Interstitial Cystitis is an inflammation of the bladder, believed to be associated with an autoimmune or allergic response. It is not the same as cystitis due to urinary tract infection.
Some 450,000 persons in this country are afflicted with interstitial cystitis, a chronic, debilitating condition that seems to defy the diagnostic efforts of many physicians. It afflicts women 10 times more frequently than men, causing its victims to get up as often as 10 times in the night to urinate, with pain in the pelvis, bladder, and vagina.
Urine cultures, cystoscopy, test of the bladder nerves, and every other diagnostic procedure are regularly negative in these patients - yet the disease is very real. Because the inflammation that produces the symptoms is within the wall of the bladder (hence its name), it is out of reach of the usual diagnostic tests for bladder disease.Symptoms
The bladder wall becomes inflamed, ulcerated, and scarred, causing frequent, painful urination. Hematuria (blood in the urine) often occurs. Patients may awaken two or more times per night to urinate.Diagnosis
A urine test may be performed to rule out a urinary tract infection and to check for hematuria (blood in the urine). Cystoscopy and biopsy may be required for diagnosis.Treatment
There is no cure, so treatment focuses on symptoms. Many approaches have been tried, including distending the bladder with fluid, infusing the bladder with a chemical called DMSO (Rimso), and giving oral medications such as pentosan polysulfate sodium (Elmiron), the antidepressant amitriptyline (Elavil), and various muscle relaxants for the bladder. None has worked consistently.
In a recent study, patients who didn't have severe pain gradually stretched their bladder by resisting the urge to urinate frequently. Each month, they increased the interval between trips to the bathroom by 15 to 30 minutes. After three months, 15 of the 21 patients reported at least a 50 percent reduction in the urgency and frequency of urination.
Approaches to the treatment of interstitial cystitis have included the following:
Hydrodistention of the bladder. Hydrodistention of the bladder is one of the oldest treatments for interstitial cystitis. Bladder distention during cystoscopy is not only diagnostic but therapeutic as well. For reasons that are unclear, hydrodistention provides short-term relief in 30 to 40 percent of patients. It is hypothesized that bladder stretching may injure nerve endings in the bladder and thereby reduce pain.
Antidepressants. Although most antidepressants do not alleviate interstitial cystitis symptoms, the use of hydroxyzine (Atarax or Vistaril) or amitriptyline (Elavil) appears quite promising.
Diet. Some patients report dramatic relief when eliminating alcohol, caffeinated beverages, artificial sweeteners, citrus fruits, and tomatoes from their diet. Although it would seem prudent to eliminate foods that are known to irritate the bladder, many patients report that dietary modification in any form does not appear to influence the course of their disease in the long term.
TENS Unit. Transcutaneous electrical nerve stimulation (TENS), used in the management of chronic pain, can be used to treat interstitial cystitis.
DMSO. In 1978, the FDA approved dimethyl sulfoxide (DMSO), an industrial solvent for use in interstitial cystitis. It is placed via catheter directly into the bladder and held for approximately 15 minutes, then voided out. Treatments are given at weekly or biweekly intervals for six to eight treatments. DMSO appears to work as an anti-inflammatory agent.
Oxychlorosene sodium (Chlorpactin) is another medication that can be placed directly into the bladder. The protocol is similar to that used for DMSO, with weekly or biweekly instillations.
Surgery is a last resort when all conservation treatments have failed. Substitution cytoplasty can be used in patients who have a significantly reduced bladder capacity resulting from scarring and contracture of the bladder wall.Questions
What is causing the bladder inflammation?
Can you prescribe any medications to relieve the pain?
Do you recommend the use of DMSO?
What are the possible adverse reactions of DMSO?
Would a TENS unit help?
Is any dietary modification indicated?
Is surgery an option?
Is a complete cure possible?