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What Is Interstitial Cystitis, Its Symptoms And Treatments

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What is interstitial cystitis

Interstitial cystitis, also called painful bladder syndrome refers to a cluster of symptoms and signs characterized by a chronic increase in the frequency and urgency of urination, pain in the pelvis or lower abdomen and / or incontinence of urine.

The International Continence Society has defined as pain above the pubic bone in relation to the filling of the urinary bladder. It is accompanied by other symptoms, such as increased urinary frequency day and night, in the absence of proven urinary infection or other disease.

It has been observed that this disease can have significant negative effects on the quality of life for people who have it. Thus, half of the patients are unable to work full-time, three of every four patients have dyspareunia, ie, painful intercourse, and 70% have sleep disorders and 9 of 10 patients indicate that the disease affects their daily activities.

Who is affected by interstitial cystitis

Interstitial cystitis is 5-10 times more common in women than in men and affects young patients of 25-55 years with a mean age of 42 years. Most patients have mild to moderate degrees of disease so often goes unnoticed or is confused with other urological or gynecological problems.

We now know that interstitial cystitis may be present in most young patients (under 50 years) who present with symptoms of urinary urgency and pelvic pain or have been diagnosed with other causes.

What causes interstitial cystitis

The causes of this disease are probably multifactorial. Include an alteration of the permeability of the epithelium or inner layer of the urinary bladder and an increased activation of the sensory nerves of the bladder.

For many years the causes of this process have been unclear, but we now have evidence that different interstitial cystitis results from disruption of the inner layer called the urothelium or bladder that causes an alteration of the natural defense mechanisms that protect the bladder, the urethra and prostate in men with potentially toxic compounds which are usually present in urine.

As a result, these substances (primarily potassium) can penetrate the protective layer of the urothelial surface and activate the nerves and muscles of the underlying tissue.

Symptoms of interstitial cystitis

What Is Interstitial Cystitis

Although the clinical presentation of the disease is variable, patients with interstitial cystitis often have symptoms of urge incontinence (uncontrollable urge to go to the bathroom), increased frequency of visits to it, pelvic pain (in the bottom of the abdomen) and / or incontinence or urine leakage, in any combination. Most patients exhibit these symptoms.

The disease onset is often insidious, ie gradually appears, and in most cases gradually progresses over years and even decades. Generally, the initial symptom is increased urinary frequency up to 8-10 per day. One manifestation of this problem, present in most patients, is called nocturia, ie getting up to the toilet at night, sometimes 2-5 or more times.

Later, the patient may begin to experience episodes of pain with exacerbations lasting from a few days to several weeks. The pain may occur:

Approximately 75% of patients (men and women) have pain during intercourse (dyspareunia).

Pain is often not always constant in relation to the filling of the urinary bladder. It may also appear to empty the bladder.

Some factors such as allergies or, in women, hormonal changes, have been associated with exacerbations of the disease. Other factors such as physical and emotional stress, sexual activity and certain foods such as coffee, citrus, tomatoes, chocolate, fizzy drinks or caffeine, alcohol and spices have also been associated with the onset of pain of interstitial cystitis.

  • In the urethra or urine pipe
  • Above the pubic area or lower abdomen
  • In the lower back or lumbar or sacral region
  • On the buttocks
  • At the top of the thighs
  • In the groin, in the vagina or vulva in women or penis, testicles or scrotum in males.

How to diagnose interstitial cystitis

Although diagnostic criteria have been proposed, both clinical and cystoscopic and histological, there is no universally accepted method for correct diagnosis of interstitial cystitis.

The general consensus is that the diagnosis of this disease is mainly clinical and should be suspected in those men and women who go to the doctor with symptoms of increased frequency of urination, urinary urgency, and pelvic pain or discomfort exacerbations or worsening symptoms with sexual activity, provided that other causes are ruled out.

In addition to a good history and a complete physical examination, various tests have been proposed, such as urinalysis to rule out infection, sensitivity test potassium, cystoscopy or bladder endoscopy and biopsy of this organ and even urodynamic testing, but none of them has proved to be particularly specific to diagnose this disease.

Before diagnosing a patient should discard interstitial cystitis urine infections and radiation effects or chemical agents on the bladder. This disease should be considered in men and women with chronic pelvic pain in patients with overactive bladder who do not respond to medical treatment.

The symptoms of this disease can get to become chronic and progressive. The disease progresses slowly and, in some cases, may stabilize and even may not advance.

Prognosis and treatments for interstitial cystitis

Most cases of interstitial cystitis can be treated properly, both men and women, by oral treatment plan that can be added intravesical treatment when necessary. Basically treatments currently available are:

For years it has been using a technique called bladder distention, consisting dilate the urinary bladder under anesthesia. This treatment alleviates the symptoms of the patients in the 20% - 90% of cases, but only for a period of 3 to 6 months. Another possibility is the intravesical treatment with substances such as pentosan polysulfate.

Finally, in the most serious cases where medical treatment has failed, it has been proposed surgery with cystectomy or even complete removal of the urinary bladder and urinary diversion to a new bladder constructed from a loop of intestine. This is a last resort as it is very aggressive surgery. In experienced hands can, however, provide good results.

  • A treatment with substances called heparinoids most notably sodium pentosan polysulfate administered to all patients to try to restore epithelial function in the lower urinary tract.
  • Oral treatment with a tricyclic antidepressant amitriptyline called used to inhibit activation that accompanies nerve disease.
  • An oral treatment with antihistamines such as hydroxyzine to control allergies that can aggravate interstitial cystitis.

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