sometimes referred to as painful bladder syndrome – is a chronic, yet treatable, condition of the bladder that affects both women and men.
If you think you have interstitial cystitis (IC), it may seem like no one understands what you are going through. Remember, you are not alone. Your doctor can help with treatment for your IC.
To better understand interstitial cystitis (IC), it's helpful to have some knowledge of the urinary system and what might cause IC. Here's a short overview.
what is interstitial cystitis?
the urinary system
upper urinary tract
The urinary system is composed of various organs, tubes, muscles, and nerves that work together to create, carry, and store urine.
The kidneys produce urine, a fluid containing irritating substances and natural waste products. From each kidney, the urine flows through a long thin tube called the ureter. From the ureters, the urine travels to the bladder.
The bladder is an organ located in the pelvic area. It is a muscular sac responsible for storing and emptying urine. Since the bladder may store urine for several hours, it has a protective lining to shield its wall from the irritating waste products of the kidneys. This protective mucous lining is called the glycosaminoglycans (GAG) layer. This layer acts as a barrier to keep the irritating substances of the urine away from the bladder wall.
Chronic pain in the bladder may also be aggravated by allergies. In some patients, symptoms may get worse when certain foods are eaten. Some experts also believe that the bladder's GAG layer has become thinned or is absent. A damaged GAG layer may allow irritating substances in the urine to aggravate the bladder wall and cause inflammation and pain. Medical experts believe that many causes could actually be working together, resulting in the same set of painful symptoms common in IC. Fortunately, there's a growing awareness of IC.
what are the symptoms of IC?
• unexplained pain or pressure in the urethra, the vagina, the area above the pubic bone, the inside of the thighs, the lower abdomen, the lower back, the groin area, or any combination of these areas
• pain during or after sexual intercourse.
• frequent, sometimes painful, urination. (normally, people urinate an average of 6 to 7 times per day. Patients with IC urinate an average of 16 times per day.)
• wake up one or more times at night to urinate.
• the urge to urinate, sometimes even after you've emptied your bladder.
• unresolved symptoms of a urinary tract infection (UTI) that have not responded to antibiotic therapy.
• symptoms come and go — flare-ups may be associated with menstruation, certain foods, allergies, and stress.
misdiagnosis is common
Although more and more doctors are gaining awareness of interstitial cystitis (IC), this condition may often be undiagnosed for a long time. And it's not uncommon for someone with IC to see several doctors, over the course of many years, before they are actually diagnosed with the condition. That's why it's important to find a doctor who is familiar with IC. Urologists and obstetrician/gynecologists (OB/GYNs) are 2 types of specialists who tend to be most familiar with the diagnosis and treatment due to their specialized clinical experience.
IC is a chronic condition of the bladder that's characterized by urinary urgency, frequency, and pelvic pain. As mentioned, IC has many symptoms that are in common with other conditions, such as: Chronic Pelvic Pain (CPP), Recurrent Urinary Tract Infections (UTIs), Endometriosis, Overactive Bladder (OAB), and Vulvodynia.
chronic pelvic pain
People with IC often feel as if they have a bladder infection, but a standard urinalysis test shows that they do not. A urine culture should bedone to rule out infection.
The Pain/Urgency/ Frequency - patient questionnaire (or PUF), which has been in use for several decades, is also a useful tool for diagnosis. Be aware that it may take several visits to multiple physicians for proper diagnosis.
cystoscopy with biopsy of the bladder wall
Cystoscopy allows the doctor to look at the bladder wall by inserting a small “scope” through the urethra into the bladder. Many physicians agree that the only definitive test to identify IC/ PBS is cystoscopy of the bladder, which identifies erythema (or reddening), inflammation, and pinpoint hemorrhages on the bladder mucosa called glomerulations, all of which are characteristic of IC.
Hydrodistention is a procedure that introduces extra fluid into the bladder through a catheter. Hydrodistention is also sometimes performed for therapeutic purposes.
standard medical treatments
Medications for treating chronic bladder problems fall into several broad categories: drugs to repair the bladder lining, drugs to treat the allergy component of IC, pain medications, antispasmodics, and antianxiety medications.
pentosan polysulfate sodium, a drug developed to help repair the bladder lining, is the only currently approved medication used specifically to treat IC.
