Interstitial cystitis (IC), describes a bladder syndrome which consists of a constellation of symptoms, including bladder as well as urethral, vaginal or pelvic pain often relieved after urination, and irritative urinating symptoms. Typically these patients do not have a bladder infection. Painful intercourse is also common. IC is one of the most challenging urological conditions to manage as there are currently no known causative factors. The general opinion is that the cause is likely multifactorial, and that it may represent a collection of symptoms rather than a specific disease. IC can be diagnosed with cystoscopic examination under a general anesthetic where we look for bleeding areas or bladder ulcerations or with a test in the office (Potassium sensitivity test).

While it most commonly afflicts between 30 to 40 years of age, the condition occurs in all age groups and in men. Generally, the symptoms do not progress continuously, but rather reach their final stage rapidly and then stabilize at that level. Major deterioration of symptoms is unusual as there is no evidence that mild cases progress to more severe forms. Up to fifty percent of patients experience spontaneous remissions but may have flare-ups. Few patients suffer such unremitting pain and frequency that they cannot maintain a normal lifestyle. There may be almost half a million patients with IC in the United States. Numerous studies have failed to find an infectious cause for IC. The most popular theory for IC suggests that there is a deficiency in one of the chemicals that lines the surface of the bladder, making the bladder more sensitive to fluid. Others theorize that IC is an allergic response. This is based on presence of inflammatory cells seen on bladder tissue biopsies.

The diagnosis of IC requires the exclusion of other specific causes of painful bladder diseases. Your urologist may choose to do a cystoscopy (examination of your bladder with a scope) with or without a bladder biopsy. A helpful finding at the time of cystoscopy for diagnosing IC is the appearance of pinpoint areas of bleeding seen in the lining of the bladder following distention. Distention of the bladder, under a general anesthetic, which can be done at the time of initial diagnosis can provide temporary resolution of symptoms in most patients. Initially following distention, however, some patients may experience an increase of symptoms before they begin to feel relief. The length of time of relief is impossible to predict for an individual patient but may last from months to years. If and when symptoms return, your urologist may recommend repeat bladder overdistention.

Another option for diagnosis is the potassium sensitivity test. Patients with IC have abnormalities in the bladder lining which allow potassium and urea to be absorbed. These chemicals irritate nerves in the bladder wall leading to pain.

Treatment options for interstitial cystitis are tailored to the individual patient. Oral medications such as bladder relaxants (Levbid/Ditropan) Elmiron®, tricyclic antidespressants, and NSAIDs may be helpful in combination. Tricyclic antidepressants (ie. Elavil) may be helpful at night due to their analgesic and sedative properties. Elmiron® is a relatively new oral medication which supplies a chemical thought to be missing from the bladder lining of patients with interstitial cystitis.

Other treatment options include installation of different chemicals to soothe or renew the bladder lining. Some chemical installations such as DMSO and heparin can be done in the office. Others (ie. silver nitrate) require patients to be anesthetized at the time of installation.

Diet modification has also been known to be helpful. Beverages known to irritate the bladder which should be avoided include coffee, tea, alcohol and citus drinks. Spicy foods, as well as tomatoes and onions, should also be avoided.