Interstitial Cystitis: Diagnosis & treatment

Interstitial cystitis or IC refers to a clinical syndrome characterized by chronic urinary urgency feeling the need to urinate immediately and frequency or frequent urination. It could appear with or without pelvic pain. Symptoms of interstitial cystitis may vary among individuals and may even vary ...

Interstitial cystitis or IC refers to a clinical syndrome characterized by chronic urinary urgency feeling the need to urinate immediately and frequency or frequent urination. It could appear with or without pelvic pain. Symptoms of interstitial cystitis may vary among individuals and may even vary with time in the same individual with this problem. The term cystitis refers to any inflammation of bladder. In contrast to bacterial cystitis that results from an infection in the bladder, no infectious organism has were identified in people with interstitial cystitis. Interstitial cystitis is diagnosed when the symptoms occur without evidence for another cause of symptoms.

Overview of urinary function

The urinary system consists of two kidneys, ureters, bladder, and urethra. The kidneys are pair of purplish-brown organs, located below the ribs toward the middle of the back. The kidneys remove water and waste from the blood in the form of urine. This way kidneys are keeping a stable balance of salts and other substances in the blood. The kidneys also produce erythropoietin. That is hormone that stimulates the formation of human red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder. This is a triangle-shaped, muscular chamber in the lower abdomen. Like a balloon, the bladder%26rsquo;s muscular and elastic walls relax and expand to store urine and contract and flatten when urine is emptied through the urethra. The typical adult bladder can store about 1.5 cups of urine inside. Adults urinate about a quart and a half of urine each day, while the amount of urine varies depending on the fluids and foods a person consumes. The volume formed at night is about half that formed during all day. Normal urine contains fluids, salts and waste products, but it is free of bacteria, viruses and fungi. The tissues of the bladder are isolated from urine and toxic substances. It is done by coating on the inside of the bladder that discourages bacteria from attaching and growing on the bladder Narrow tubes called ureters carry urine from the kidneys to the bladder, which is placed in lower abdomen.

What is interstitial cystitis?

Sometimes doctors use the term painful bladder syndrome or PBS to describe cases of pelvic pain that do not meet the strict criteria for interstitial cystitis established by the National Institute of Diabetes and Digestive and Kidney Diseases. An estimated one million Americans suffer from interstitial cystitis, and about 90 percent of patients with interstitial cystitis are women. While individuals of any age can be affected, including children, the average age of onset age is 40. Interstitial cystitis has not been considered to be a hereditary disorder, but multiple cases have occurred among some families. It is prompting ongoing investigation of the possible role of hereditary factors in the development of interstitial cystitis. Some associations with other medical conditions are seen with the probolem of interstitial cystitis. Women with interstitial cystitis are more likely to have had frequent urinary tract infections. These women also tend to have previous gynecologic surgery than women without interstitial cystitis. Certain chronic illnesses have been described as occurring more frequently in people with interstitial cystitis than in general population. Examples of these associated conditions are inflammatory bowel disease, systemic lupus erythematous, irritable bowel syndrome, allergies, endometriosis and fibromyalgia. Each of these conditions has been described in at least some studies to be more common in people with interstitial cystitis than in the general population, but there is no evidence that any of these conditions is cause of interstitial cystitis. Interstitial cystitis has been classified into two forms, ulcerative and nonulcerative. It is depending upon the presence or absence of ulcerations in the bladder lining as seen during cystoscopy. Citoscopy is visual examination of the inside of the bladder via a probe. Star-shaped ulcerations in the bladder wall are famous as Hunner%26rsquo;s ulcers. The ulcerative type of interstitial cystitis that is sometimes termed classic interstitial cystitis, is found in less than 10% of cases in the U. S. Problem is that over time, interstitial cystitis can cause physical damage to the bladder wall.

Scarring and stiffening of the bladder wall may occur as a result of the chronic inflammation. It could lead to a decrease in bladder capacity. Glomerulations, or areas of pinpoint bleeding, may be seen on the bladder wall.

What is cause of interstitial cystitis?

