Interstitial cystitis is a long-term (chronic) problem in which pain, pressure, or burning is present in the bladder. It is also called painful bladder syndrome.
Cystitis - interstitial; IC
Causes, incidence, and risk factors
The bladder is a hollow organ with a thin layer of muscle that stores urine. When your bladder fills up with urine, it sends a signal to your brain, telling the muscles to squeeze. In most people, these signals are not sent until your bladder is almost full. If you have interstitial cystitis, the signal to empty your bladder is sent more often or when your bladder is not very full.
The condition most often occurs between ages 30 to 40, although it has been reported in younger people.
Women are 10 times more likely to have IC than men.
The exact cause of this condition is unknown.
Symptoms of IC are chronic. They have a tendency to come and go with periods of lesser or worse severity. Common symptoms include:
Many people who have long-term interstitial cystitis are also depressed because of the pain and changes to their lifestyle.
Signs and tests
Your doctor will look for other causes of your symptoms. These include:
Sexually transmitted infections
Tests are performed on your urine look for infection or cells that suggest cancer inside the bladder. During a cystoscopy, the doctor uses a special tube with a small camera on the end to look inside your bladder. A sample or biopsy of the lining of your bladder may be taken.
Tests at your doctor's office may also be done to show how much urine must be in the bladder before you feel the need to urinate.
There is no cure for IC, and there are no standard treatments. Treatment is based on trial and error until you find relief. Results vary from person to person.
DIET AND LIFESTYLE CHANGES
Some patients find that making changes in their diet can help control symptoms. Try to avoid foods and beverages that can cause bladder irritation. Stop eating certain foods, one at a time, to see if your symptoms get better. Reduce or stop consuming caffeine, chocolate, carbonated beverages, citrus drinks, and foods with high levels of vitamin C.
Other foods that the Interstitial Cystitis Association lists as possibly causing bladder irritation are:
Fava and lima beans
Meats that are cured, processed, smoked, canned, aged, or that contain nitrites
Most fruits except blueberries, honeydew melon, and pears
Nuts except almonds, cashews, and pine nuts
Seasonings that contain MSG
You and your doctor should discuss methods you can use for bladder training, such as training yourself to urinate at specific times or using biofeedback to relieve pelvic floor muscle spasms.
MEDICINE AND PROCEDURES
Combination therapy may include medicines such as:
Pentosan polysulfate sodium, the only medication taken by mouth that is approved for treating IC
Tricyclic antidepressants such as amitriptyline to relieve pain and urinary frequency
Vistaril (hydroxyzine pamoate), an antihistamine that causes sedation and helps reduce urinary frequency
Other therapies include:
Over-filling the bladder with fluid while under general anesthesia, called bladder hydrodistention
Medicines placed directly into the bladder, including dimethyl sulfoxide (DMS), heparin, or lidocaine
Bladder removal (cystectomy) for extremely difficult cases
Cody JD, Nabi G, Dublin N, McClinton S, Neal DE, Pickard R, Yong SM. Urinary diversion and bladder reconstruction/replacement using intestinal segments for intractable incontinence or following cystectomy. Cochrane Database Syst Rev. 2012;2:CD003306. DOI: 10.1002/14651858.CD003306.pub2.
French LM, Bhambore N. Interstitial cystitis/painful bladder syndrome. Am Fam Physician. 2011;83(10):1175-1181.
Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. The Journal of Urology. 2011;185:2162-2170.
Louis S. Liou, MD, PhD, Chief of Urology, Cambridge Health Alliance, Visiting Assistant Professor of Surgery, Harvard Medical School. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.