Interstitial Cystitis Treatment

What is Interstitial Cystitis?

Interstitial cystitis is a medical condition characterized by pain and discomfort in the region of the bladder.  These features are usually associated with urinary tract symptoms such as urinary frequency (polyuria), burning on urination (dysuria), and urgency.  The diagnostic criteria require that symptoms be present for more than six weeks in the absence of other causes.  Interstitial cystitis is typically diagnosed around age 40 or later and is more common in women compared to men.

Patients with the disease tend to have coexisting pain syndromes such as fibromyalgia or irritable bowel syndrome.  Individuals often suffer from decreased quality of life.  Due to the importance of this condition, it is critical that patients understand its causes, symptoms, and treatment.  By the end of this article, you will have the answers to these essential questions:

What causes Interstitial Cystitis?

The cause of interstitial cystitis is unknown.  Studies show that certain foods and beverages (eg, caffeine, alcohol, citrus) can worsen symptoms, but these findings are inconsistent.

Bladder biopsies in patients with interstitial cystitis often show urothelial abnormalities but it is not clear whether these findings are related to other disorders.  Female gender is the only consistently identified risk factor for the condition.  There may also be a genetic susceptibility to developing the disease.

How common is Interstitial Cystitis?

Interstitial cystitis is a common disorder that is often initially evaluated in the primary care clinic.  The prevalence of interstitial cystitis is about 850 per 100,000 women and 60 per 100,000 men.  The disease is about 5 times more common in women compared to men.  A major study found that approximately 2.7%-6.5% of American women have symptoms consistent with the disorder.

What are the symptoms and signs of Interstitial Cystitis?

Symptoms of interstitial cystitis often include bladder discomfort and pain in addition to the following urinary tract symptoms:

  • Frequency (polyuria)
  • Burning on urination (dysuria)
  • Urgency
  • Urinating frequently at night (nocturia)

Individuals often experience an increase in discomfort with bladder filling and an improvement with urinating.  Patients also typically have pelvic tenderness on physical examination, although this finding is not require to make the diagnosis.

How is Interstitial Cystitis diagnosed?

The diagnosis of interstitial cystitis is suggested based on symptoms, history, and physical examination.  The key feature is the presence of bladder discomfort or pain and urinary symptoms for at least 6 weeks not explained by another medical condition.

Laboratory studies, imaging studies, and diagnostic procedures are typically performed if the diagnosis is unclear to rule out alternative disorders.  Your doctor will typically order a urine analysis with microscopy to evaluate for signs of infection such as white cells, red cells, high protein, positive nitrite, and positive leucocyte esterase.  They will also obtain a urine culture to evaluate for bacterial growth if your urinalysis is consistent with infection.

Your doctor may also request a postvoid residual volume  – during this test, a radiology technician will typically measure the urinary volume in your bladder with ultrasound before and after voiding.  Cystoscopy is not necessary but may help support the diagnosis and exclude other disorders.  During this procedure, a urologist will visualized the bladder by inserting a scope through the urethra.

How is Interstitial Cystitis treated?

The goals of therapy for interstitial cystitis are to improve symptoms and quality of life as there is no cure for the condition.  During the initial evaluation, patients are normally educated about the condition, coexisting conditions are evaluated and treated, and psychosocial support is provided.

Physical therapy may be beneficial for individuals with pelvic floor muscle tenderness.

Opiate pain medications (analgesics) may be used for short-term relief of disease flares to reduce pain and maximize function.  These medications may include codeine, Vicodin (hydromorphone-acetaminophen), or Percocet (hydrocodone-acetaminophen).  They should be used cautiously in patients with a history of substance-dependence and at the lowest dose possible for the shortest duration of time.

Urinary analgesics may also be helpful and include Pyridium (phenazopyridine) and antibacterial agent Hiprex (methenamine).  These agents are taken orally but coat the urinary tract with analgesic medication.  Intravesical lidocaine is used for acute refractory pain episodes.  This therapy involves instillation of lidocaine with heparin into the bladder and is often performed in the clinic.

Elavil (amitriptyline) is a tricyclic antidepressant that may be effective, particularly in patients with coexisting depression.  Treatment with Elmiron (pentosan polysulfate sodium) is an alternative to Elavil.  Patients with interstitial cystitis and coexisting allergies may notice improvement with use of oral antihistamines such as Benadryl (diphenhydramine).

Patients with refractory symptoms that have not responded to the aforementioned measures often require cystoscopy, distention of the bladder with water, and treatment of bladder lesions.  Botox (botulinum toxin) injections are often considered in those that fail to respond to cystoscopy.

Interstitial Cystitis Patient Summary:

  • Interstitial cystitis is a medical condition characterized by pain and discomfort in the region of the bladder usually associated with urinary frequency (polyuria), burning on urination (dysuria), or urgency.
  • The diagnostic criteria require that symptoms be present for more than six weeks in the absence of other causes.
  • Interstitial cystitis is typically diagnosed around age 40 or later and is more common in women compared to men.
  • Physical therapy may be beneficial for individuals with pelvic floor muscle tenderness.
  • Opiate pain medications (analgesics) may be used for short-term relief of disease flares and may include Codeine, Vicodin (hydromorphone-acetaminophen), or Percocet (hydrocodone-acetaminophen).
  • Urinary analgesics may also be helpful and include Pyridium (phenazopyridine) and antibacterial agent Hiprex (methenamine).
  • Intravesical lidocaine – instillation of lidocaine with heparin into the bladder - is used for acute refractory pain episodes and is often performed in the clinic.
  • Elavil (amitriptyline) is a tricyclic antidepressant that may be effective. Treatment with Elmiron (pentosan polysulfate sodium) is an alternative to Elavil. 
  • Patients with refractory symptoms that have not responded to the aforementioned measures often require cystoscopy, distention of the bladder with water, and treatment of bladder lesions.

Botox (botulinum toxin) injections are often considered in those that fail to respond to cystoscopy.

References:

  1. Rovner E, Propert KJ, Brensinger C, et al. Treatments used in women with interstitial cystitis: the interstitial cystitis data base (ICDB) study experience. The Interstitial Cystitis Data Base Study Group. Urology 2000; 56:940.
  2. Hanno PM, Burks DA, Clemens JQ, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol 2011; 185:2162.
  3. Pazin C, de Souza Mitidieri AM, Silva AP, et al. Treatment of bladder pain syndrome and interstitial cystitis: a systematic review. Int Urogynecol J 2016; 27:697.

Popular Interstitial Cystitis Medications

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.