Urological Disorders

Interstitial Cystitis (IC)

What is interstitial cystitis (IC)?

Interstitial cystitis (IC) is complex, chronic disorder characterized by an inflamed, or irritated, bladder wall. It can lead to scarring and stiffening of the bladder, decreased bladder capacity, glomerulations (pinpoint bleeding) and, in rare cases, ulcers in the bladder lining. IC may also be known as:

painful bladder syndrome
frequency-urgency-dysuria syndrome

An estimated 500,000 people have IC, and about 90 percent of them are women. People of any age can be affected with IC, although it is rare in children. About two-thirds of patients are in their 20's, 30's, or 40's. There is no evidence that the disorder is hereditary, or genetically passed from parent to child.

What are some of the types of IC?

IC symptoms and severity vary greatly. It is believed that it may be several diseases, not just one. Two types of IC are usually diagnosed and listed below:

nonulcerative IC: this is the most common type of IC, and usually affects young to middle-age women who have a normal, near normal, or increased bladder capacity. Glomerulations can be seen in the bladder wall.

ulcerative IC: this type of IC tends to be found in middle-age to older women who have low bladder capacity (less than 1 1/2 cups). The decrease is thought to result in part from fibrosis, which makes the bladder stiff and small. Cracks, scars, and Hunner's ulcers (star-shaped sores) in the bladder wall may bleed when the bladder is filled to capacity during a cystoscopy.

What are the causes of IC?

The cause of IC is still unknown, however, the disorder is a real, physical problem, not the result, symptom, or sign of an emotional problem as once thought. Research focused on finding the cause of IC has been directed toward the bladder lining -- called the glycocalyx -- which is made up primarily of substances called mucins and glycosaminoglycans (GAGs). This layer normally protects the bladder wall from toxic effects of urine and its contents, however, some researchers found that this protective layer of the bladder was "leaky" in about 70 percent of IC patients. This may allow substances in urine to pass into the bladder wall and trigger IC symptoms.

Some people are diagnosed with IC after taking antibiotics for a presumed urinary tract infection, and it has been suggested that antibiotics may damage the bladder wall making it leaky. But, because antibiotics have not been found to harm the bladder wall in most cases, other hypotheses are more likely to explain why some IC patients are diagnosed after a urinary tract infection.

What are the symptoms of IC?

The symptoms of IC vary greatly from person to person, but often resemble the symptoms of a urinary tract infection, and may include:

a decreased bladder capacity

an urgent need to urinate frequently day and night

feelings of pressure, pain, and tenderness around the bladder, pelvis, and perineum (the area between the anus and vagina or anus and scrotum), which may increase as the bladder fills and decrease as it empties

painful sexual intercourse

in men, discomfort or pain in the penis and scrotum

in most women, symptoms may worsen around the menstrual cycle

Stress may also intensify symptoms but does not cause them.

A differential diagnosis (ruling out other conditions):
Symptoms of IC are similar to those of other disorders of the urinary system. And, because there is no definitive test to identify IC, ruling out other conditions becomes necessary before a diagnosis can be made. Among these disorders are:

urinary tract infections
vaginal infections
bladder cancer
bladder inflammation or infection caused by radiation to the abdomen
eosinophilic and tuberculous cystitis
kidney stones
endometriosis
neurological disorders
sexually transmitted diseases
low-count bacteriuria
in men, chronic bacterial or non-bacterial prostatitis

Diagnosing interstitial cystitis:
The diagnosis of IC in the general population is generally based on:

presence of urgency, frequency or pelvic/bladder pain

cystoscopic evidence (under anesthesia) of bladder wall inflammation and glomerulations or Hunner's ulcers

absence of other diseases that may cause the symptoms.

Medical tests that help identify other conditions often include:

urinalysis and urine culture - tests that can detect and identify the most common organisms in the urine that may be causing symptoms.

cystoscopy - use of a cystoscope -- an instrument made of a hollow tube about the diameter of a drinking straw with several lenses and a light -- to see inside the bladder and urethra to detect inflammation; a thick, stiff bladder wall; Hunner's ulcers; and glomerulations (pinpoint bleeding) that may be seen only after the bladder is stretched.

biopsy of the bladder wall - for a microscopic examination of tissue to rule out bladder cancer and confirm bladder wall inflammation.

laboratory examination of prostate secretions (in men)

How is IC often treated?

Currently, there is no specific way to diagnose IC, and no cure for IC, making it unpredictable to determine who will respond best to which treatment protocol.

Treatments are focused on relieving symptoms. Most patients are helped for variable periods of time by one or a combination of the following treatments. This determination will be made by your physician based on your medical profile and the severity of your symptoms:

bladder distension

bladder instillation (may also be called a bladder wash or bath) - the bladder is filled with a solution that is held for varying periods of time, from a few seconds to 15 minutes, before being drained through a catheter. The only drug approved by the US Food and Drug Administration (FDA) for bladder instillation is dimethyl sulfoxide (DMSO, RIMSO-50).

oral medication (over-the-counter and prescription)

TENS - transcutaneous electrical nerve stimulation - mild electric pulses enter the body for minutes to hours two or more times a day either through wires placed on the lower back, between the navel and the pubic hair, or through special devices inserted into the vagina in women or into the rectum in men.

diet - no scientific evidence links diet to IC, but some doctors and patients believe that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation, as well as eating or drinking products containing artificial sweeteners.

smoking cessation - the major known cause of bladder cancer.

exercise - may help relieve symptoms or hasten remission.

bladder training - patient voids at designated times and uses relaxation techniques and distractions to help keep to the schedule. Gradually, the patient tries to lengthen the time between the scheduled voids.

surgery

This page was last updated on: February 28, 2008.

For more information, call the University Physicians Consultation and Referral Service at 1-800-492-5538 (patients) or 1-800-373-4111 (physicians).