Women’s health—Interstitial cystitis and painful bladder syndrome
What is interstitial cystitis?
Interstitial cystitis (IC) is a condition associated with bladder pain and a frequent, and often urgent, need to pass urine. Women with IC may have a bladder wall that is inflamed and irritated. In severe cases, the bladder wall inflammation can scar and stiffen the bladder so that it cannot hold as much urine.
Women with IC may experience many of the following symptoms:
- an urgent need to urinate, both day and night
- a frequent need to urinate
- pressure, pain, and tenderness around the bladder, pelvis and perineum (the area between the anus and vagina). This pain and pressure may increase as the bladder fills and then decrease as the bladder empties
- a bladder that will not hold as much urine as it did previously
- pain during sexual intercourse.
The symptoms of IC vary from person to person. For many women, the symptoms become worse before their menstrual period. Stress may also intensify symptoms, but it does not cause them.
What causes interstitial cystitis?
The cause of IC is currently unknown. However, it may be caused by a defect in the lining of the bladder. Normally, the lining protects the bladder wall from the toxic effects of urine. In about 70 per cent of people with interstitial cystitis, this protective layer is ‘leaky’ and may allow urine to irritate the bladder wall, causing interstitial cystitis.
We do know that bladder infections, with a bacteria or virus, do not cause IC.
How does my doctor know I have interstitial cystitis?
You may have IC if any of the following occur:
- you have to urinate frequently or urgently
- you have persistent pelvic or bladder pain
- a doctor finds bladder wall inflammation, pinpoint bleeding or ulcers during an examination with a cystoscope (special telescope) that looks inside your bladder
- your doctor has ruled out other diseases such as urinary tract infections, vaginal infections, bladder cancer, and sexually transmitted diseases that may mimic some of the symptoms of interstitial cystitis.
How is interstitial cystitis treated?
Given the causes of IC are unknown, current treatments are aimed at relieving symptoms.
Most people feel better after trying one or more of the following treatments:
You may need to avoid certain foods and beverages such as alcohol, tomatoes, spices, chocolate, caffeine, citrus drinks, artificial sweeteners and acidic foods, as these may irritate your bladder. Try eliminating these foods from your diet for a few weeks then re-introduce them, one food at a time, to see if they make your symptoms worse.
Many people with IC find that smoking makes their symptoms worse. Because smoking is also a cause of bladder cancer, people with IC will reduce their risk if they are able to quit smoking.
A physiotherapist can help you with techniques that can reduce pain by using muscle relaxation techniques and reduce the number of times you have to pass urine.
They can also help you with bladder training. If you have no pain but are bothered by frequency or urgency, you may be able to train your bladder to hold more by going to the toilet at scheduled times and using relaxation techniques. After a while, you try to stretch the time you can wait before emptying your bladder.
- Your doctor may recommend you take oral medicine called amitriptyline which blocks pain perception related to bladder filling and reduces bladder spasm. This medicine can make you sleepy and is best taken at night.
- Cimetidine may also help some patients as it reduces inflammation.
- Pentosan polysulfate (Elmiron) helps to protect the lining of the bladder wall from the toxic effects of urine; however, it is very expensive and availability is limited.
If you have not experienced any relief from these treatments then you will be referred to a specialist in the urological service for alternative treamtent options:
- Bladder distension as part of a cystoscopy (bladder investigation with a telescope) under a general anaesthetic does have some effect on improving symptoms, although this only gives temporary relief. Bladder instillation where a catheter (a thin tube) is used to fill your bladder with a liquid medicine called dimethyl sulfoxide (DMSO). You hold the medicine inside your bladder for up to 15 minutes then the liquid drains out through the catheter. Treatments are given every one to two weeks for six to eight weeks. The treatment can be repeated as needed.
- Other therapies currently being assessed as a treatment for this condition include injecting Botox into the bladder and nerve stimulation devices. These are usually only considered if the above measures do not control your symptoms.
All of these treatments have temporary effects on bladder’s nerve supply and their transmission of sensation to the brain.
Mater acknowledges consumer consultation in the development of this patient information.
Last modified 06/11/2015.