Interstitial Cystitis

Causes of interstitial cystitis

No one really knows what causes interstitial cystitis and because it varies from person to person, specialists believe there may be multiple causes such as:

• A defect in the lining of the bladder, which allows harmful substances found in urine to come into contact with the bladder wall.
• Changes in nerves inside the bladder.
• An overproduction of histamine or other potentially harmful chemicals by mast cells (a special type of cell that is involved in allergic reactions).
• An autoimmune response, whereby the body attacks its own organs and tissue.

The urine of people with interstitial cystitis contains a substance known as antiproliferative factor (APF), which appears to block the development of cells in the bladder lining. Therefore it could be that some people are predisposed to get interstitial cystitis after an infection or injury to the bladder.

Symptoms of interstitial cystitis

Symptoms of interstitial cystitis vary from individual to individual. Some people may have only a mild sense of urgency while others have multiple symptoms. Any of the following symptoms could indicate the presence of interstitial cystitis:

• Pain ranging from mild to intense in the bladder and surrounding pelvic region and perineum – the area between the anus and vagina in women and the anus and scrotum in men.
• Urgent need to urinate, even if only small amounts of urine are present.
• Frequent need to urinate.
• Pain that worsens during menstruation in women.
• Painful sexual intercourse in women.
• Pain or discomfort in the scrotum or penis in men.

Diagnosis of interstitial cystitis

There is no one test that is specific for interstitial cystitis. Because other conditions can cause the same symptoms, a diagnosis is made only after other possible causes are ruled out. Other conditions that can cause the same symptoms include:

• bladder cancer
• chronic prostatitis in men
• endometriosis
• kidney stones
• sexually transmitted infection
• urinary tract infection
• vaginal infection

The doctor will start by asking you about your symptoms. Then the doctor will give you a physical examination and arrange a series of tests to rule out other possible causes. Those tests include:

• Urine analysis and urine culture. This involves dipstick testing a sample of urine and having the urine examined in the lab. Red and white blood cells and bacteria in the urine can indicate an infection. If the urine is sterile while symptoms persist, the doctor may suspect IC.
• Ultrasound. An imaging test is performed to visualise inner organs such as the bladder, kidneys and ureters.
• Cystoscopy with bladder distention. With this test, a specialist looks at the inside of your bladder using a cystoscope. That’s a hollow tube with a light and lenses that the doctor inserts through the urethra, the tube that urine passes through when you urinate. During the examination, the specialist may fill the bladder with a liquid or gas to distend or stretch it. This allows a better view of the walls and makes it easier to check for abnormalities. Because distension is painful, this procedure is done with some form of anaesthesia.
• Biopsy. During the cystoscopy, the specialist may take a small sample of tissue to examine under a microscope to rule out bladder cancer. Having IC does not increase your risk for bladder cancer.

Treatment of interstitial cystitis

Because there is no cure for interstitial cystitis, the goal of treatment is to relieve symptoms. Not everyone with IC responds the same way to the same treatment. What works for one person may not work for another. In addition, IC treatments generally take several weeks to several months to provide relief. When you discuss your treatment options, your doctor will help you decide which one might work best for you. Treatment options include:

• Bladder distension. Some patients report feeling better after the bladder distension used during diagnosis. Symptoms often worsen within the first two days after distension. However, they return to pre-distension levels or improve within two to four weeks. It isn’t clear why distension causes symptom relief in some people. It may be that distension increases the capacity of the bladder, or it may be that it interrupts the pain signals.
• Bladder instillation. This is also called a bladder wash or bath. A catheter is used to fill the bladder with a solution containing a medication to reduce the bladder wall inflammation. The solution is held in the bladder for an average of 10 to 15 minutes before the bladder is emptied. Treatment is given either every week or every other week for a period of six to eight weeks and then repeated as needed. Improvement is usually seen three to four weeks after the first six- or eight-week cycle.
• Oral medications. The doctor may suggest aspirin and ibuprofen as well as prescription medicines to help control pain. The doctor may also prescribe an antidepressant or an antihistamine. Both have been effective in treating IC. The oral contraceptive pill can improve symptoms in some women.
• Electrical nerve stimulation. Sometimes mild electrical pulses are used to stimulate nerves to the bladder. This may increase blood flow to the bladder, strengthen the bladder muscles and trigger chemicals that block pain. The impulses are sent through the skin using a TENS machine through wires placed on the lower back or just above the pubic area. TENS stands for “transcutaneous electrical nerve stimulation”. The electrical impulse can also be delivered using a special device inserted into the vagina for women or into the rectum for men. If nerve stimulation works, there is a device that can be implanted under the skin to deliver regular impulses to the bladder.

None of the IC treatments work immediately, and it can take weeks or months before the symptoms improve. Because interstitial cystitis is a chronic condition, most patients need to continue treatment indefinitely to keep the symptoms from returning. It’s also important to note that not all patients will become symptom-free. Many still have an issue with frequency or with some level of persistent discomfort.

Contact us

London Urology are experts in diagnosing and treating interstitial cystitis and can offer same day appointments to ensure you are treated as soon as possible. If you have any questions or would like to book an appointment then you can contact our team by calling 020 7432 8297 or emailing [email protected].