Interstitial Cystitis

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Published: May 21, 2014
Last reviewed: September 4, 2017

What is interstitial cystitis?

Interstitial cystitis is an inflammation of the bladder with small bleeding wounds or ulcers beneath the bladder lining 1. In 90%, it occurs in women. It sometimes runs in families; the cause is uncertain 1.

Synonyms: painful bladder syndrome

Triggers

Possible triggers of the inflammation include urinary tract infections, injuries of the bladder or pelvic floor (accidents with bicycles or motorbikes, athletic injuries, childbirth), allergies, ketamine (an anesthetic) and chemotherapy 1,3,4.

Symptoms

Symptoms usually appear in women around 40, sometimes before 30, but rarely in children and adolescents:

  • Urgent and very¬†frequent urination–up to 50 or more times during the day and night–, chronic pain, discomfort, throbbing or spasms in the bladder when it is filling and relief when it is emptying; sometimes pain in the back, vulva (vulvodynia), groin or rectum, pain during menstruation and sex; rarely blood in urine. Some individuals may experience only pain and some only urgency.
  • Certain dietary triggers (about the same as in overactive bladder; see above) can worsen the symptoms.
  • In some individuals, symptoms can last for few months and go away completely, in others, they resolve spontaneously for few months to several years and come back, and yet in others, they have a chronic, waning and waxing course.
  • Commonly associated disorders: irritable bowel syndrome (IBS), systemic lupus erythematosus (SLE), inflammatory bowel disease (IBD), chronic fatigue syndrome (CFS), fibromyalgia, endometriosis, allergies, panic attacks.
  • References: 1,4

Diagnosis

Diagnosis is made by exclusion of other urinary tract disorders. Currently, no definite cure for interstitial cystitis is known.

Treatment

Measures to reduce symptoms:

  • Drink enough water, avoid diet triggers, learn to relax pelvic floor muscles with walking or easy stretching exercises, but not Kegel exercises, wear loose clothes, try to cope with stress (meditation), try bladder training (postponing toilet visits), cold or heat pads, physical therapy or OTC supplements (calcium glycerophosphate, phenazopyridine, L-arginine).
  • Heating pads or cold packs placed in the crotch can relieve pain.
  • Drugs that may help: painkillers (aspirin, ibuprofen), pentosan polysulfate sodium, antihistamines (hydroxyzine, cimetidine), anticonvulsants (gabapentin), steroids, triamcinolone; in resistant cases: cyclosporine.
  • In some women, bladder distension, usually during cystoscopy, relieves pain. Flushing the bladder (via urethral catheter) with special solutions can also relieve pain.
  • References: 2,5,6,7

Bladder ulcers can be burned with a laser (fulguration) or excised by an endoscopic surgery 7. Surgery is not always successful and is often associated with complications, such as recurrence of ulcers, urinary incontinence or retention. Some individuals may feel pain (phantom pain) even after bladder removal.

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