Interstitial Cystitis

Interstitial cystitis (IC), also known as painful bladder syndrome or frequency-urgency-dysuria syndrome, is a complex, chronic disorder characterized by an inflamed or irritated bladder wall. It can lead to scarring and stiffening of the bladder, decreased bladder capacity, and pinpoint bleeding (glomerulations).

About 700,000 people in the U.S. have IC, and about 90 percent of them are women. People of any age can be affected with IC, although it is rare in children. The cause of IC is still unknown, and patients with IC do not respond to antibiotic medication. Researchers are currently investigating many possible causes of IC to determine the most effective treatments.

Symptoms of Interstitial Cystitis

Common symptoms of IC include: frequent urination; feelings of pressure, pain, and tenderness around the bladder, pelvis, and perineum (the area between the anus and vagina or anus and scrotum); painful sexual intercourse; in most women, symptoms may worsen around the menstrual cycle.

Stress may also intensify symptoms, but stress does not cause symptoms to occur. IC tends to develop in people with a number of other conditions including endometriosis, hay fever and asthma, inflammatory bowel disease, lupus, migraine headaches, rheumatoid arthritis, and fibromyalgia.

Diagnosis of Interstitial Cystitis

Physicians diagnose IC by excluding any other condition that might be producing symptoms --urinary tract infections, sexually transmitted diseases, vaginal infections, bladder cancer and inflammation, tuberculosis cystitis, kidney stones, and endometriosis. To exclude these other conditions, urologists may perform simple blood and urine tests and cystoscopy to look at the inner walls of the bladder. They may stretch the bladder to capacity with fluid (called hydrodistension) while the patient is under general anesthesia and then inspect the bladder for areas of inflammation and cracks that bleed. They may perform a biopsy, removing a small sample of bladder tissue for examination under a microscope. In patients with frequency and urgency of urination, they may perform urodynamic studies to quantify the bladder pressure and capacity, urinary flow, and the patient's ability to empty the bladder. They may examine the bladder for Hunner's ulcers, a specific type of inflammation that is strongly associated with IC, but is rare.

Treatment for Interstitial Cystitis

As yet there is no cure for IC, so treatment approaches are designed to control symptoms. Each patient has his or her own unique subset of bothersome symptoms. At Columbia University Department of Urology at NewYork-Presbyterian Hospital, our urologists and other specialists work as a team to design therapies to alleviate each patient's symptoms.

Treatment may include:

• Bladder distension for interstitial cystitis, a surgical procedure during which the bladder is filled to capacity with water, is used to diagnose IC and has also been found to alleviate symptoms, perhaps by increasing bladder capacity and interfering with the pain signals transmitted by the nerve cells in the bladder.
• Bladder instillation for interstitial cystitis (also called a bladder wash or bath), a procedure in which the bladder is filled with a therapeutic solution that is retained in the bladder for varying periods of time, from a few seconds to 15 minutes, before it is drained through a catheter. Doctors use treatments to either coat and protect the bladder or suppress inflammation.
• Medications for interstitial cystitis such as Elmiron may reduce bladder discomfort and pain in some people with IC and may work by repairing the damaged bladder lining. Doctors may also prescribe antihistamines to alleviate inflammation in the bladder, antidepressants for their anti-pain properties, and analgesics for pain relief.
• Transcutaneous posterior tibial nerve stimulation for interstitial cystitis in which doctors send mild electric pulses to a nerve in the foot through a small acupuncture needle. These pulses may work by increasing blood flow to the bladder, strengthening pelvic muscles that help control the bladder, and triggering the release of hormones that block pain.
• Bladder training for interstitial cystitisis a therapeutic technique in which patients void at designated times and use relaxation techniques and distractions to help keep to the schedule. Gradually, the patient tries to lengthen the time between the scheduled voids.
• Interstim for interstitial cystitis is a small pacemaker that sends impulses to the sacral nerve, which controls the bladder. Some patients with IC find that it helps relieve their frequency, but it is usually reserved for patients who have not responded to other