It typically takes at least 3-4 months to work. The most common side effects are minor gastrointestinal discomfort and headaches. There may be concern of increased bruising and risk of bleeding. It is not recommended in pregnancy.
hydroxyzine hydrochloride is a strong antihistamine with both pain-relieving yet sedating properties. It should not be taken before driving or going to work.
Frequent side effects include drowsiness, dizziness, blurred vision, dry mouth, and headache. Very serious reactions can include irregular heartbeat, seizures, and difficulty breathing caused by anaphylaxis, a life-threatening reaction. Not safe in pregnancy or breast feeding.
amitriptyline is an antidepressant often used to treat chronic pain. It may block nerve signals that trigger pain in the bladder and is very inexpensive.
It may cause drowsiness, dizziness, increased sun sensitivity, blurred vision, orthostatic hypotension (dizziness upon rising from a sitting or lying position), dry mouth, and restlessness but most people find the side effects manageable side effects. Other antidepressants maybe considered.
A combination of three drugs—Elmiron, an antihistamine, and an antidepressant—is a common pharmaceutical approach to treating IC.
Gabapentin, an anticonvulsant, also works on neuropathic pain. However in some with IC it may cause bladder pain. Side effects include dizziness and drowsiness and it is not safe for use in pregnancy.
Pregalbin is a newer drug similar to Neurontin but it does have some risk of addiction. It should never be stopped abruptly. It reduces the level of perceived pain but the mechanism of action is unknown. It may cause dizziness and sleepiness as well as weight gain. It is not recommended for use during pregnancy.
Doctors may offer to prescribe narcotic pain medications to help manage severe IC pain. However, they are the LEAST effective medications for chronic pain, they are addictive, and they produce other common side effects such as severe constipation. They are NOT a good choice to use on a regular basis unless there is no other solution.
Antianxiety Medications & Muscle Relaxants
are meant to be used “as needed,” in order to control severe flare-ups in bladder pain, spasms, and the extreme anxiety that can go along with these symptoms. These drugs may include baclofen (Lioresal) to treat muscle spasms and alprazolam (Xanax) which is commonly used to treat anxiety it may also relax the bladder. Both of these drugs have significant side effects, and they should be used very carefully. unt ut labore et dolore a alit enim ad minim veniam, quis nostrud.
Other prescription drugs to help with bladder spasms include Detrol (tolterodine), Vesicare (solifenacin), Sanctura (trospium), Toviaz (fesoterodine fumarate), and Enablex (darifenacin). These medications may be useful for treating OAB, but they are less useful for IC, especially over time. Some patients using these medications may experience difficulty urinating or suffer from urinary hesitancy—a particularly annoying, stress-producing symptom that occurs with many anticholinergics and bladder relaxants. The most common side effects are dry mouth and constipation. Pyridium (phenazopyridine hydrochloride) is often prescribed to reduce discomfort and irritation during urination.
Over-the-Counter Pain Medication
The over-the-counter pain medications acetaminophen and ibuprofen are not strong enough to handle the severe pain of IC for most people. Ibuprofen and other NSAIDs may even provoke symptoms in people with sensitive, fragile bladder linings
This treatment, also referred to as intravesical therapy, involves instilling various “cocktails” of medications into the bladder via a catheter. A standard cocktail combines lidocaine (a local anesthetic), sodium bicarbonate, and either Elmiron or heparin (which are molecularly similar).
The treatment needs to be repeated at regular intervals, which are determined by your physician based on your response or progress. More recently, studies have shown the effectiveness sulfate to aid in the repair of the damaged surface of bladder epithelium in IC patients. Due it its high binding capacity with bladder epithelium, it helps to “plug the holes” and to decrease permeability. Hyaluronic acid is another GAG present in the mucous layer lining the bladder epithelium.
This procedure is exactly what it sounds like. The bladder is distended, or inflated, with liquid, usually a saline solution combined with specific medications. It is used as both a diagnostic test and initial therapy. This is because up to 25 percent of people with IC/PBS have noted at least a temporary improvement in symptoms after a bladder hydrodistention was performed to help diagnose their condition. Temporary bladder distention may increase capacity and interfere with pain signals transmitted by nerves in the bladder. Although symptoms may initially worsen for four to forty-eight hours after distention, they should return to baseline levels or begin to improve within two to four weeks. The effect lasts for variable amounts of time in different people, but as a general rule may last for up to three to six months.
