Interstitial Cystitis/Bladder Pain Syndrome

What is interstitial cystitis/bladder pain syndrome?

Interstitial cystitis/ Bladder pain syndrome (IC/BPS) is a complex, chronic disorder characterized by bladder pain often with urinary frequency and urgency. In some cases IC/BPS can be caused by an inflamed or irritated bladder wall or ulcer in the bladder, while at other times the bladder may look normal.

What causes interstitial cystitis/bladder pain syndrome?

The cause of IC/BPS is still unknown and patients do not respond to antibiotic medication. Researchers are investigating many theories to understand the causes of IC and to determine appropriate treatments. Most people with IC find that certain foods make their symptoms worse, including most commonly: citrus fruits, tomatoes, chocolate, and coffee, and potassium-rich foods. Other foods that bother many patients are alcoholic beverages, caffeinated beverages, spicy foods, and some carbonated beverages.

What are the symptoms of interstitial cystitis/bladder pain syndrome?

Pain localized to the bladder is the hallmark symptom of IC/BPS. That pain usually increases with bladder filling and decreases with bladder emptying. There are other symptoms that can be associated with IC/BPS and each individual may experience symptoms differently. Symptoms may include:

• Frequent urination
• Urgent urination
• Feelings of pressure, pain, and tenderness around the bladder, pelvis, and perineum (the area between the anus and vagina
• Generalized pelvic pain
• Painful sexual intercourse
• Blood in the urine

Stress may also intensify symptoms, but stress does not cause symptoms to occur.

The symptoms of IC may resemble other conditions or medical problems. Always consult your doctor for a diagnosis as it is important to exclude other conditions.

How is interstitial cystitis/bladder pain syndrome diagnosed?

Because there is no definitive test to diagnose BPS/IC, and because symptoms of BPS/IC are similar to other urinary disorders, a variety of diagnostic tests and procedures may be necessary. In addition to a complete medical history and physical examination, diagnostic procedures for BPS/IC may include the following:

• Urinalysis: Laboratory examination of urine for various cells and chemicals, such as red blood cells, white blood cells, infection, or excessive protein.
• Urine culture: to definitively check for infection
• Cystoscopy: an examination in which a scope, a flexible tube and viewing device, is inserted through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones. In some women with IC/BPS an ulcer or Hunner's lesion may be identified in the bladder. These inflammatory areas can be the direct cause of pain.
• Bladder biopsy: a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope to determine if abnormal pathology is present. This is done at the time of cystoscopy when an abnormality in the bladder is seen.

What is the treatment for interstitial cystitis/bladder pain syndrome?

Specific treatment for IC will be determined by your doctor based on:

• Your age, overall health, and medical history
• Extent of the disease
• The presence of an ulcer in the bladder
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

Often times more than one treatment is necessary to optimally treat IC/BPS. In general your doctor will usually recommend the simplest treatments first. Treatments are primarily focused on relieving symptoms, and may include:

• Lifestyle and Dietary Changes: There are many self-care practices and behavioral modifications that can be used to improve symptoms. Stress management has been shown to help some patients with IC/BPS. For some women, symptoms can be triggered by certain activities of food/drinks. If these can be identified, reducing or eliminating them can be very helpful. Some patients respond well to an IC diet where many acid foods are eliminated.
• Physical Therapy: Appropriate manual physical therapy techniques that are designed to reduce pelvic pain may be performed by trained clinicians. Pelvic floor strengthening exercises should be avoided.
• Medications: There are a number of oral medications that may be helpful for some patients. These may be tried alone or in combination.
• Bladder instillations: The bladder is filled with one of several solutions that are held for varying periods of time.
• Cystoscopy with hydrodistension: In some women, the bladder can be filled under anesthesia for a period of time under low pressure. This has been found be relieve symptoms is some patients who have not responded to behavioral therapy, physical therapy or medication.
• Cystoscopy with fulguration of a Hunner's lesion: If a Hunner's lesion or ulcer is identified with cystoscopy fulguration with laser or electrocautery may be recommended. This has a high likelihood of resolving pain.
• Botulinum Toxin: In rare circumstances you doctor may recommend that you consider Botox injections into the bladder when other conventional treatments have not worked.
• Sacral Neuromodulation: Sacral neuromodulation or Interstim where the nerves to the bladder are stimulated with an electric current supplied by an implanted device or "pacemaker" may be considered in cases when other conventional treatments have not worked.
• Reconstructive Surgery: This may be considered as a last resort for some women with severe IC/BPS that has not responded to other treatments.

Consult your doctor with any questions of concerns you may have regarding this condition.

Download: AUA Guidelines for Interstitial Cystitis