What does Interstitial Cystitis mean?
The term Interstitial means pertaining to being between things, especially between things that are normally closely spaced.
The word “interstitial” comes from the Latin “interstitium” which was derived from “inter” meaning “between” + “sistere” meaning “to stand’ = to stand between.
cystitis refers to any inflammation of the bladder
What is interstitial cystitis?
IC is a chronic inflammation of the bladder wall. It is not believed to be caused by bacteria, and does not respond to conventional antibiotic therapy. In contrast to bacterial cystitis that results from an infection in the bladder, no infectious organism has were identified in people with interstitial cystitis. IC is diagnosed when the symptoms occur without evidence for another cause of symptoms.
Who are likely to be affected by interstitial cystitis?
IC can affect men and women but is more prevalent in women.
Women with interstitial cystitis are more likely to have had frequent urinary tract infections. These women also tend to have previous gynaecologic surgery than women without IC.
What are the symptoms?
The symptoms of IC vary greatly from one person to another but have some similarities to those of urinary tract infection.
These symptoms include:
FREQUENCY Day and/or night frequency of urination (up to 60 times a day in a few, very severe cases). In early or very mild cases, frequency is sometimes the only symptom.
URGENCY The sensation of having to urinate immediately may also be accompanied by pain, pressure or spasms.
PAIN – Can be in the abdominal, urethral or vaginal area. Pain is also frequently associated with sexual intercourse in both male and female.
Around the time of menstruation, in most women with IC symptoms usually worsen.
What is the cause of interstitial cystitis?
No one knows what causes IC, but doctors studying IC believe that it is a real, physical problem and not a result, symptom, or sign of an emotional problem. Because the symptoms of IC are varied, most researchers believe that it represents a spectrum of disorders rather than one single disease.
One area of research on the cause of IC has focused on the layer that coats the lining of the bladder called the glycocalyx, made up primarily of substances called mucins and glycosaminoglycans (GAGs). This layer normally protects the bladder wall from toxic effects of urine and its contents. Researchers have found that this protective layer of the bladder is “leaky” in about 70 percent of interstitial cystitis patients and have hypothesized that this may allow substances in urine to pass into the bladder wall where they might trigger interstitial cystitis.
Is there a cure for interstitial cystitis?
There is no cure yet for this condition and there is not a specific treatment that works for everyone. People who suffer from IC will need to investigate ways to help them manage the condition.
It can be a lengthy and difficult process finding a diagnosis for IC.
The first step would be that the doctor would take a urine sample to identify whether a bacterial infection is present.
He or She will then look to rule out any other conditions that have similar symptoms to IC, such as cancer, kidney problems, vaginal infections and neurological disorders.
It is a slow process of elimination.
What treatments am I likely to be offered?
Stretching the bladder is both a test and the first treatment for IC.
How it is performed:
Under a general anaesthetic, surgeons fill the bladder with fluid and keep it stretched for 5-10 minutes. During this time, they put a small telescope into the bladder to look for redness, swelling and small bleeds – the typical signs of IC.
Stretching the bladder in this way also has the effect of breaking up some of the damaged tissue in the lining and about one in three people find that, after their bladder has settled down, their symptoms are improved. The effect can last for several months and stretching can be repeated if it is found to help.
Relining the bladder
As many people with IC have lost the protective coating in their bladder lining which prevents urine from causing irritation, surgeons may try to replace it. Cystistat is a fluid, which contains sodium hyaluronate – a substance that is an essential component of the protective coating in the bladder. Surgeons inject the fluid directly into the bladder once a week for the first month, then once a month until the symptoms improve. If the treatment helps, it may only be needed once every 6-12 weeks, but not everyone responds, and those whom it does not respond can be found to be as painful if not worse than IC itself.
Aspirin and ibuprofen may be a first line of defence against mild discomfort. Doctors may recommend other drugs to relieve pain. Please remember that aspirin and ibuprofen can corrode the stomach lining and is not recommended if you have stomach ulcers. It is a good idea to eat something first to line the stomach before taking these drugs.
The principal type of oral medication is the heparinoid drug pentosan polysulfate sodium. PPS is chemically similar to the substance that lines the bladder, and it is believed that PPS assists in the repair or restoration of the lining tissues in bladder. Other oral medications that may be used to treat IC along with PPS include antidepressants of tricyclic group. This is not due to a belief that IC is a psychological condition but due to the fact that tricyclic antidepressants can help reduce the hyper-activation of nerves within the bladder wall.
Oral antihistamines may also be prescribed to help reduce allergy symptoms that may be worsening the patient’s interstitial cystitis. Beside this, bladder distension sometimes is used for therapy of interstitial cystitis. Bladder distension helps reduce symptoms in approximately 20-30% of people with problem called interstitial cystitis.
Muscle relaxants such as Oxybutynin, which can calm the contractions of the bladder muscle – also used for an overactive bladder. Anti-inflammatory such as Diclofenac can reduce the inflammation and antihistamines such as hydroxyzine can be used. Certain anti-depressants can also be used such as Amitriptyline, which have pain relieving qualities. As with all medication always find out what the side effects are and if you are on any other medication would they pose as a conflict whilst taking them.
Electrical Nerve Stimulation
Mild electrical pulses can be used to stimulate the nerves to the bladder—either through the skin or with an implanted device. The method of delivering impulses through the skin is called transcutaneous electrical nerve stimulation (TENS). With TENS, mild electric pulses enter the body for minutes to hours, two or more times a day either through wires placed on the lower back or just above the pubic area—between the navel and the pubic hair—or through special devices inserted into the vagina in women or into the rectum in men. Although scientists do not know exactly how TENS relieves pelvic pain, it has been suggested that the electrical pulses may increase blood flow to the bladder, strengthen pelvic muscles that help control the bladder, or trigger the release of substances that block pain.
TENS is relatively inexpensive and allows people with IC to take an active part in treatment. Within some guidelines, the patient decides when, how long, and at what intensity TENS will be used. Improvement is usually apparent in 3 to 4 months.
No scientific evidence links diet to IC, but many doctors and patients find that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation. Some people also note that their symptoms worsen after eating or drinking products containing artificial sweeteners. Eliminating various items from the diet and reintroducing them one at a time may determine which, if any, affect a person’s symptoms. However, maintaining a varied, well-balanced diet is important.
We are working with dieticians to create recipes which may help relieve symptoms.