Interstitial Cystitis

Definition
Interstitial cystitis — also called painful bladder syndrome — is a chronic condition characterized by a combination of uncomfortable bladder pressure, bladder pain and sometimes pain in your pelvis, which can range from mild burning or discomfort to severe pain.

Interstitial cystitis is a chronic condition that affects an estimated 1 million Americans. While it can affect children and men, most of those affected are women. Interstitial cystitis can have a long-lasting adverse impact on your quality of life.

The severity of symptoms caused by interstitial cystitis often fluctuates, and some people may experience periods of remission. Although there's no treatment that reliably eliminates interstitial cystitis, a variety of medications and other therapies offer relief.

Symptoms
The signs and symptoms of interstitial cystitis vary from person to person. If you have interstitial cystitis, your symptoms may also vary over time, periodically flaring in response to common triggers such as menstruation, seasonal allergies, stress and sexual activity.
Interstitial cystitis symptoms include:

• A persistent, urgent need to urinate.
• Frequent urination, often of small amounts, throughout the day and night. People with severe interstitial cystitis may urinate as often as 60 times a day.
• Pain in your pelvis (suprapubic) or between the vagina and anus in women or the scrotum and anus in men (perineal).
• Pelvic pain during sexual intercourse. Men may also experience painful ejaculation.
• Chronic pelvic pain.

Some people affected by interstitial cystitis experience only pain and some experience only frequent, urgent urination. Most affected people, however, experience both pain and frequent, urgent urination.

Although signs and symptoms of interstitial cystitis may resemble those of a chronic urinary tract infection, urine cultures are usually free of bacteria. However, a worsening of symptoms may occur if a person with interstitial cystitis gets a urinary tract infection.

Causes
Your bladder is a hollow, muscular, balloon-shaped organ that stores urine until you're ready to empty it. In adults the bladder expands until it’s full and then signals the brain that it's time to urinate, by communicating through the pelvic nerves. This creates the urge to urinate in most people. With interstitial cystitis, these signals somehow get mixed up, and you feel the need to urinate more often and with smaller volumes of urine than most people.

It's likely that many people with interstitial cystitis also have a defect in the protective lining (epithelium) of their bladder. A leak in the epithelium, for example, may allow toxic substances in urine to irritate your bladder wall.
Suggested but unproven factors that may contribute to interstitial cystitis include an autoimmune reaction, heredity, infection or allergy.

Risk factors
These factors are associated with a higher risk of interstitial cystitis:

• Sex. Women receive a diagnosis of interstitial cystitis far more often than do men or children. Men can have nearly identical symptoms to those of interstitial cystitis, but they're more often associated with an inflammation of the prostate gland (prostatitis).
• Age. Most people with interstitial cystitis are diagnosed in their 30s or 40s.
• Other chronic disorders. Interstitial cystitis may be associated with other chronic pain syndromes, such as irritable bowel syndrome and fibromyalgia. Any common connection between these syndromes is unknown.

Complications
Interstitial cystitis can result in a number of complications, including:

• Reduced bladder capacity. Interstitial cystitis can lead to a stiffening of the wall of your bladder and reduced bladder capacity, meaning your bladder holds less urine.
• Lower quality of life. Frequent urination and pain may interfere with social activities, work and other activities of daily life.
• Relationship troubles. Frequent urination and pain may strain your personal relationships, and sexual intimacy is commonly affected.
• Emotional troubles. The chronic pain and interrupted sleep associated with interstitial cystitis may cause emotional stress and can lead to depression. Likewise, having depression or anxiety can worsen symptoms of interstitial cystitis.

 When to see a doctor 
If you're experiencing chronic bladder pain or urinary urgency and frequency, contact your doctor.

Preparing to see your doctor
Your doctor may use a questionnaire to make a preliminary assessment of your symptoms. You may also be asked to keep a voiding diary for a few days, in which you record information such as how frequently you urinate and how much and what kinds of fluid you consume.

For further testing, you may be referred to a specialist in urinary disorders (urologist) or urinary disorders in women (urologist or urogynecologist).

What you can do 
To get the most from your visit to the doctor, prepare in advance:

• Write down any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
• Make a list of any medications or vitamin supplements you take, regardless of how common you think they are. Many over-the-counter supplements can irritate the urinary tract. Also write down doses and how often you take the medication.
• Have a family member or close friend accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
• Take a notebook or notepad with you. Use it to write down important information during your visit.
• Prepare a list of questions to ask your doctor. List your most important questions first, in case time runs out.

For interstitial cystitis, some basic questions to ask your doctor include:

• Will my symptoms go away eventually?
• What kind of tests might I need to undergo?
• Will changing my diet help with my symptoms?
• Could the medicines I take be aggravating my condition?
• Are there any medications that would help ease my symptoms?
• Will I need surgery?

Make sure that you understand what your doctor tells you. Don't hesitate to ask your doctor to repeat information or to ask follow-up questions for clarification.

What to expect from your doctor 
Be prepared to answer questions from your doctor. Potential questions your doctor might ask include:

• How often do you feel the urge to urinate with little or no warning?
• Do you still feel the urge to urinate immediately after you've urinated?
• Do you ever urinate less than two hours after you finished urinating?
• Do you wake up at night to urinate?
• Do you have pain or burning in your bladder?
• Do you feel pain in your abdomen or pelvis?
• Are you currently sexually active?
• How much do your symptoms bother you?

Source: Mayoclinic.com

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