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Understanding Interstitial Cystitis (Painful Bladder Syndrome)

Interstitial cystitis (IC), also known as painful bladder syndrome, is a chronic inflammatory condition of the bladder lining that causes pain and pressure in the pelvic area around the bladder. Women with IC often feel the need to urinate frequently in addition to experiencing painful urination even though bladder infection is not the cause. For many women, IC interrupts their normal daily activities because of the need to stay close to a bathroom and a constant feeling of discomfort.

What is often most frustrating about this condition is that no exact cause has been pinpointed; however, IC patients may also have other health conditions such as fibromyalgia, irritable bowel syndrome, and pelvic floor dysfunction, among other conditions.

Symptoms of Interstitial Cystitis

  • Pain in the bladder and in the pelvic region surrounding the bladder. Pain may range from mild to severe.
  • Urgent and frequent need to urinate, even if the bladder is not full.
  • Pain that worsens during menstruation
  • Pain during sexual intercourse

Possible Causes

  • Defects in the bladder wall that allow irritation of the bladder wall
  • A specific type of cell that releases histamine and other chemicals which lead to symptoms
  • Something in the urine that damages the bladder
  • Changes in the nerves that carry bladder sensations making normal events, like bladder filling, painful
  • The body’s immune system attacks the bladder

Diagnosing Interstitial Cystitis

Typically, your doctor will begin testing for other conditions that cause the same symptoms and come to a diagnosis of IC once other causes are ruled out.

Your doctor will perform a comprehensive physical exam and may order additional testing including:

  • Urine analysis and urine culture.
  • Biopsy – During the bladder biopsy, your doctor will take a small bladder tissue sample for examination.
  • Cystoscopy with bladder distention – Your doctor uses a small instrument called a cystoscope to view the inside of your bladder. Your doctor may also fill the bladder with a liquid or gas to distend it, which provides a clearer view of the bladder walls.

Treatment Options for Interstitial Cystitis

While there is no cure for IC, treatments can provide relief from painful symptoms. Your doctor may provide several different therapies that have been shown to alleviate and/or diminish many of the symptoms of IC.

  • Physical therapy – Physical therapy is often the go-to therapy for women suffering from IC and is an effective treatment for underlying pelvic floor dysfunction. Physical therapy has been shown to greatly improve painful symptoms associated with IC for many women.
  • Dietary changes
  • Bladder instillation – Your doctor will insert a catheter into the bladder and instill special medication designed to provide relief from pain. The solution may also relieve inflammation.
  • Neuromodulation and Botox – Implanted neuromodulation devices such as InterStim® send mild electrical impulses to the nerves in and around the bladder to stimulate blood flow and produce chemicals that block pain.  The impulses may also decrease urinary urgency in some patients. Botox injections can help with frequency and urgency symptoms.
  • Bladder distention – Your doctor stretches the bladder by filling it with liquid or gas for a short period of time while you are under general anesthesia. Some women find short-term relief from distention.
  • Oral medication – Elmiron® is an FDA-approved drug for the treatment of IC. This drug has been shown to improve symptoms including frequency, urgency, burning, and pain.
  • Surgery – Typically reserved for the most severe cases, surgery may be considered when all other treatments have failed to provide symptom relief. Surgical options may include diverting urine from the bladder or enlarging the bladder but are usually only recommended as a last resort, if at all.

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