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Interstitial cystitis

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Overview of Interstitial cystitis

Interstitial Cystitis Meaning in Urdu

یہ ایک مثانے کی دائمی بیماری ہے جس کی وجہ سے مثانے کی تکلیف کا سامنا کرنا پڑتا ہے۔ جب کہ کچھ لوگوں کو مثانے میں زیادہ پریشر اور جسم کے نچلے حصے میں درد کا بھی سامنا کرنا پڑ سکتا ہے۔ یہ بیماری مردوں کی نسبت عورتوں کو زیادہ متاثر کرتی ہے۔ اس بیماری کی وجہ سے پیشاب پر کنٹرول ختم ہو سکتا ہے، جب کہ کچھ افراد کو پیشاب میں خون بھی آ سکتا ہے۔ ابھی تک یہ معلوم نہیں کیا جا سکا ہے کہ اس بیماری کی بنیادی وجہ کیا ہے اور یہ لوگوں کو کیوں متاثر کرتی ہے۔

Interstitial cystitis (IC) is a bladder disorder in which the bladder is extremely sensitive. It is a chronic health condition, It is also known as painful bladder syndrome as it causes bladder pain, bladder pressure, and pelvic pain. The pain ranges from mild discomfort to severe pain. 

This painful condition is part of a spectrum of diseases therefore it is known as painful bladder syndrome. It can also lead to an increasing need for urination or a sudden urge to urinate for at least 6 weeks.

Our bladder is a muscular hollow organ that stores urine. The bladder expands and stores urine until it’s full and sends a signal to the brain when it’s time to urinate. The bladder sends these signals via pelvic nerves. 

In interstitial cystitis, these signals get mixed up and you feel the need to pee more often as compared to normal people.

Prevalence 

 

Painful bladder syndrome or interstitial cystitis is a common condition. It approximately affects 1 to 4 million men and 3 to 8 million women. Interstitial cystitis affects women more as compared to men and has long-lasting effects. Even if there is no cure for painful bladder syndrome, therapies, and medications may offer relief.

Signs and Symptoms of Interstitial cystitis

Interstitial cystitis symptoms vary from person to person. If you suffer from interstitial cystitis or painful bladder syndrome, your signs and symptoms may also vary from time to time. It can show a high response to the triggers such as stress, menstruation, sitting for long periods of time, sexual activity, or exercise. 

Painful bladder syndrome or interstitial cystitis symptoms include

  • Chronic pelvic pain
  • In women, the pain is either in the pelvis or between the anus and vagina
  • In men, the pain is between the anus and scrotum
  • Continuous urge to urinate
  • Frequent urination throughout the day and night, often small in amount but like up to 60 times a day
  • Pain during sexual activity (sex)
  • Discomfort or pain when the bladder is filled and then relief after urination
  • Waking up several times at night to pee
  • Urinary inconsistency
  • Blood in the urine (haematuria)
  • Difficulty peeing

The severity of signs and symptoms of painful bladder syndrome or interstitial cystitis is different for everyone. Some people may even suffer from painless periods. 

Even though interstitial cystitis resembles that of chronic urinary tract infections or UTIs, there is no infection. But, when interstitial cystitis worsens, a person may suffer from a urinary tract infection. 

Types of Interstitial cystitis

Interstitial cystitis or bladder pain syndrome are of two types i.e. ulcerative and non-ulcerative.

  1. Non-Ulcerative Interstitial Cystitis 

90% of the patient suffer from a non-ulcerative type of interstitial cystitis or painful bladder syndrome. Non-ulcerative painful bladder syndrome is like a pinpointed hemorrhage in the wall of the bladder. These hemorrhages are also known as glomerulations. However, such a kind of hemorrhage is not necessarily linked with IC/BPS. But, instead, any inflammation in the bladder can look like these.

  1. Ulcerative Interstitial Cystitis 

About (5-10)% of interstitial cystitis can have an ulcerative form of painful bladder syndrome. These patients normally have patches or Hunner’s ulcers, which are red and bleeding areas on the wall of the bladder.

Causes of Interstitial cystitis

The exact interstitial cystitis causes are not known. But, it can be due to various factors. For example, people with interstitial cystitis may suffer from a defect in the epithelium lining of the bladders. If there is a leak in the epithelial lining of the bladder, it can cause toxic substances to enter urine and it can irritate the wall of the bladder. 

Other possible causes may include infection, autoimmune reaction, allergy, or heredity. 

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Risk Factors of Interstitial cystitis

The interstitial cystitis risk factors are as follows:

  • Gender - Women are more prone to interstitial cystitis as compared to men. In men, the symptoms may look like interstitial cystitis while in case, it is linked with prostate gland inflammation. 
  • Age - People in their 30s and above are mostly diagnosed with interstitial cystitis. 
  • Chronic Pain Disorder -  Interstitial cystitis is mostly linked with chronic pain disorders such as fibromyalgia or irritable bowel syndrome (IBS). 

Health Complications Due to Interstitial Cystitis

Interstitial cystitis can lead to various health complications such as:

 

  • Emotional Health Issues - You may suffer from chronic pain and sleep disorder due to interstitial cystitis. It can further lead to emotional stress and depression. 
  • Lower Quality of Life - Pain and frequent urination may interfere with a person’s social life such as work and other daily life activities.
  • Reduced Capacity of Bladder - The walls of the bladder are stiffened due to interstitial cystitis. Due to this, your bladder is unable to hold urine for a longer period of time. 
  • Problems of Sexual Intimacy - Pain and frequent urination may affect your personal relationships. It can affect your sexual intimacy as well.

