Interstitial cystitis, also called bladder pain syndrome, is a chronic inflammatory condition of the bladder, which causes recurring discomfort or pain in the bladder region. The continuing bladder irritation causes the bladder wall to become stiff and scarred. However, the irritation is not due to infection or urinary stones.
People with this condition experience abdominal or pelvic discomfort, which ranges from a feeling of mild pressure to intense pain. There is frequent urination, sometimes interfering with night sleep. There is also urinary urgency, and increase in pain during micturition, or afterwards. Women may also experience pain during menstruation, or dyspareunia. More women than men develop interstitial cystitis. Women often have fibromyalgia or irritable bowel syndrome as well, pointing to the possibility of a widespread inflammatory state rather than a specific bladder etiology.
Diagnosis and treatment
A diagnosis of interstitial cystitis is made by ruling out other causes of bladder irritation. These include common conditions, such as urinary infection, bladder cancer, prostatitis in men, endometriosis in women, and chronic pelvic pain.
Some tests may be needed to rule out these conditions. These include urine analysis, urine culture, cystoscopy and bladder wall biopsy if indicated. Under anesthesia, an assessment of the bladder capacity may be required. Cystoscopy may reveal glomerulations or Hunner’s ulcers are seen over the bladder interior. These refer to pinpoint bleeding points, and ulcerated skin patches, respectively.
Treatment is symptomatic, since no specific cause can be identified. Bladder distension under anesthesia, which is a diagnostic test, is often followed by relief of symptoms as well. Bladder instillation with dimethyl sulfoxide (DMSO) is also often useful in interstitial cystitis. Here, a DMSO solution is instilled into the bladder and allowed to remain for 15 minutes, before being drained through the same catheter used for instillation. The instillation is repeated every 1-2 weeks, for up to 8 weeks, and then according to requirement.
The effects of bladder instillation may be due to its ability to treat inflammation in deeper tissues during the contact period of 15 minutes. It can also reduce pain, and prevent bladder contractions, which in turn relieves common symptoms such as frequency and urgency. DMSO does, however, leave a garlicky odor on the breath, but has no other significant side effects. However, liver and kidney functions, as well as blood counts, should be assessed every 6 months or so.
Other drugs for this problem include:
- Pentosan polysulfate sodium, which is effective in bringing about pain reduction in about a third of patients, but may take up to 6 months for relief to appear.
- NSAIDs like aspirin and ibuprofen.
- Antidepressants and antihistamines.
Other modes of treatment include:
- Transcutaneous electrical nerve stimulation (TENS) which helps to relieve pain in some cases, though the mechanism is not clear.
- Avoidance of some foods, such as chocolate, alcohol, spices, caffeine, and acidic foods or beverages.
- Quitting smoking.
- Gentle stretches
- Development of a voiding routine to reduce frequency.
- Physical therapy is useful in some cases.
- Surgery is a last resort, used only in selected cases, but recurrence may occur after the procedure. Various types of surgery are used, such as:
- Fulguration of the ulcers.
- Bladder augmentation.
- Cystectomy with construction of an artificial opening to drain urine to a bag, outside or inside the body.