What is interstitial cystitis?
Interstitial cystitis — also called painful bladder syndrome — is a chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain. The pain ranges from mild discomfort to severe.
Your bladder is a hollow, muscular organ that stores urine. The bladder expands until it’s full and then signals your brain that it’s time to urinate, communicating through the pelvic nerves. This creates the urge to urinate for most people.
With interstitial cystitis, these signals get mixed up — you feel the need to urinate more often and with smaller volumes of urine than most people.
How common is interstitial cystitis?
Interstitial cystitis most often affects women and can have a long-lasting impact on quality of life. Please discuss with your doctor for further information.
What are the symptoms of interstitial cystitis?
The common symptoms of interstitial cystitis are:
- Bladder pressure and pain that gets worse as your bladder fills up.
- Pain in your lower tummy, lower back, pelvis, or urethra (the tube that carries pee from your bladder out of your body)
- For women, pain in the vulva, vagina, or the area behind the vagina
- For men, pain in the scrotum, testicles, penis, or the area behind the scrotum
- The need to pee often (more than the normal 7-8 times daily)
- The feeling you need to pee right now, even right after you go
- For women, pain during sex
- For men, pain during orgasm or after sex
The bladder pain people feel with IC can range from a dull ache to piercing pain. Peeing may feel like just a little sting, or it can feel like serious burning.
All people with it have an inflamed bladder. About 5% to 10% of people get ulcers in their bladder.
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes interstitial cystitis?
The exact cause of interstitial cystitis isn’t known, but it’s likely that many factors contribute. For instance, people with interstitial cystitis may also have a defect in the protective lining (epithelium) of the bladder. A leak in the epithelium may allow toxic substances in urine to irritate your bladder wall.
Other possible but unproven contributing factors include an autoimmune reaction, heredity, infection or allergy.
What increases my risk for interstitial cystitis?
There are many risk factors for interstitial cystitis, such as:
- Your sex. Women are diagnosed with interstitial cystitis more often than men. Symptoms in men may mimic interstitial cystitis, but they’re more often associated with an inflammation of the prostate gland (prostatitis).
- Your skin and hair color. Having fair skin and red hair has been associated with a greater risk of interstitial cystitis.
- Your age. Most people with interstitial cystitis are diagnosed during their 30s or older.
- Having a chronic pain disorder. Interstitial cystitis may be associated with other chronic pain disorder, such as irritable bowel syndrome or fibromyalgia.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is interstitial cystitis diagnosed?
The following may be helpful in diagnosing interstitial cystitis:
- Medical history and bladder diary. Your doctor will ask you to describe your symptoms and may ask you to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass.
- Pelvic exam. During a pelvic exam, your doctor examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. Your doctor may also examine your anus and rectum.
- Urine test. A sample of your urine is analyzed for signs of a urinary tract infection.
- Your doctor inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. Your doctor may also inject liquid into your bladder to measure your bladder capacity. Your doctor may perform this procedure, known as hydrodistention, after you’ve been numbed with an anesthetic medication to make you more comfortable.
- During cystoscopy under anesthesia, your doctor may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. This is to check for bladder cancer and other rare causes of bladder pain.
- Urine cytology. Your doctor collects a urine sample and examines the cells to help rule out cancer.
- Potassium sensitivity test. Your doctor places (instills) two solutions — water and potassium chloride — into your bladder, one at a time. You’re asked to rate on a scale of 0 to 5 the pain and urgency you feel after each solution is instilled. If you feel noticeably more pain or urgency with the potassium solution than with the water, your doctor may diagnose interstitial cystitis. People with normal bladders can’t tell the difference between the two solutions.
How is interstitial cystitis treated?
No simple treatment eliminates the signs and symptoms of interstitial cystitis, and no one treatment works for everyone. You may need to try various treatments or combinations of treatments before you find an approach that relieves your symptoms.
Working with a physical therapist may relieve pelvic pain associated with muscle tenderness, restrictive connective tissue or muscle abnormalities in your pelvic floor.
Oral medications that may improve the signs and symptoms of interstitial cystitis include:
- Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), to relieve pain.
- Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax your bladder and block pain.
- Antihistamines, such as loratadine (Claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms.
- Pentosan polysulfate sodium (Elmiron), which is approved by the Food and Drug Administration specifically for treating interstitial cystitis. How it works is unknown, but it may restore the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It may take two to four months before you begin to feel pain relief and up to six months to experience a decrease in urinary frequency.
