Cystitis - interstitial

Alternative names
Interstitial cystitis (IC)

Definition
Interstitial cystitis is a bladder condition caused by chronic inflammation, leading to difficulties with urination.

Causes, incidence, and risk factors

Interstitial cystitis (IC) is an inflammation of the tissues of the bladder wall, with no known infectious (bacterial, viral, or fungal) cause. The condition is identified through a diagnosis of exclusion.

Women are 10 times more likely to be affected than men. The condition is more common in Jewish women and is rare in African-Americans.

IC generally occurs during the third or fourth decades of life. For the average person with Interstitial cystitis, there is a 4-year delay between the time the first symptoms occur and the diagnosis. This demonstrates both the difficulty of diagnosis and how infrequently this condition is suspected.

Symptoms

• Urinary frequency (can be as often as 60 or 70 times per day)
  
• Urinary urgency
  
• Urinary discomfort
  
• Pain during intercourse

Diagnosis is made by ruling out other causes. Urine analysis, urine culture, and urine cytology tests are essential.

Usually, cystoscopy (endoscopy of bladder) and bladder biopsy are performed. The characteristic finding of Interstitial cystitis during cystoscopy is pinpoint bleeding in the lining of the bladder.

Video urodynamics may also be performed.

Treatment

There are no standard or consistently effective treatments for Interstitial cystitis. Results vary from individual to individual. As long as the cause is unknown, treatment is based on trial and error until relief is found.

Some of the treatments that have been tried include:

• Dilation of the bladder with fluid (hydrodistention)
  
• Oral medications:
  o Elmiron (coats the bladder like Pepto-Bismol)
  o Opiates (Nalmefene)
  o Psychiatric medications such as Elavil or Vistarul (may have a pain-relieving effect, also helpful for psychiatric conditions such as depression, which often accompany this disorder)
  
• Intravesical therapy (instillation into the bladder) of medications such as dimethyl sulfoxide, heparin, clorpactin, lidocaine, doxorubicin, or BCG vaccine
  
• Surgery, ranging from cystoscopic manipulation to cystectomy (removal of the bladder)

For additional information and support, see Interstitial cystitis support groups.

Expectations (prognosis)

Treatment results vary. Some people respond well to simple treatments. Others may require extensive treatments or surgery to relieve symptoms.

Complications

• Chronic (long-term) pain that may cause a change in lifestyle
  
• Emotional trauma
  
• High costs associated with frequent medical visits
  
• Chronic depression (and accompanying suicidal thoughts)
  
• Adverse effects of treatments (depending on the treatment)

Call your health care provider if you have symptoms suggestive of Interstitial cystitis. Be sure to mention that you suspect this disorder. It is not well-recognized nor is it easily diagnosed.

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