Interstitial cystitis (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Interstitial cystitis is a long-term (chronic) inflammation of the bladder wall.

What are the symptoms of Interstitial cystitis?

 * Pain during intercourse
 * Pelvic pain
 * Urinary discomfort
 * Urinary frequency (up to 60 times a day in severe cases)
 * Urinary urgency

What causes Interstitial cystitis?
Interstitial cystitis (IC) is a painful condition due to inflammation of the tissues of the bladder wall. The cause is unknown. The condition is usually diagnosed by ruling out other conditions (such as sexually transmitted disease, bladder cancer, and bladder infections).

IC is frequently misdiagnosed as a urinary tract infection. Patients often go years without a correct diagnosis. On average, there is about a 4-year delay between the time the first symptoms occur and the diagnosis is made.

Who is at highest risk?
The condition generally occurs around age 30 to 40, although it has been reported in younger people. Women are 10 times more likely to have IC than men.

When to seek urgent medical care?
Call your health care provider if you have symptoms of interstitial cystitis. Be sure to mention that you suspect this disorder. It is not well recognized or easily diagnosed.

Diagnosis
Diagnosis is made by ruling out other causes. Tests include:
 * Bladder biopsy
 * Cystoscopy (endoscopy of bladder)
 * Urine analysis
 * Urine culture
 * Urine cytology
 * Video urodynamics (shows how much urine must be in the bladder before you feel the need to urinate)

Treatment options
There is no cure for IC, and there are no standard or consistently effective treatments. Results vary from person to person. As long as the cause is unknown, treatment is based on trial and error until you find relief.

Elmiron is the only medication taken by mouth that is specifically approved for treating IC. This medicine coats the bladder like Pepto-Bismol coats the stomach.

Other medicines may include: Other therapies include: Diet modification
 * Opioid painkillers for severe pain
 * Tricyclic antidepressants such as Elavil (amitriptyline) to relieve pain and urinary frequency
 * Vistaril (hydroxyzine pamoate), an antihistamine that causes sedation, helps reduce urinary frequency
 * Bladder hydrodistention (over-filling the bladder with fluid while under general anesthesia)
 * Bladder training (using relaxation techniques to train the bladder to go only at specific times)
 * Instilled medications - medicines are placed directly into the bladder. Medicines that are given this way include dimethyl sulfoxide (DMS), heparin, Clorpactin, lidocaine, doxorubicin, or bacillus Calmette-Guerin (BCG) vaccine.
 * Physical therapy and biofeedback (may help relieve pelvic floor muscle spasms)
 * Surgery, ranging from cystoscopic manipulation to bladder removal (cystectomy)
 * Some patients find that changes in their diet can help control symptoms. The idea is to avoid foods and beverages that can cause bladder irritation. Below are some of the foods that the Interstitial Cystitis Association says may cause bladder irritation.
 * Aged cheeses
 * Alcohol
 * Artificial sweeteners
 * Chocolate
 * Citrus juices
 * Coffee
 * Cranberry juice (Note: Although cranberry juice is often recommended for urinary tract infections, it can make IC symptoms worse.)
 * Fava and lima beans
 * Meats that are cured, processed, smoked, canned, aged, or that contain nitrites
 * Most fruits except blueberries, honeydew melon, and pears
 * Nuts except almonds, cashews, and pine nuts
 * Onions
 * Rye bread
 * Seasonings that contain MSG

Experts suggest that you do not stop eating all of these foods at one time. Instead, try eliminating one at a time to see if that helps relieve your symptoms.

What to expect (Outlook/Prognosis)?
Treatment results vary. Some people respond well to simple treatments and dietary changes. Others may require extensive treatments or surgery.

Where to find medical care for Interstitial cystitis?
Directions to Hospitals Treating Interstitial cystitis

Possible complications

 * Chronic depression
 * Chronic pain that may cause a change in lifestyle
 * Emotional trauma
 * High costs associated with frequent medical visits
 * Side effects of treatments (depending on the treatment)

Prevention
Currently the cause of interstitial cystitis is not known, thus there is no way to prevent it. In people who already have been diagnosed with interstitial cystitis, symptoms may be less likely to flare up if the patient quits smoking cigarettes; avoids drinking beverages containing alcohol, caffeine or citrus juice; and avoids eating chocolate, spices or high-acid foods, such as tomatoes and citrus fruits.