Interstitial cystitis
Hunner’s Ulcer seen on Cystoscopy
Interstitial cystitis (IC), also known as painful bladder syndrome, is a complex, chronic disorder characterised by an inflamed or irritated bladder wall. It can lead to scarring and stiffening of the bladder, decreased bladder capacity, bleeding from specific spots in the bladder (glomerulations) and localised areas of significantly damaged bladder lining (ulcers).
People of any age can be affected with IC, although it is rare in children. The cause of IC is still unknown and although there is a degree of overlap with the symptoms of chronic UTI, patients with IC do not respond to even extended courses of antibiotic medication. Research is ongoing to investigate possible causes of IC and although in advanced IC, antibiotics do not seem to help, the damage may originally have occurred as a result of infection.
Symptoms
Common symptoms of IC include: pain as the bladder fills up, increased frequency of urination; painful sexual intercourse; plus many women notice worsening in symptoms around the menstrual cycle. Stress will often intensify symptoms, but stress does not itself cause symptoms to occur. IC tends to develop in people with a number of other conditions including endometriosis, hay fever and asthma, inflammatory bowel disease, lupus, migraine headaches, rheumatoid arthritis, and fibromyalgia.
Diagnosis
IC is diagnosed by excluding other condition that might be producing symptoms. These include chronic or recurrent urinary tract infections, sexually transmitted diseases, vaginal infections, bladder cancer and inflammation, tuberculosis cystitis, kidney stones, and endometriosis. To exclude these other conditions, blood tests, urine tests and a cystoscopy (telescope examination of the inner walls of the bladder) are required.
Investigations for chronic urinary tract infection (CUTI) are especially important in IC as many patients are incorrectly diagnosed with IC when better testing shows that they have CUTI instead. Even in patients with IC, urinary tract infection can be a major cause of acute ‘flare-ups’.
It is important to make sure that the bladder is visualised with a cystoscope as rarely there can be abnormal changes of the bladder cells known as ‘keratinising squamous metaplasia’ which require closer follow-up. The bladder may need to be stretched to capacity with fluid (called hydrodistension) while you are under general anaesthetic (asleep) to see if there are areas of inflammation, bleeding points or ulcers. You may also require a biopsy (which involves removing a small sample of bladder tissue for examination under a microscope).
Where there is significant frequency and urgency of urination, you may require urodynamic studies to help quantify the bladder pressure and capacity, urinary flow, and how well the bladder empties when you pass urine.
Treatment
Unfortunately, there is no cure for IC, so treatment approaches are geared towards controlling symptoms and trying to stop the condition getting worse. Each patient has his or her own unique subset of bothersome symptoms. At Yorkshire Urology, treatments we offer include:
Bladder distension for interstitial cystitis – this is a surgical procedure during which the bladder is filled to capacity with water, it is primarily used to diagnose IC but in some patients can also alleviate symptoms, possibly by increasing bladder capacity and interfering with the pain signals transmitted by the nerve cells in the bladder.
Medications – Pentosan polysulphate (Elmiron) may reduce bladder discomfort and pain in some people with IC and may work by repairing the damaged bladder lining. Antihistamines or steroids can alleviate inflammation in the bladder and neuropathic pain agents for pain relief.
Bladder instillation (also called a bladder wash) – this a procedure in which the bladder is filled with a therapeutic solution via a catheter which is then retained in the bladder for varying periods of time, up to 30-minutes before it is urinated out. These treatments can help to coat and protect the bladder or suppress inflammation.
Bladder training – this is a therapeutic technique in which you are asked to try to void at designated times and use relaxation techniques and distractions to help keep to the schedule. Gradually, you can lengthen the time between the scheduled voids.
Sacral nerve stimulation – this is the use of a small electrical pacemaker that sends impulses to the sacral nerve, which controls the bladder. Some patients with IC find that it helps relieve some of their symptoms.