Interstitial Cystitis — An Uncommon But Incapacitating Condition

Interstitial cystitis (IC), also referred to as painful bladder syndrome (PBS), is a chronic inflammatory condition of the bladder wall of unknown etiology. The prevailing opinion is that IC is a constellation of signs and symptoms arising from bladder inflammation that is aggravated by infectious, chemical, mechanical, allergic, autoimmune, neurogenic, and other factors. Some believe that a defect in the epithelial barrier, glycosaminoglycan (GAG) layer, of the bladder is a part of the pathogenesis of interstitial cystitis. IC is not psychosomatic and is not caused by stress.

Although IC can strike anyone of any age, race or gender, women are most commonly afflicted by IC. There are more than 700,000 cases of IC in the United States.

IC has been associated with other chronic conditions, such as vulvar vestibulitis, irritable bowel syndrome, and fibromyalgia.

IC produces symptoms like a urinary tract infection (UTI), but is not caused by a bacterial infection. A UTI, unlike IC, can be successfully treated with antibiotics and a UTI should be considered as a cause for an exacerbation of IC symptoms.

The most common symptoms of IC are urinary frequency, urgency and pain. Frequency can be the first symptom of IC in early or mild cases. The frequency of urination can be astonishing and disabling in severe cases up to 60 times in a 24-hour period. Urgency can be seen with pain, pressure and/or spasms. Pain is often located in the pelvis, bladder, urethral, or vaginal areas. Pain is commonly associated with sexual intercourse. Men can experience genital and/or perineal pain as well as painful ejaculation. Some patients can complain of muscle and joint pain. IC is not excluded in the absence of night time urination or lack of pain.

The first step in diagnosing IC is ruling out other disorders that can mimic IC. Urine cultures can detect the presence or absence of a UTI. Other disorders to exclude include bladder cancer, bladder TB, STDs, vaginal infections, endometriosis, radiation cystitis, spinal cord/CNS conditions, and rheumatological diseases.

IC is diagnosed with the use of cystoscopy and hydrodistention of the bladder to identify pinpoint hemorrhages (glomerulations) in the bladder wall. These findings are characteristic of IC and are found in 90% of IC patients. Ulcers on the bladder wall are present in 5 to 10% of IC patients.

There are a variety of treatment options for the IC patient including diet, nutritional supplements, oral medications, physical therapy, bladder instillation techniques and surgery. Surgical options include laser treatment of bladder ulcers; sacral nerve root stimulation for treatment of bladder urgency and frequency; and only as a last resort internal pouch construction, urinary diversion or bladder augmentation. Urethral dilatation and urethrotomy are not surgical treatment options for IC.