What is interstitial cystitis?
Interstitial cystitis is chronic inflammation of the bladder. People who have the condition have a bladder wall that is irritated and inflamed (sore and red). This inflammation can scar the bladder or make it stiff. A stiff bladder can’t expand as urine fills it. In some cases, the walls of the bladder may bleed slightly. Some people get sores in the bladder lining. More than 3 million American women and 1 million men have interstitial cystitis.
What are the symptoms of interstitial cystitis?
People who have interstitial cystitis may have the following symptoms:
- An urgent need to urinate, both in the daytime and during the night. They may pass only very small amounts of urine each time.
- Pressure, pain, and tenderness around the bladder, pelvis, and perineum. (The perineum is the area between the anus and vagina or the anus and the scrotum). This pain and pressure may increase as the bladder fills and decrease as it empties with urination.
- A bladder that won’t hold as much urine as it used to hold
- Pain during sexual intercourse
- In men, discomfort or pain in the penis or scrotum
For many women, the symptoms get worse before their menstrual period. Stress may also make the symptoms worse, but it doesn’t cause them.
What causes interstitial cystitis?
Doctors don’t know exactly what causes interstitial cystitis. However, they do know that it isn’t caused by bacterial or viral infections that can be tracked through standard tests.
A defect in the lining of the bladder might cause the condition. Normally, the lining protects the bladder wall from the toxic effects of urine. In about 70% of the people who have interstitial cystitis, the protective layer of the bladder is “leaky.” This may let urine irritate the bladder wall, causing interstitial cystitis. If the urine contains an abnormal substance, it can be even more irritating.
Other possible causes may be an increase of histamine-producing cells in the bladder wall (allergy). Or it could be caused by an autoimmune response. This is when your body mistakenly fights something healthy elsewhere in your body.
How is interstitial cystitis diagnosed?
It’s difficult to diagnose cystitis, so your doctor may have to rule out other conditions first. Your doctor will ask you questions about your medical history. They may ask you to keep track of:
- How much fluid you drink
- How often you urinate
- How much urine you pass
Your doctor will rule out other diseases such as:
- Urinary tract infections
- Bladder cancer
- Endometriosis
- Kidney stones
- Sexually transmitted infections (STIs)
- Chronic prostatitis in men
- Vaginal infections in women
Your doctor may also refer you to a urologist. This is a doctor whose specializes in problems of the urinary tract. The urologist may use a special scope (called a cytoscope) to look inside your bladder. They will look for inflammation, for ulcers, or to pinpoint bleeding. These things could indicate that you have interstitial cystitis.
Can interstitial cystitis be prevented or avoided?
You cannot prevent this condition because doctors aren’t sure what causes it.
Interstitial cystitis treatment
There is no cure for interstitial cystitis. You may need to try several treatments or a combination of treatments before you notice an improvement in your symptoms. Most people feel better after trying one or more of the following treatments:
- Diet. Your doctor may tell you to change what you eat. You may need to avoid alcohol, acidic foods, and tobacco.
- Bladder distention. Under anesthesia, a doctor overfills your bladder with gas or fluid. This stretches the walls of the bladder. Doctors are not sure exactly why this helps. It may make your bladder better able to hold more urine. It may also interfere with the pain signals sent by nerves in the bladder.
- Medicine. Your doctor may have you take an oral medicine called pentosan polysulfate. This medicine protects the lining of the bladder wall from the toxic parts of urine. Another oral medicine used to treat interstitial cystitis is an antihistamine called hydroxyzine. This medicine reduces the amount of histamine that is made in the bladder wall. Another medicine that may help is amitriptyline. It blocks pain and reduces bladder spasms. This medicine can make you sleepy, so it is usually taken at bedtime. Your doctor may also suggest that you take an over-the-counter pain medicine to ease pain.
- Bladder instillation. During a bladder instillation, a catheter (a thin tube) is used to fill your bladder with liquid medicine. You hold the medicine inside your bladder for a few seconds to 15 minutes. Then the liquid is released through urination. Treatments are given every 1 to 2 weeks for 6 to 8 weeks. The treatment can be repeated as needed.
Living with interstitial cystitis
The treatments listed above should provide some relief from interstitial cystitis. But there are also things you can do on your own to help relieve symptoms.
- Diet. Alcohol, tomatoes, spices, carbonated drinks, chocolate, caffeine, citrus fruits and drinks, pickled foods, artificial sweeteners, and acidic foods may irritate your bladder. That makes symptoms worse. Try removing these things from your diet for a couple of weeks. Then try eating one food at a time to see if it makes your symptoms worse.
- Smoking. Many people who have interstitial cystitis find that smoking makes their symptoms worse. Because smoking is also a main cause of bladder cancer, people who have interstitial cystitis have another good reason to quit smoking.
- Bladder training. Many people can train their bladder to urinate less often. You can train your bladder by going to the bathroom at scheduled times and using relaxation techniques.
- Physical therapy. People who have interstitial cystitis may have painful spasms of pelvic floor muscles. If you have muscle spasms, you can learn exercises to help strengthen and relax your pelvic floor muscles.
- TENS (transcutaneous electrical nerve stimulation). You can use a TENS machine to put mild electrical pulses into your body through special wires. Some doctors think that electrical pulses increase blood flow to the bladder. The increased blood flow strengthens the muscles that help control the bladder. It also releases hormones that block pain.
- Support group. You might consider joining a support group. The support of family, friends and other people who have interstitial cystitis can help you cope. People who learn about interstitial cystitis and participate in their own care do better than people who do not. A support group can provide you and your family with helpful tips and additional information.
Questions to ask your doctor
- How do my symptoms indicate interstitial cystitis, instead of another condition, such as an infection or urinary incontinence?
- Do I need any tests to confirm a diagnosis of interstitial cystitis?
- Will I need to see a specialist?
- What are my treatment options? Which treatment is best for me?
- How can I help manage my symptoms? Will diet changes, bladder training, or physical therapy help?
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.
