Causes, incidence, and risk factors

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.

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.

Symptoms

• Pain during intercourse

• Pelvic pain

• Urinary discomfort

• Urinary frequency (up to 60 times a day in severe cases)

• Urinary urgency

Signs and tests

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

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:

• 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

Other therapies include:

• 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)

Diet modification

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

• Sour cream

• Sourdough bread

• Soy

• Tea

• Tofu

• Tomatoes

• Yogurt

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.

Support Groups

For additional information and support, see interstitial cystitis support groups.

Expectations (prognosis)

Treatment results vary. Some people respond well to simple treatments and dietary changes. Others may require extensive treatments or surgery.

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)

Calling your health care provider

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.