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Prevention

There is no known way to prevent interstitial cystitis (IC). However, if you suffer from IC, you can manage your symptoms and pain by modifying your lifestyle.

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Diagnosis

There is no single test that can lead to interstitial cystitis. Your doctor would recommend several other tests to exclude other causes of your symptoms before a proper diagnosis is provided. 

The interstitial cystitis diagnosis is done in the following way:

 

  • Medical History - The doctor will ask you about your symptoms, and medical history and will ask you to keep track of your fluid intake and urination. 
  • Pelvic Exam - In a pelvic exam, the doctor will examine your external genitals, cervix, and vagina and check your abdomen to check your internal pelvic organs.
  • Urine Test - A complete urine test and urine culture test is done to check if there are any signs of urinary tract infections. 
  • Cystoscopy - The cystoscopy test is done to measure the capacity of the bladder. The healthcare provider would often provide anesthesia to make patients comfortable. 
  • Biopsy - A tissue sample from the bladder and urethra is taken and studied under a microscope in a biopsy. This is done to check the cause of bladder pain and bladder cancer.
  • Urine Cytology - The urine cytology test is done to rule out cancer. 
  • Potassium Sensitivity Test - In the potassium sensitivity test, your healthcare provider places two solutions, one with potassium chloride and the other with water. In this, a patient is asked to rate from 0 to 5 the urgency to pee and the pain. If a person feels more pain and urgency to pee then they might be diagnosed with interstitial cystitis. While people with normal bladder do not feel any difference.
  • Imaging Tests - Ultrasound, CT Scan, or MRI scan of the urinary tract and kidney is done to diagnose painful bladder syndrome 
  • Vaginal swabs
  • Urodynamics - A range of tests are conducted to check the function of the urethra and bladder functioning

Treatment of Interstitial cystitis | When to Consult a Doctor

When a certified doctor diagnoses you with IC/BPS (Interstitial cystitis or painful bladder syndrome), there are various treatment options based on the patient’s condition. 

Most interstitial cystitis patients are treated by one of the following methods:

  1. Diet

You need to eliminate certain foods such as spicy or the ones that are acidic as they can help in decreasing the severity of interstitial cystitis. You also need to avoid coffee, tea, cigarette, and alcohol as they can irritate interstitial cystitis. 

  1. Self Help

The following techniques can help improve the quality of life and reduce the severity and incidence of interstitial cystitis flare-ups. It includes

  • Stress Management and Reduction
  • Visualization
  • Changes in diet
  • Exercise
  • Biofeedback
  • Bladder retraining etc

  1. Physical Therapy 

A physiotherapist will help you in relieving pelvic pain that is linked to muscle tenderness, muscle abnormalities, or restrictive connective tissue in your pelvic floor muscle. 

  1. Oral Medications 

Some oral medications can help you in relieving the symptoms of interstitial cystitis such as:

  • Antihistamines such as Claritin (loratadine or others) can reduce the frequency or urgency of urine along with relieving other symptoms.
  • Nonsteroidal Anti-inflammatory drugs such as Aleve (naproxen sodium) or ibuprofen (Motrin IB, Advil, others) to relieve the pain
  • Tricyclic antidepressant such as imipramine (Tofranil) or imipramine is taken to help relax your bladder or block your pain
  • Pentosan polysulfate sodium (Elmiron) is approved by FDA for the treatment of interstitial cystitis. Macular eye disease is associated with the use of this drug so a patient needs comprehensive eye treatment to continue therapy. 

  1. Nerve Stimulation

Neuromodulation therapy or Nerve Stimulation helps to regulate your bladder by reducing your frequency and urgency. It also helps in alleviating the pain in your abdominal area or your bladder. 

  1. Botulinum Toxin Injections

Botox or botulinum toxin is also used as a treatment for IC/BPS. Your doctor can inject botox into your bladder muscle through the cystoscope. A small amount of botox can paralyze the muscle and it can help alleviate the pain. You may require the botox injections after every 4 to 9 months. 

  1. Bladder Instillations 

Some medicine is also directly entered into the bladder using a thin tube known as a catheter. 

It is known as bladder instillations or intravesical medicines. Examples of intravesical medicine include:

  • Hyaluronic acid or Chondroitin Sulphate - This helps in restoring the bladder lining.
  • A mixture of compounds including sodium bicarbonate, steroids, and heparin are used for this process. 
  • Lignocaine - a local anesthesia that numbs the bladder is used 
  • Antibiotics alone or combined with a local anesthetic and steroid - it can help calm inflammation and reduce friction.

Bladder Stretching (Hydrodistension)

In this, the doctor fills your bladder with sterile water to stretch out your bladder to increase the amount of pee it can hold. This can also help in calming or breaking the overactive nerve endings telling your brain that your bladder is in pain. The doctor will give you anesthesia so that you aren’t awake and won’t feel any pain. 

  1. Surgery 

Surgery is recommended for those patients whose symptoms are severe and do not respond to any other treatment options. 

Surgery options are

  • Fulguration - It is a minimally invasive surgery, that involves the insertion of instruments through the urethra to burn any ulcers that are present with interstitial cystitis. 
  • Resection - This is another minimally invasive surgery in which instruments are inserted through the urethra to cut any ulcers.
  • Bladder Augmentation- A surgeon increases the capacity of the bladder in this procedure by putting a patch of the intestine on the patient’s bladder. But, this is a very rare surgery. This surgery does not eliminate pain and some people may need to empty their bladder with the help of a catheter throughout the day.

If you observe any concerning signs and symptoms regarding interstitial cystitis, you need to visit a certified urologist as soon as possible to get it treated.

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