Nerve stimulation techniques include:
- Transcutaneous electrical nerve stimulation (TENS). With TENS, mild electrical pulses relieve pelvic pain and, in some cases, reduce urinary frequency. TENS may increase blood flow to the bladder. This may strengthen the muscles that help control the bladder or trigger the release of substances that block pain.Electrical wires placed on your lower back or just above your pubic area deliver electrical pulses — the length of time and frequency of therapy depends on what works best for you.
Sacral nerve stimulation. Your sacral nerves are a primary link between the spinal cord and nerves in your bladder. Stimulating these nerves may reduce urinary urgency associated with interstitial cystitis. With sacral nerve stimulation, a thin wire placed near the sacral nerves sends electrical impulses to your bladder, similar to what a pacemaker does for your heart. If the procedure decreases your symptoms, you may have a permanent device surgically implanted. This procedure doesn’t manage pain from interstitial cystitis, but may help to relieve some symptoms of urinary frequency and urgency.
Some people notice a temporary improvement in symptoms after cystoscopy with bladder distention. Bladder distention is the stretching of the bladder with water. If you have long-term improvement, the procedure may be repeated.
Medications instilled into the bladder
In bladder instillation, your doctor places the prescription medication dimethyl sulfoxide (Rimso-50) into your bladder through a thin, flexible tube (catheter) inserted through the urethra.
The solution sometimes is mixed with other medications, such as a local anesthetic, and remains in your bladder for about 15 minutes. You urinate to expel the solution.
You might receive dimethyl sulfoxide — also called DMSO — treatment weekly for six to eight weeks, and then have maintenance treatments as needed — such as every couple of weeks, for up to one year.
A newer approach to bladder instillation uses a solution containing the medications lidocaine, sodium bicarbonate, and either pentosan or heparin.
Doctors rarely use surgery to treat interstitial cystitis because removing the bladder doesn’t relieve pain and can lead to other complications.
People with severe pain or those whose bladders can hold only very small volumes of urine are possible candidates for surgery, but usually only after other treatments fail and symptoms affect quality of life. Surgical options include:
- This minimally invasive method involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
- This is another minimally invasive method that involves insertion of instruments through the urethra to cut around any ulcers.
- Bladder augmentation. In this procedure, a surgeon increases the capacity of your bladder by putting a patch of intestine on the bladder. However, this is performed only in very specific and rare instances. The procedure doesn’t eliminate pain and some people need to empty their bladders with a catheter many times a day.
Two complementary and alternative therapies show some promise in treating interstitial cystitis:
- Guided imagery. This type of therapy employs visualization and direct suggestions using imagery to help you imagine healing, with the hope that the body will follow the mind’s suggestions.
- Acupuncture. During an acupuncture session, a practitioner places numerous thin needles in your skin at specific points on your body. According to traditional Chinese medicine, precisely placed acupuncture needles relieve pain and other symptoms by rebalancing the flow of life energy. Western medical practitioners tend to believe that acupuncture boosts the activity of your body’s natural painkillers.
These treatments have not been well-studied for interstitial cystitis, so be sure to discuss the use of these therapies with your doctor.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage interstitial cystitis?
The following lifestyles and home remedies might help you cope with interstitial cystitis:
Dietary changes. Eliminating or reducing foods in your diet that irritate your bladder may help to relieve the discomfort of interstitial cystitis. Common bladder irritants — known as the “four Cs” — include: carbonated beverages, caffeine in all forms (including chocolate), citrus products and food containing high concentrations of vitamin C. Consider avoiding similar foods, such as tomatoes, pickled foods, alcohol and spices. Artificial sweeteners may aggravate symptoms in some people. If you think certain foods may irritate your bladder, try eliminating them from your diet. Reintroduce them one at a time and pay attention to which, if any, worsen symptoms.
Bladder training. Bladder training involves timed urination — going to the toilet according to the clock rather than waiting for the need to go. You start by urinating at set intervals, such as every half-hour — whether you have to go or not. Then you gradually wait longer between bathroom visits. During bladder training, you may learn to control urinary urges by using relaxation techniques, such as breathing slowly and deeply or distracting yourself with another activity.
These self-care measures also may help:
- Wear loose clothing. Avoid belts or clothes that put pressure on your abdomen.
- Reduce stress. Try methods such as visualization and biofeedback.
- If you smoke, stop. Smoking may worsen any painful condition, and smoking contributes to bladder cancer.
- Easy stretching exercises may help reduce interstitial cystitis symptoms.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Interstitial cystitis. http://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/home/ovc-20251830. Accessed July 14, 2017.
Interstitial cystitis. http://www.webmd.com/urinary-incontinence-oab/interstitial-cystitis#2-6. Accessed July 14, 2017.
Review Date: July 14, 2017 | Last Modified: July 14, 2017