Pelvic floor rehabilitation. At your first visit, you may have to undergo a physical exam that can feel invasive, as the PT checks for proper internal alignment; she or he will also check the function of the delicate muscles surrounding the vagina, rectum, groin, and pelvic floor. Once your PT diagnoses any specific problems and develops a treatment plan to help you regain normal function, you’ll begin regular sessions of physical therapy. You’ll usually also be given a set of exercises to do at home between visits. Using a biofeedback technique, your PT can teach you to recognize and release the tension in your pelvic floor muscles and can address any other issues that might be related to your urological dysfunction, including, possibly, birth trauma, sexual trauma, or even childhood abuse.
alternative options for treating IC
derived from fish oil at a dose of 2 grams per day has been shown to be effective in several studies. Omega-3 fatty acids are the precursor of the potent anti-inflammatory and vasodilating eicosanoids. This conversion requires niacin, magnesium, vitamin B6, vitamin C, and zinc. Omega-6 fatty acids are the basis for producing pro-inflammatory vasoconstrictor eicosanoids. Increasing the proportion of omega-3 to omega-6 reduces inflammation and improves vascular flow, reducing tissue hypoxia.
Beneficial eicosanoid precursors can be found in black currant oil, evening primrose oil, pumpkin, and flax seeds.
2,500 international units (IUs) daily for five days, overlapping the time of pain, has also been shown to be effective
was found to be more effective than placebo in a 2001. Magnesium is a muscle relaxant, helping to diminish uterine contractility as a source of pain, as well as improving vascular flow. Magnesium glycinate at 400 milligrams is helpful when taken once to twice daily starting several days before menses starts through the end of flow.
at high doses (50,000 IUs weekly) has been shown to be useful in treating dysmenorrhea, but additional studies evaluating the efficacy of vitamin D have not been as convincing.
vitamin B1 (thiamine)
at a dose of 100 milligrams daily has been shown to be effective in a randomized controlled study in a group of 500 Indian women.
acts in a multitude of beneficial ways to reduce dysmenorrhea. It increases insulin sensitivity, thus reducing inflammation. It reduces the volume of menstrual flow. It is an anti-spasmodic. It also improves circulation, thus reducing tissue hypoxia.
has been found to have a substantial impact on menstrual pain. Two components in ginger, the gingerols and gingerdiones, inhibit leukotriene and prostaglandin synthesis, thus decreasing pain. One study evaluated a dose of 500 mg three times daily for five days, beginning two days prior to the onset of flow. Another study used 250 mg four times daily for three days beginning on the first day of flow. Ginger was as or more effective than placebo as well as NSAIDs with the added bonus of diminishing nausea.
is an anti-inflammatory agent as well as an analgesic when taken systemically. Both effects are very useful in the treatment of dysmenorrhea. CBD is also an anxiolytic. Anxiety is a risk factor for primary dysmenorrhea, and is also a result of cyclic pain, the anticipation of pain produces anxiety.
diet & lifestyle
low-fat vegan diet
a low-fat vegan diet has been shown to significantly reduce pain for many women
eliminates all animal fats and nearly all vegetable oils.
emphasizes plant-based foods, rich in fiber
a low-fat, high-fiber diet can reduce estrogen levels by about 20 percent.
Since estrogen is responsible for growth of endometrium, less estrogen equates with less endometrium, less menstrual flow and less prostaglandin production.
The high amount of vegetable fibers assists in estrogen metabolite elimination. Improved bowel elimination also prevents reabsorption via the enterohepatic circulation.
Paleo or Mediterranean diet
inflammation is the hallmark of dysmenorrhea Paleo and Mediterranean style diets are known to be anti-inflammatory
high amounts of vegetables
low in sugars and other carbohydrates
reduced or eliminated dairy and gluten
use of healthy oils such as avocado and olive oils, and use of nuts and seeds.
the Standard American Diet (or SAD) is high in processed sugary foods, animal fats from industrialized animals, and refined vegetable oils
these "foods" are known to be highly inflammatory
Aerobic exercise is anti-inflammatory, improves circulation, improves anxiety and depression, improves bowel function and estrogen metabolite elimination, and results in an outpouring of endogenous endorphins, our own natural pain relievers.
Similarly, orgasms have been promoted to have similar effects as exercise with the added benefit of directly increasing uterine circulation.
Stress management is an integral part of treating women with dysmenorrhea, as their cyclic pain will surely contribute to angst and further dysfunction. Meditation, yoga, prayer, mindful awareness, and other stress-reduction efforts are an essential part of caring for women in pain.