Interstitial Cystitis

Interstitial cystitis (IC) is a chronic and painful condition of the bladder. People with IC have a bladder wall that is tender and easily irritated, leading to uncomfortable symptoms. Although IC currently has no cure, the symptoms can be managed to help you feel better and live more comfortably.

When You Have Interstitial Cystitis (IC)

The bladder stores urine until it has passed out of the body. What happens in the bladder to cause IC is not clear, but some changes have been observed. The protective lining that keeps urine away from the bladder walls may become thinner. The walls may stiffen and harden so the bladder can’t expand to hold urine. During certain tests, pinpoints of bleeding (glomerulations) may be seen on the bladder wall. Rarely, a crater (called a Hunner’s ulcer) may also be found.

Symptoms of Interstitial Cystitis

The frequent and urgent need to urinate
Pain or pressure in the bladder area, often relieved for a short time after urinating
Pain in the genitals or anus
Painful sexual intercourse
Symptoms in women may get worse during their period. Symptoms may go away for a period of time (remission), but they often come back again.

Possible Causes of Interstitial Cystitis

Damage to the protective bladder lining, allowing urine to irritate the bladder wall
Infection of the bladder
Allergic reaction in the bladder
Neurological (nerve) problems
Substances found in the urine that are irritating to the bladder

Treating Interstitial Cystitis

Lifestyle Changes

Many different types of treatment are available to help manage IC symptoms and relieve pain. Some may work well for one person and not for another, so several types of treatment may be tried before you and your doctor determine the plan that’s best for you.

Avoiding Certain Foods
Avoid certain foods that may worsen your symptoms. These include alcohol, spicy food, chocolate, caffeine, citrus fruits and juices, tomatoes, and carbonated drinks. You may want to try cutting certain foods out of your diet for several weeks, and then add the food back into your diet to see whether this has any effect on your symptoms.
Retraining Your Bladder
Retrain your bladder if recommended by your doctor. Many women with IC have become accustomed to urinating very frequently to try and avoid discomfort. As a result the bladder becomes less and less able to hold urine creating a vicious cycle. Bladder retraining involves holding urine in for longer and longer periods to help stretch the bladder and increase the amount the bladder can hold comfortably.
Managing Stress
Manage stress in your life. Stress doesn’t cause IC, but it can make your symptoms worse. Ask your doctor about techniques to help you relax and relieve stress. Meditation, massage, acupuncture and yoga are some possibilities. Exercise is an excellent way to help relieve stress. Walking and swimming are two good choices that may be comfortable enough for you to do regularly.

Medications

Oral Medications
Your doctor may give you one or more of the medications below. Other medications may be available—talk to your doctor about your options.
- Pain medications may be taken for a short time to help ease discomfort.
- Antispasmodic medications may help relax the bladder muscles and decrease the need to urinate.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) and antihistamines may help reduce inflammation and relieve pain.
- Antidepressants in low doses may help relieve IC symptoms, perhaps by blocking pain receptors.
- Medications to restore the bladder lining such as pentosan polysulfate sodium (Elmiron).
  - Elmiron/Pentosan Polysulfate has recently reported serious side effects regarding changes in the retina of the eye. This is called pigmentary maculopathy; these side effects may continue even after stopping this medication. For this reason, we recommend all patients taking this medication to follow up for regular eye exams and to contact their providers if any vision changes occur.

Other Treatments

Bladder Instillation
Also called bladder wash or bath, bladder instillation may help relieve inflammation or repair the bladder’s protective lining. During this treatment, the bladder is filled with medications using a slender tube called a catheter. One or more types of medication may be used. The medication is held inside the bladder for a period of time (usually from 15–30 minutes). Then the medication is urinated out or drained from the bladder through the catheter. Instillation treatments are often repeated several times over a period of two to three months. These treatments can sometimes be done at home.
Bladder Hydrodistention
Hydrodistention is a process where your bladder is filled with fluid to stretch the walls of the bladder. Some patients have relief from symptoms for a time after bladder hydrodistention is done to diagnose IC. If this is true for you, your doctor may choose to repeat the hydrodistention procedure as a form of treatment.

Special Therapies and Surgery

Biofeedback

Biofeedback is a painless technique that can help you learn to control the movement of your bladder muscles. During biofeedback, sensors are placed on your abdomen. The sensors convert signals given off by your muscles into lines on a computer screen.

Electrical Stimulation

Stimulation of the area around your bladder with electrical signals may help relieve symptoms by blocking the nerve sensations to and from the bladder, by improving blood flow, or by strengthening the pelvic muscles. For this treatment (sometimes called TENS), wires are placed on the skin of the lower back or abdomen. Mild electric pulses are then sent into the body for several minutes to hours. The therapy may be repeated one or more times daily, and may continue for several weeks to months.

Other Types of Treatments

Certain other types of treatments may be tried to help relieve your IC symptoms. Therapeutic massage of the abdominal muscles using heat or ice may help relieve pain. Acupuncture, the therapeutic use of needles, may also help relieve pain in some cases.

Surgery

Very rarely, surgery may be recommended for severe cases of IC that are not relieved by any other types of treatment. The results of surgery can be unpredictable. If your doctor recommends surgery, he or she can discuss the procedure’s risks and benefits with you.