What Are the Symptoms of Interstitial cystitis?

There is significant variation among individuals in the frequency, type, and severity of symptoms. Chevy Chase Interstitial Cystitis Treatment patients can present primarily with pain/pressure symptoms, others have only urinary frequency and urgency, and others have both pain and urinary symptoms.

The pain may be experienced in the lower abdomen, back, vulva, urethra, vagina and/or perineum. Pain with intercourse is also very common. It is not unusual for a patient to remember exactly when her symptoms started. She may report that it felt like a urinary tract infection but the culture was negative. Additionally, the symptoms do not improve quickly with antibiotics. A patient who reports frequent urinary tract infections, that are not substantiated by positive urine cultures, is likely to have Interstitial cystitis instead. There may be a history of problems dating as far back as childhood.

A patient may have memories of being teased by family and friends on road trips for having a “teensy bladder.” Although a patient may experience frequency and urgency, it is not qualitatively the same as the overactive bladder patient. Patients with overactive bladder will feel a sudden urgency that is difficult to defer and are fearful of possible urinary leakage. An Interstitial cystitis patient has frequency and urgency driven by bladder discomfort. Emptying their bladder will typically give them partial or complete relief of bladder pressure. Postponing urination usually aggravates their discomfort. Symptoms during pregnancy vary, depending on the severity of interstitial cystitis. Generally, symptoms for most slightly worsen over the pregnancy with the exception of patients with severe Interstitial cystitis that may see some improvement during the first two trimesters.

What Causes Interstitial cystitis?

To date, the cause of Interstitial cystitis remains undetermined. It is postulated that the bladder lining (glycoaminoglycan layer) suffers some trauma and is quantitatively or qualitatively damaged. When the GAG layer is damaged, molecules such as potassium are able to penetrate into the deeper layers resulting in muscle and nerve irritation.

A useful analogy is the layers of car paint. When the clear coat of the car paint is damaged, the deeper base and primer coats become exposed to damage from the elements. The most prevalent thought is that Interstitial cystitis patients are not capable of properly repairing the damage to the bladder lining. The reason the damage cannot be repaired properly may have something to do with a protein called antiproliferative factor (APF) found only in the bladders of Interstitial cystitis patients. APF prevents bladder cells from growing and, thus, may interfere with the body’s repair mechanisms.

APF is a urine marker that may soon be available as a useful test to diagnose the condition. Recent research has also shown increased levels of tryptophan (an amino acid) and its metabolite in the blood samples of Interstitial cystitis patients. This finding may open the door to another useful diagnostic marker of the condition. A number of triggers may lead to the development of interstitial cystitis. These include pelvic surgery, urethral catheterization, pelvic floor dysfunction, bladder overdistension, urinary tract infection, autoimmune disorders, pelvic nerve inflammation, and spinal cord injury.

What Treatments Are Available for Interstitial cystitis?

Since the nature of interstitial cystitis is multifactorial, typically multimodality treatment strategies are more effective than single agents alone. Treatments are typically geared to treating the GAG layer abnormalities, neurogenic inflammation and mast cell dysfunction.

I.Dietary Modifications

An Interstitial cystitis diet typically involves avoidance of caffeinated, carbonated, alcoholic, citrus, artificial sweeteners and spicy foods. The list of dietary substances that trigger flares varies significantly among Interstitial cystitis patients. Each patient needs to identify their unique food triggers and modify their diet accordingly.

II.Pelvic Floor Muscle Therapy and Bladder Retraining Exercises

Learning to relax the pelvic floor muscles and resist giving in to going to the bathroom frequently can help improve symptoms and bladder capacity. Working together with a specialized women’s pelvic health specialist who is trained in hands-on pelvic floor therapy can make a dramatic difference in symptoms.

III.Stress Management

Stress is a known trigger of symptoms. Relaxation techniques and meditation can be helpful.

IV.Bladder Hydrodistension:

Under general anesthesia, the bladder is distended at a pre-determined pressure and time period. This bladder “stretch” can be helpful in some cases to relieve incalcitrant pain. Additionally, if Hunner’s ulcers are identified, they can be fulgurated (some have injected these areas with steroids). It is common to experience an initial flare that may last 2 weeks or more before any relief is experienced.

