What is Interstitial Cystitis - Overview

What is interstitial cystitis?

Interstitial cystitis (IC) causes chronic pain or discomfort in the bladder and surrounding pelvic region. Cystitis, meaning inflammation of the bladder, generally refers to bacterial cystitis, or the common bladder and urinary tract infection.

Bacterial infection, however, does not appear to cause IC. "Interstitial" means “within the bladder wall.” The bladder’s wall represents the area in which most of the difficulties of the condition can be traced. Symptoms vary widely from individual to individual and can even change in the same patient. Often, physicians have trouble diagnosing the condition because laboratory tests and physical exams show no specific bacterial findings.

What is interstitial cystitis - Statistics and Symptoms

Generally, patients (women make up about 1.2 of the total 1.3 million estimated sufferers, though some sources place the total as high as 8 million) experience pressure, mild discomfort, tenderness or sometimes intense pain in the pelvic area. Symptoms include the need to urinate urgently or frequently, and symptoms tend to worsen for women during menstruation.

Some women note that the flow of the urine slows, and the urethra burns constantly, or only during urination. Some symptoms may worsen after particular meals or beverages. Sometimes, women may also experience pain during intercourse, and symptoms worsen twelve to twenty four hours following intercourse.

What is interstitial cystitis - Diagnosis and Other Names

What is interstitial cystitis? Many researches believe that IC actually represents a host of related conditions since symptoms tend to vary so widely. In recent years, the term painful bladder syndrome (PBS) has emerged as the preferred term to describe urinary pain that cannot be attributed to other conditions, such as urinary stones or infection.

A patient will be diagnosed with IC if he / she meets all the conditions outlined by the National Institute of Diabetes and Digestive and Kidney Disorders. Some literature refers to the condition as chronic pelvic pain syndrome (CPPS) or bladder pain syndrome (BPS).

What is interstitial cystitis - Types

Two main sub-types of IC have been recognized: non-ulcerative IC, and ulcerative IC. By far the more common condition (90%), non-ulcerative IC presents the classic glomerulations, or bleeding pinpoint hemorrhages often seen by clinicians when performing a cystoscopy.

Some patients have many more glomerulations than others, though their symptoms may not necessarily be worse. Patients with the condition may develop an irritated bladder wall which becomes scarred and stiff.

In addition to glomerulations appearing on the bladder wall, some patients present Hunner’s ulcers (affecting the approximately 10% suffering from ulcerative IC). Individuals with severe IC / PBS may find that they must urinate up to 60 times in a day, including frequent nocturnal urination which disrupts sleep.

What is interstitial cystitis - Causes

What is interstitial cystitis caused by? Up until recently, researchers speculated about what causes IC / PBS. Certain symptoms approximate those of a bacterial infection; yet upon appropriate medical testing no such infection can be found.

However, new studies into the isolated substance antiproliferative factor, or APF, found almost exclusively in the urine of IC sufferers shows promise of an explanation. The factor seems to block the normal growth of cells which line the bladder wall, leading to the irritation and infection-like symptoms of the condition. As cells cannot be generated to repair the bladder’s lining, the bladder wall become subject to irritation, inflammation and scarring.

In addition, the resulting scarred tissue allows urine contents like potassium to enter into the lining and stimulate an allergic reaction when histamines release into the area. These constant allergic reactions lead to chronic nerve pain and continue to traumatize the bladder.

As researchers discover more about APF, better treatments and a greater comprehension of the disorder may be possible. Interestingly, many women who suffer from IC / PBS have co-occurring fibromyalgia and irritable bowel syndrome, leading some experts to believe that these patients have a generalized disorder causing inflammation in the body.

Other experts theorize that bladder trauma from pelvic surgery may trigger the condition, as might bladder over distention, autoimmune disorders, pelvic floor muscle trauma, bacterial infection (by as yet undetectable pathogens), inflammation in the pelvic nerves and even spinal cord trauma. Any damage to the bladder may make it more sensitive and prone to irritation.

Tests and Diagnosis

No definitive test exists at this time for IC / PBS, so doctors seeking to help affected patients must rule out every other possibility before settling on IC. In the past, this meant that some patients went undiagnosed for years. Physicians use the following diagnostic tests to rule out other possible causes: urine culture, urinalysis, biopsy of the bladder wall, distention of the bladder under anesthesia, urine cytology, cystoscopy, and laboratory examination of the prostate secretions.

Cure

What is interstitial cystitis cured by? Currently, no known cure exists for IC. Physicians will attempt a variety of remedies, as some patients react to certain treatments better than others. Occasionally, symptoms disappear after a change in diet or other treatment, only to reappear in weeks, months, or years. As the exact cause has not yet been determined, most treatments focus on relieving symptoms, rather than promising a cure.

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