Interstitial Cystitis A Painful Bladder Syndrome

Interstitial Cystitis (painful bladder syndrome)

Interstitial cystitis is the occurrence of persistent/recurrent pain in the urinary bladder. The term is mostly used for patients with typical cystoscopic features. It is usually accompanied by at least one other symptom. There is usually no obvious infection or any other specific issue. The condition is mostly connected with negative cognitive, behavioral, sexual or emotional consequences, and symptoms suggestive of lower urinary tract and sexual dysfunction.    

What Are The Symptoms?

The usual symptoms of interstitial cystitis/painful bladder syndrome (IC/PBS) include:

• Urinary urgency  
• Urinary frequency (daytime/night-time)  
• Nocturia    
• Suprapubic or pelvic pain without any known causal factor (sometimes radiating to the groins, vagina, rectum or sacrum)  
• Relieved by voiding, but soon reoccurs    
• Aggravated by food or drink/s    
• In women, worse symptoms often during menstruation       

Who Can Suffer From IC/PBS?

The problem primarily affects women. Due to late treatment seeking, the average age at the time of diagnosis is around 40 years. Although, as per statistics, almost 35% of patients start having symptoms in childhood. Thus, the condition can also affect children.      

What Causes Painful Bladder Syndrome?

Causes include:

• Epithelial dysfunction    
• Subclinical infection    
• Mast cell and vascular abnormalities    
• Neurogenic inflammation    
• Autoimmune phenomena    
• Up-regulation of sensory nerves in the bladder    
• Injury/dysfunction of the glycosaminoglycan layer that covers the urothelium (can be caused by bacterial cystitis, childbirth, pelvic surgery or urological instrumentation)

How is The Condition Diagnosed?

The diagnosis of interstitial cystitis is usually based on a thorough assessment and exclusion of other causes. Some of the ways are mentioned here:  

• Urinalysis and midstream urine for urine cultures: rule out urinary tract infection, including tuberculosis  
• Cervical swabs for herpes and chlamydia    
• Urodynamic studies    
• Cystoscopy (mainly to exclude bladder cancer)    
• Urethral swabs and prostatic secretion cultures (for men and chronic prostatitis)    
• Hydro-distension and biopsy – mostly used for pediatric patients

What Are The Treatments Available for IC/PBS?

Your doctor will choose the treatment best suited to your needs. Usually, treatment modalities are symptomatic and supportive in nature. Some of the them are mentioned here:

• Oral or intravesical therapies
• Surgical procedures (for refractory cases)
• Helpful dietary control (usually alcohol, tomatoes, spices, chocolate, caffeinated drinks, citrus drinks, acidic foods cause bladder irritation and inflammation)
• Complementary and alternative medicine/s    
• Behavioral therapy like biofeedback, pelvic floor exercises and bladder training programs    
• Distension of the bladder during diagnostic cystoscopy (distending results in nerve cells getting stretched and causes less sensitivity, for a time)    
• Transcutaneous electrical nerve stimulation (TENS); usually helps in conjunction with other therapies    
• Oral medications    
• Intravesical drugs    
• At times, Botulinum toxin type A can be useful in managing this condition (though there is no consistency in the results, across range of patients)    
• All ablative organ surgery    
• Surgical removal of the diseased bladder (as the last option)

How Does The Recovery Happen?

Most people will have complete resolution of symptoms within months. Some patients may experience the below recovery phase/s:

• A waxing and waning course  
• Completely asymptomatic with intermittent flares    
• Follow a chronically progressive course of increasing symptoms over many years    
• Some patients may recover spontaneously, but tend to have the condition for many years, while there may be spontaneous resolution, only to return days or months later    
• Short-term (up to one year) cure rates range from 50% to 75% for non-invasive or minimally invasive therapies (repeat administration of a therapeutic agent is required)    
• Definitive surgical interventions provide greater long-term cure rates (≥80%). Although, significant short-term and long-term adverse effects can occur frequently    
• Interstitial cystitis tends to have a significant and even profound effect on quality of life