The first step in diagnosing interstitial cystitis is to rule out other diseases or conditions. Several other conditions can cause similar symptoms, such as infections or even cancer of the bladder.
After other conditions have been ruled out, some doctors perform a special diagnostic procedure. During this procedure, water is injected into the bladder. The bladder of people with this condition is able to hold only a small amount of water due to stiffness of the bladder walls. When the water is put into the bladder, people with this condition will feel pain and the urge to urinate, whereas people without this condition do not.
The inside of the bladder is also viewed with a special tool called a cystoscope. This scope is inserted through the genital area and into the bladder. If this condition is present, the inside of the bladder wall will often show small ulcers. However, these are sometimes seen in people who do not have any bladder symptoms.
What are the long-term effects of the condition? There is no evidence that this condition leads to more dangerous conditions such as cancer. However, it does have a negative affect on quality of life. The extent of the problem varies from person to person. Some people have only one or two very bad episodes in a lifetime. For others, symptoms are much worse. Most of the time, symptoms come and go.
What are the risks to others? This condition cannot be passed from person to person.
What are the treatments for the condition? There are many treatments for this condition. Most of them only work in a small number of cases. The general approach is start with the therapy with the fewest side effects. If this does not work, individuals may want to try other things.
After the initial test, in which water is injected into the bladder, symptoms often get worse for a week or two. When the initial reaction goes away, most people will experience some relief. This can last from one to six months. Periodic flushing of the bladder is sometimes effective. Some people find this a better option than taking medications. Another approach is to eliminate irritating foods from the diet. If symptoms improve, foods can be put back one by one. In this way, the culprit can be identified.
Typical oral therapy includes amitriptyline. The use of narcotics, which are strong analgesics with a high potential for addiction, is considered only as last resort.
Another type of treatment is the rinsing of the bladder with various substances. These include substances called DMSO, silver nitrate, and heparin. Other materials are currently being tested. Some studies have also shown electric nerve stimulation and acupuncture to be helpful.
When interstitial cystitis does not respond to anything else, surgery is an option. It is performed only in the worst cases. Results are often less than expected. Possible procedures include:
removal of a portion of the bladder
complete removal of the bladder
What are the side effects of the treatments? All medications have possible side effects.
amitriptyline taken orally can make a person sleepy.
Filling the bladder with liquid through a catheter has few side effects. It often makes symptoms worse for a short time after therapy.
Side effects from surgery vary depending on the procedure done. All surgery carries a risk of bleeding, infection, and reaction to pain medications.
What happens after treatment for the condition? The course of this condition is often unpredictable. Individuals may or may not get better with treatment. Symptoms often come and go. Treatment may be needed for years in severe cases.
How is the condition monitored? The affected person monitors his or her symptoms. Repeat examinations and other monitoring depend on the severity of the condition and the treatments used.
Author: Stuart Wolf, MD Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 19/05/2005 Contributors Potential conflict of interest information for reviewers available on request