V.Over-The-Counter

Nonsteroidal anti-inflammatories (Advil, Aleve, Naproxen)
Phenazopyridine (pyridium): local analgesic
Antihistamines: Claritin, Zyrtec, Benadryl
H2histamine blockers: Zantac, Pepcid
Dietary Supplements
Containing Quercetin (natural anti-inflammatory): Cysta-Q, Cysto-Renew, Cysto-Protek
Prelief: contains calcium glycerophosphate that has been shown to reduce pain when ingesting acidic foods and beverages.
Desert Harvest Aloe Vera Capsules: anti-inflammatory and pain reliever.
Bladder Rest: An advanced nutraceutical for individuals who want to implement a natural approach for symptomatic relief of IC

VI.Intravesical Instillations

This treatment modality is primarily used for patients who have a flare or who do not tolerate or benefit from oral medications. A small catheter is used to place the medication directly into the bladder. It can be administered in the office or the patient can be instructed on home self-administration. Instillations are typically performed one to three times per week for six to eight weeks. If improvement is seen, the interval is reduced to every two weeks, three weeks, four weeks, and eventually discontinued, depending on symptom resolution.

Alkalinized lidocaine and heparin: proprietary pre-mixed solution
DMSO (dimethyl sulfoxide): FDA approved in 1978. Has anti-inflammatory and antispasmodic activity.
Various cocktails that may include differing mixtures of heparin, marcaine, lidocaine, sodium bicarbonate, DMSO, and steroids.

VII. Medications Used to Manage Both the Urinary Symptoms and Bladder Pain

Elmiron (pentosan): only FDA approved oral medication. Typical starting dose is 200 mg, twice daily. The exact mechanism of action is not known but it is thought to function like a synthetic glycoaminoglycan layer by coating the bladder lining. In clinical practice, approximately 30 to 40% of patients will see benefit from taking this medication over time. It may take 6 to 9 months to see benefit
Anticholinergics: in this category, the most useful medication is trospium chloride as it has been shown to have a topical effect on the bladder lining in addition to an anti-spasmodic effect.
Beta-3 agonists : Myrbetriq (mirabegron) has shown antispasmodic benefit as well as bladder pain benefit.
Antidepressants: useful for treating chronic pain. The most helpful subcategory of antidepressants are the tricyclic antidepressants (amitriptyline, nortriptyline, doxepin, trazodone). They modulate pain, have a mild antihistamine effect, have a sedative effect that can help with sleep, and can help with frequency and urgency. They are typically dosed at night. Selective serotonin inhibitors (SSRI’s) can be utilized if a patient does not tolerate tricyclic antidepressants. Common medications used in this category are paroxetine, fluoxetine, citalopram, venlafaxine, and sertraline.
Anti-seizure: Neurontin (gabapentin) can decrease neurogenic inflammation and improve pain. Dosages range from 300 mg to 2400 mg per day. Other options in this category are valproic acid, carbamazipine, and phenytoin.
Alpha-blockers: Flomax (tamsulosin) relaxes muscles in the bladder neck making it easier to urinate.
Immunosuppressants: cyclosporine, CellCept
Leukotriene inhibitor : Singulair helps to block leukotrienes produced by mast cells that promote inflammation.
Antispasmodics: Uribel, Urelle, Utira have bladder muscle antispasmodic with bacteriocidal or bacteriorstatic and mild analgesic properties
Compounded topical medications: allow use of therapeutic medications with less side effects.
- Vaginal valium suppositories: helpful to relieve pelvic floor muscle spasm with less sedation than taking valium orally.
- Amitriptyline/Gabapentin/Lidocaine/Baclofen creams, alone or in mixtures of one or more.
- Lidoderm patches: topical pain relieving patches
Antihistamines: especially useful for patients who suffer from allergies IBS, and migraines. This class of medications stabilize mast cells to help prevent release of histamine granules, which are very irritating to the bladder nerves.
- Hydroxyzine: also has sedative properties, which are helpful for better sleep and less nocturia
H2 histamine blockers: Cimetidine has been shown to help reduce bladder pain perhaps by blocking histamine.
Urinary alkalinizers: may help with discomfort by decreasing urinary acidity.

Interstitial Cystitis Treatment