Interstitial Cystitis

What is Interstitial Cystitis (IC) or chronic pelvic pain?

Interstitial Cystitis (IC) or chronic pelvic pain is a chronic inflammatory condition of the bladder that affects millions of men, women and children in the U.S. While most commonly found in women, it can affect people of any age, race or gender. Symptoms associated with this condition include pain, painful urination, urinary frequency, urgency, and painful intercourse. Other symptoms might include muscle and joint pain, migraines, allergies and gastrointestinal problems.

Unfortunately, most IC patients have difficulty obtaining a diagnosis. However, the effect of IC on an individual’s life should never be underestimated. IC can be debilitating and may cause the patient to experience feelings of helplessness and despair. Today, more than ever before, there is an improved understanding and awareness of pelvic pain by the medical community and the public at large. 

What causes chronic pelvic pain?

There are many theories as to the cause of IC. One prominent theory relating to the bladder symptoms has to do with the cells lining the inside of the bladder. The natural internal lining of the bladder is protected from toxins in the urine by a layer of protein called Glycosaminoglycan. In IC this protective layer may be broken down, allowing toxins to irritate the bladder wall. The bladder may then become inflamed, tender and fail to store urine well. Another theory is that IC is an autoimmune response following a bladder infection. Others believe that bacteria may be present in bladder cells that are not detectable through a routine urine test. Some scientists have also suggested that certain substances in the urine may be irritating to people with IC, but no substance unique to people with IC has as yet been isolated. Researchers are beginning to explore the possibility that heredity may also play a part in some forms of IC.

Early in the disease process, IC closely resembles a bladder infection. A person may complain of longstanding pain in the lower abdomen, feeling like they have a bladder infection, frequent urination during day and night, and pain associated with sexual relations. Women may suffer increased vulvar pain and may experience pain in the perineum. The symptoms may intensify as the bladder fills, while diminishing after urination. The pain often gets worse during menstruation. For men, symptoms may include pain and inflammation of the prostate, and ejaculation may be painful.

The symptoms of IC do not go away on their own, but may persist for a long time and even get worse. Symptoms usually worsen within the first 5 years and then level off. Patients with IC typically experience a period of symptom flare, or intensification, followed by periods of remission.

How is chronic pelvic pain diagnosed?

Because symptoms are similar to those of other disorders of the urinary system, doctors must first rule out other conditions before considering a diagnosis of IC. The usual urine analysis and cultures typically do not show anything abnormal in patients with IC, although a small amount of red blood cells may be found. In men, prostatic fluid may also be cultured.

A cystoscopy, performed under general anesthesia, is often used to evaluate patients with suspected IC. During a cystoscopy, the bladder is stretched with the addition of water which allows a better visualization of the bladder wall. The urologist can examine the epithelium with a small, telescopic fiber-optic camera, or scope, that is inserted through the urethra into the bladder. During the cystoscopy, a urologist may detect bladder wall inflammation, a thick stiff bladder wall or Hunners ulcers. Glomerulations (tiny hemorrhages that can be signs of IC) may also be revealed while the bladder is stretched to capacity. These hemorrhages may be present in up to 95% of IC cases.

A biopsy of the bladder, in which a tissue sample is removed and analyzed, is performed to distinguish between ulcers and cancer and to evaluate the presence of mast cells, which are sometimes seen in abundance in IC-affected bladders. Some IC sufferers do not have epithelial glomerulations or ulcers.

Unfortunately, there is no cure for IC. The goal of the treatment is to relieve symptoms. Most people are helped (for a varying amount of time) by one or a combinations of treatments. Treatment options can include:

  • Oral medications
  • Bladder instillations
  • Dietary changes to avoid irritants
  • Bladder training to reduce urinary frequency
  • TENS unit for pain control
  • Surgery