Interstitial Cystitis & Painful Bladder Syndrome

Background

Interstitial cystitis (IC) is a syndrome whose symptoms are bladder and/or pelvic pain for which no definable cause can be found – it is NOT caused by other conditions affecting the bladder such as infections, cancer, stones, irritation from drugs or radiation, etc. or affecting the reproductive tract such as endometriosis and pelvic inflammatory disease. While many theories have been put forward, the exact cause of IC remains unknown. For this reason, the treatments are ‘empiric’ – or based on educated guesses of what should work best. This is an ongoing area of intense research.

 

It is very common for us to see patients whom have been seen by many other specialists beforehand. Patients are looking for a cure and for answers. There is a lot of information on the internet on IC including many theories on causes and treatments. The science was recently reviewed and for those patients whom are interested in reviewing the latest information on their own, the American Urological Association produced a document summarizing the data. There are a few key points

  1. There are probably multiple different causes. As a result, treatment is tailored to the patient.
  2. There is no known cure for this condition. The goal is to improve on the symptoms to the greatest degree possible.
  3. Patient empowerment to help themselves is a primary goal.

 

Download the AUA  Guidelines for Interstitical Cystitis

 

Causes

Currently, the cause of this conditions remains unknown.  There are several theories which are being investigated.  Possible causes being investigated include - disorder of the bladder's sensory nerves, problem with the lining of the bladder, autoimmune inflammation of the bladder among several others.

 

You might be surprised to know that not all urinary problems or even  all pelvic pain originates inthe bladder! There are numerous other potential causes including problems:

  1. Gastrointestinal: hemorroids, perianal fistula and fissures, constipation, inflammatory bowel disease, rectal cancer
  2. Gynecologic: atropic vaginitis, menstrual abnormalities, endometriosis (can involve the bladder), fibroids, infection
  3. Musculoskeletal: muscle and fascial sprains and strains can occur in the pelvic muscles just like anywhere else

 

Diagnosis & Evaulation

One of the most important issues with pelvic pain is to exclude the presence of serious conditions involving the pelvis lower urinary tract and reproductive system. IC is a diagnosis of exclusion which means that testing is required to rule out other causes of the same symptoms (eg. infection, stone, inflammation of reproductive or urinary tract).

 

Physical examination is an unavoidable and very important part of the evaluation to exclude serious causes and localize any pain you may have. Please note that your symptoms may be come worse following the examination - this will not be permanent.

 

 

Treatment

IC tends to be a chronic condition with exacerbations and remissions; late deterioration is unusual. About half of all patients will have remissions lasting several months, though episodes may last as little as 1 month or as long as several years. There is no ‘easy cure’ for IC. Improving your quality of life by minimizing symptoms is the primary goal.

 

There are several things you can do to help yourself.  In general, regular exercise, stress reduction and a healthy diet are key.  Consider warm (or cool baths) for pelvic floor tension relief. If there are obvious triggers for your symptoms, try to avoid them (eg. certain foods).

 

IT IS CRITICAL THAT YOU KEEP WITH THE TREATMENTS FOR LONG ENOUGH. EACH CHANGE MAY TAKE 3 MONTHS TO TAKE EFFECT. DON'T GIVE UP TOO EARLY!