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Interstitial cystitis (IC) is a condition that results in
recurring discomfort or pain in the bladder and the surrounding
pelvic region. The symptoms vary from case to case and even
in the same individual. People may experience mild discomfort,
pressure, tenderness, or intense pain in the bladder and
pelvic area. Symptoms may include an urgent need to urinate
(urgency), a frequent need to urinate (frequency), or a combination
of these symptoms. Pain may change in intensity as the bladder
fills with urine or as it empties. Women's symptoms often
get worse during menstruation. They may sometimes experience
pain with vaginal intercourse.
Because IC varies so much in symptoms and severity, most
researchers believe that it is not one, but several diseases.
In recent years, scientists have started to use the term
painful bladder syndrome (PBS) to describe cases with painful
urinary symptoms that may not meet the strictest definition
of IC. The term IC / PBS includes all cases of urinary pain
that can't be attributed to other causes, such as infection
or urinary stones. The term interstitial cystitis, or IC,
is used alone when describing cases that meet all of the
IC criteria established by the National Institute of Diabetes
and Digestive and Kidney Diseases (NIDDK).
In IC / PBS, the bladder wall may be irritated and become
scarred or stiff. Glomerulations (pinpoint bleeding caused
by recurrent irritation) often appear on the bladder wall.
Hunner's ulcers are present in 10 percent of patients with
IC. Some people with IC / PBS find that their bladders cannot
hold much urine, which increases the frequency of urination.
Frequency, however, is not always specifically related to
bladder size; many people with severe frequency have normal
bladder capacity. People with severe cases of IC / PBS may
urinate as many as 60 times a day, including frequent nighttime
urination (nocturia).
IC / PBS is far more common in women than in men. Of the
estimated 1 million Americans with IC, up to 90 percent are
women.
What causes IC?
Some of the symptoms of IC / PBS resemble those of bacterial
infection, but medical tests reveal no organisms in the urine
of patients with IC / PBS. Furthermore, patients with IC
/ PBS do not respond to antibiotic therapy. Researchers are
working to understand the causes of IC / PBS and to find
effective treatments.
In recent years, researchers have isolated a substance found
almost exclusively in the urine of people with interstitial
cystitis. They have named the substance antiproliferative
factor, or APF, because it appears to block the normal growth
of the cells that line the inside wall of the bladder. Researchers
anticipate that learning more about APF will lead to a greater
understanding of the causes of IC and to possible treatments.
Researchers are beginning to explore the possibility that
heredity may play a part in some forms of IC. In a few cases,
IC has affected a mother and a daughter or two sisters, but
it does not commonly run in families.
How is IC / PBS diagnosed?
Because symptoms are similar to those of other disorders
of the urinary bladder and because there is no definitive
test to identify IC / PBS, doctors must rule out other treatable
conditions before considering a diagnosis of IC / PBS. The
most common of these diseases in both genders are urinary
tract infections and bladder cancer. IC / PBS is not associated
with any increased risk in developing cancer. In men, common
diseases include chronic prostatitis or chronic pelvic pain
syndrome.
The diagnosis of IC / PBS in the general population is based
on
- presence of pain related to the bladder, usually accompanied
by frequency and urgency
- absence of other diseases that could cause the symptoms
Diagnostic tests that help in ruling out other diseases
include urinalysis, urine culture, cystoscopy, biopsy of
the bladder wall, distention of the bladder under anesthesia,
urine cytology, and laboratory examination of prostate secretions.
Urinalysis and Urine Culture
Examining urine under a microscope and culturing the urine
can detect and identify the primary organisms that are known
to infect the urinary tract and that may cause symptoms similar
to IC / PBS. A urine sample is obtained either by catheterization
or by the "clean catch" method. For a clean catch, the patient
washes the genital area before collecting urine "midstream" in
a sterile container. White and red blood cells and bacteria
in the urine may indicate an infection of the urinary tract,
which can be treated with an antibiotic. If urine is sterile
for weeks or months while symptoms persist, the doctor may
consider a diagnosis of IC / PBS.
Culture of Prostate Secretions
Although not commonly done, in men, the doctor might obtain
prostatic fluid and examine it for signs of a prostate infection,
which can then be treated with antibiotics.
Cystoscopy Under Anesthesia With Bladder Distention
The doctor may perform a cystoscopic examination in order
to rule out bladder cancer. During cystoscopy, the doctor
uses a cystoscope—an instrument made of a hollow tube
about the diameter of a drinking straw with several lenses
and a light—to see inside the bladder and urethra.
The doctor might also distend or stretch the bladder to its
capacity by filling it with a liquid or gas. Because bladder
distention is painful in patients with IC / PBS, they must
be given some form of anesthesia for the procedure.
The doctor may also test the patient's maximum bladder capacity—the
maximum amount of liquid or gas the bladder can hold. This
procedure must be done under anesthesia since the bladder
capacity is limited by either pain or a severe urge to urinate.
Biopsy
A biopsy is a tissue sample that can be examined under a
microscope. Samples of the bladder and urethra may be removed
during a cystoscopy. A biopsy helps rule out bladder cancer.
Future Diagnostic Tools
Researchers are investigating and validating some promising
biomarkers such as anti-proliferative factor (APF), some
cytokines, and other growth factors. These might provide
more reliable diagnostic markers for IC and lead to more
focused treatment for the disease.
To read the rest of this article (including treatment information)
from the The National Kidney and Urologic Diseases Information
Clearinghouse (NKUDIC), please click here: http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/index.htm
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