Interstitial cystitis And Its Treatment

 

What is Interstitial cystitis?

Usually, the urinary bladder stores the urine after it gets filtered by the kidneys. It keeps expanding until it gets full. AIt is a chronic, long-lasting urinary condition which is primarily characterized by painful urination. It is also known as painful bladder syndrome. The pain may vary from mild to moderate to severe. The condition affects women more than men and tends to have a long-term effect on one’s lifestyle. The causes are still unknown.

After it stops expanding, a signal is sent to the brain that it is time to urinate. In this condition, these signals get weakened and there is an urge to urinate every if there is a smaller amount of urine in the bladder.  

Signs and symptoms

There is a wide range of signs and symptoms related to interstitial cystitis. The symptoms usually get flared up in response to certain triggers such as menstruation, long-sitting, exercise, stress or sexual activity. Some of the most common signs and symptoms include:

• Chronic pelvic pain - Women experience pain between the vaginal and anus, and men experience pain between the scrotum and anus.  

• Persistent urge to urinate

• Frequent urination

• Pain when the bladder is full

• Pain during sexual intercourse

 

Sometimes the symptoms of interstitial cystitis can also be confused with those of urinary tract infection.

 

Possible Causes

Even though the exact cause of the condition is not known, there may be several factors responsible for initiating the symptoms:

• A source of irritation in the bladder.

• Inflammation in the body leading to the release of certain substances that cause the symptoms.

• The problem in the nerves supplying the bladder may cause pain.

• Auto-immune disorder

• Stress, anxiety or any emotional disorder

• Having a menstrual cycle

• History of urinary tract infection

• Holding the urine for a long time

• Certain allergies

• Frequent changes in the weather

• Continuous standing for a long time

 

How is it diagnosed?

After you notice the aforementioned symptoms, you must consult a urologist. There are some of the best urologists in India, who hold a vast experience and have the skills to treat the patient with sheer precision. A detailed case history is taken, in which you must give all the details related to any past medical illness, any related family history or any addictive habits. This is followed by a clinical examination by the doctor.

In case of a woman, a pelvic exam is conducted in which the floor muscles of the pelvis are examined to check for the spasms.

In case of a man, a digital rectal exam is conducted to look out for prostate problems.

 

 

Other than the physical examination, followed investigations are recommended:

Urinalysis - A sample of urine is collected and sent for the examination to look for any evidence of any urinary tract infection. Presence of white blood cells and red blood cells in the urine indicate that there may be UTI.

Cystoscopy - This is a procedure in which a thin tube with a camera is inserted through the urethra where the bladder lining can be seen. Sometimes fluid is injected to check the bladder capacity. This process is called hydrodistention and is done after giving the anesthesia.

Biopsy - With the help of cystoscopy under anesthesia, the doctor may also remove a sample of tissue from the bladder and the urethra and send it for microscopic examination. This can help to diagnose bladder cancer or other causes of bladder pain.

Potassium sensitivity test - Two types of fluids including water and potassium chloride, is instilled into the bladder one by one. Then the patient is asked to rate the pain on a scale of 0 to 5 and also tell about urgency. If there are more pain and urgency felt by potassium chloride than water, the condition may be diagnosed as interstitial cystitis. People with normal condition are unable to tell any difference between the two solutions.

Postvoid residual urine volume - The amount of urine left in the bladder after micturition is measured with the help of an ultrasound.

Bladder-stretching - The bladder is filled with a liquid or a gas to expand the muscles after giving anesthesia. This is done with cystoscopy and may also be done as a therapeutic procedure.

 

How is it treated?

The treatment includes the following steps:

1. Lifestyle changes

• Dietary changes

• Bladder training

• Wearing loose-fit clothes

• Stress management

• Quit smoking

• Exercise

 

     2. Oral medications:

• Non-steroidal Anti-inflammatory drugs (NSAIDS)

• Tricyclic antidepressants

• Antihistamines

• Pentosan polysulfate sodium

 

     3. Nerve stimulation

• Transcutaneous electric nerve stimulation (TENS)

• Sacral nerve stimulation

 

     4. Surgical options

• Fulguration

• Resection

• Bladder augmentation

 

     5. Bladder distention

     6. Bladder instillation with medications