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| Interstitial Cystitis |
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It is a chronic inflammatory condition of the bladder with unclear etiology.? Inside the bladder, there is a mucous layer that lines and protects the bladder wall. When someone has IC, the mucous layer is believed to be damaged, which may allow irritating substances in the urine to aggravate and inflame the bladder wall, resulting in pain.
| Symptoms |
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The symptoms of IC vary from person to person; and even change, over time, in just one individual. In fact, IC can often be misdiagnosed because its symptoms resemble those of other conditions.
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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
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pain during or after sexual intercourse
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frequent, sometimes painful urination, (normally people urinate an average of 6-7 times per day; patients with IC urinate an average of 16 times per day, and some urinate as often as 60 times per day)
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waking more than once a night to urinate
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feeling the urge to urinate, sometimes even if there's nothing left in the bladder
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a urinary tract infection (UTI) or being diagnosed with more than 2 UTIs per year; symptoms that come and go - flare-ups associated with menstruation, certain foods, allergies or stress
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| Causes |
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No one is 100% sure of what causes interstitial cystitis (IC). But experts who study IC do have several theories to help explain why some people develop IC and other do not.
The GAG theory
The most widely held theory about what may cause IC involves the protective mucous lining of the bladder - or the glycosaminoglycans (GAG) layer. The job of the GAG layer is to act as a barrier to keep urine from irritating the bladder wall and prevent urine from leaking out of the bladder into the blood stream.
People with IC may have a damaged GAG layer that lines their bladder. Substances in the urine are then able to irritate or leak out of the bladder wall. This results in injury to the bladder muscle, inflammation and pain.
The bacterial infection theory
Medical tests do not reveal any organisms in the urine of patients with IC – and those affected do not respond to antibiotic therapy.? It is possible that bacterial may be presented in bladder cells, but not detectable through routine urine tests.
Other theories
- body releases substances that cause inflammation
- allergic response to the body’s own chemicals or to foods |
| Who gets IC? |
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| Although IC is most commonly recognized in women, more and more men are being diagnosed. IC can affect people of any age, race or sex. Approximately 25% of patients are under 30 years old when they first develop symptoms, and the mean age at diagnosis is 44 years. |
| Diagnosing IC |
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Interstitial cystitis (IC) is a treatable medical condition. But it can be very difficult to diagnose. Although in recent years, the medical community has been focusing more attention on IC, many healthcare professionals are still limited in their knowledge of this illness. And that can mean a frustrating journey for people with IC. In fact, it’s not uncommon for someone with IC to see several doctors, over the course of many years, before they actually diagnosed with the condition.
To complicate matters, there is no single test to determine whether or not a person has IC. The doctors must first rule out other conditions, which may be causing the symptoms.
Urinalysis and urine culture
To rule out genuine bacterial infection which may mimic symptoms of IC
Potassium sensitivity test
Most patients with IC respond positively to the PST; however, a small percentage of patients with IC have a negative result, and the reason for this is not known.
Cystoscopy
Many patients with IC have changes seen in the bladder but some have not. |
| Treatment of IC |
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Intravesical therapy
With intravesical therapy, normal saline or medication is instilled directly into the bladder. In intravesical therapy for IC, the bladder is filled with a solution that is held for varying periods of time, averaging 10 to 15 minutes, before it is then emptied.
Dimethyl sulfoxide (DMSO) is the one of the approved drug for intravesical use in the Unite States. The medication is known for its strong anti-inflammatory and pain-relieving properties.
Oral therapy
Typically, oral therapy is more convenient than intravesical therapy. Pentosan Polysulfate Sodium is the first and oral medication approved by the Food and Drug Administration (FDA) for the relief of bladder pain or discomfort associated with IC. It is a capsule that the patients have to take 3 times a day (or as recommended by the doctors). Although how Pentosan Polysulfate Sodium is not completely understood, it is believed to replenish the bladder wall, thus minimizing the irritation of the bladder lining.
The longer the administration period, the better it may work. So it is important for the patients to continue the treatment as directed by the doctors. In patients whose pain has not improved after 3-6 months of therapy, the clinical relevance and risk of continual treatment should be re-evaluated.
The most common side effects would be blood in stool, diarrhea, nausea, hair loss, headache, rash, upset stomach, abdominal pain, liver function abnormalities and dizziness. ?When side effects occur, they would be generally be mild and usually do not interfere with continuing treatment.
Pentosan Polysulfate Sodium is a weak anticoagulant (blood thinner), which may increase bleeding. The doctors should be informed if the patients will be undergoing surgery or will begin taking anticoagulant therapy, such as warfarin, heparin or high doses of aspirin; or anti-inflammatory drugs, such as ibuprofen. |
| Non-medical measures |
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Some people find that a warm compress or heating pad on the lower abdomen helps. Others find that a cold pack may help. For pain in the external genitalia, a bath in warm water with baking soda or Epsom salts may be soothing. The patients should speak to the doctors to see if these comfort measures are right for them.
Changing the diet
Changing the diet may help, so the patients should review what they are eating. Some patients will experience flare-ups of their IC for as long as 3 days after they have eaten certain foods, which include:
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Foods and drinks that contain caffeine, such as chocolate, coffee, tea and soft drinks
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Fermented foods and drinks, including cheeses and alcohol
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Aged, canned, cured, processed, and smoked meats and fish; anchovies; caviar; animal livers; corned beef; and meats that contain nitrates or nitrates.
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Fava beans, lima beans, onions, rhubarb and tofu
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Rye and sourdough breads.
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Most nuts except for almonds, cashews and pine nuts.
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Spicy foods (especially Chinese, Mexican, Indian and Thai foods).
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Acidic items, such as oranges, tomatoes and cranberry juice.
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Foods and drinks containing some artificial sweeteners, such as aspartame or saccharin.
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Preservatives, such as citric acid and monosodium glutamate (MSG).
Food diary
Some people may be sensitive to foods that other people are not. To help avoid flare-ups, it may be useful to keep a ‘bad day’s food list’.? So the patients should mark down what they ate over the last 3 days, and they can see what foods might repeatedly be giving them trouble.
Voiding diary
The patients can create a record of when they go to the bathroom and keep track of their diet which can help them to see the benefits of treatment with Pentosan Polysulfate Sodium. By making daily entries, the patients can help the doctors monitoring the progress.
Although the symptoms of IC are like those of lower urinary tract infections (UTI), the patients should be careful that simple home remedies (such as cranberry juice or various herbs) for UTIs may actually worsen the IC condition. Best of all, the patients should consult their doctors for remedies. |
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