No one knows what causes interstitial cystitis, but doctors studying interstitial cystitis believe that it is a real, physical problem. They also say it is not a result, symptom, or sign of an emotional problem. Because the symptoms of interstitial cystitis are varied, most researchers believe that it represents a spectrum of disorders rather than only one single disease. One area of research on the cause of interstitial cystitis has focused on the layer that coats the lining of the bladder. This area is called the glycocalyx and is made up primarily of substances called mucins and glycosaminoglycans. This layer normally protects the bladder wall from toxic effects of the urine and its contents. Researchers have found that this protective layer of the bladder is leaky in about 70% of interstitial cystitis patients. Researches also hypothesized that this may allow substances in urine to pass into the bladder wall where they might trigger interstitial cystitis. Along with altered permeability of the bladder wall, researchers are also examining the possibility that interstitial cystitis results from decreased levels of protective substances found in the bladder wall. Reduced levels of glycosaminoglycans or other protective proteins might also be responsible for the damage to the bladder wall that is seen in interstitial cystitis. No matter what the mechanism for disruption of the bladder lining, potassium is one substance that may be involved in damage to bladder wall. Potassium is present in high concentrations in urine and is normally not toxic to the bladder lining, but if the tissues lining the inside of the bladder are disrupted or are abnormally leaky, potassium could then penetrate the lining tissues. Then it enters the muscle layers of the bladder, where it can cause damage and promote inflammation. Researchers have isolated a substance known as antiproliferative factor that appears to block normal growth of cells that make up lining of bladder. That antiproliferative factor has been identified almost exclusively in the urine of people suffering with interstitial cystitis. Research is underway to clarify the potential role of this factor in development of interstitial cystitis. Increased activation of sensory nerves in the bladder wall is also thought to contribute to the symptoms of interstitial cystitis. Cells known as mast cells, which play a role in the body%26rsquo;s inflammatory response to injury release some specific chemicals. These chemicals are believed to be capable of contributing to the symptoms of interstitial cystitis. Other theories about the cause of interstitial cystitis are that it is a form of autoimmune disorder or that infection with an unidentified organism may be producing the damage to the bladder.

The signs and symptoms of interstitial cystitis?

The symptoms of interstitial cystitis vary greatly from one person to another but have some similarities to those of urinary tract infection. These symptoms include decreased bladder capacity, an urgent need to urinate frequently day and night, feelings of pressure, pain, and tenderness around the bladder, pelvis, and perineum. Perineum is the area between the anus and vagina, or anus and scrotum, which may increase as the bladder fills and decrease as it empties. Patients are also complaining about painful sexual intercourse and discomfort or pain in the penis and scrotum. Most people suffering from interstitial cystitis have both urinary frequency and pelvic pain, although these symptoms may also occur singly or in any combination with others. In most women with interstitial cystitis, symptoms usually worsen around the time of their periods. As with many other illnesses, stress also may intensify the symptoms. However, stress does not cause them. The symptoms usually have a slow onset, and urinary frequency is erly symptom.

Diagnosis of interstitial cystitis

Because the symptoms of interstitial cystitis are similar to those of other disorders of the urinary system and because there is no definitive test to identify interstitial cystitis, doctors must exclude other conditions before making exact diagnosis. Medical tests that help identify other conditions include a urinalysis, urine culture, cystoscopy, biopsy of bladder wall and, in men, laboratory examination of prostatic secretions. Physical examination of an individual with interstitial cystitis may reveal tenderness of the bladder either when pushing on the abdomen over the bladder or during the pelvic examination in women. Laboratory tests should also be done to diagnose interstitial cystitis.

Treatment of interstitial cystitis?

The principal type of oral medication is the heparinoid drug pentosan polysulfate sodium. PPS is chemically similar to the substance that lines the bladder, and it is believed that PPS assists in the repair or restoration of the lining tissues in bladder. Other oral medications that may be used to treat interstitial cystitis along with PPS include antidepressants of tricyclic group. This is not due to a belief that interstitial cystitis is a psychological condition. It is rather due to the fact that tricyclic antidepressants can help reduce the hyper-activation of nerves within the bladder wall. Oral antihistamines may also be prescribed to help reduce allergy symptoms. that may be worsening the patient%26rsquo;s interstitial cystitis. Beside this, bladder distension sometimes is used for therapy of interstitial cystitis. Bladder distension helps reduce symptoms in approximately 20-30% of people with problem called interstitial cystitis.