Interstitial Cystitis

Interstitial Cystitis (IC)/painful bladder syndrome is a used to describe a debilitating, chronic inflammatory bladder disorder. The causes of IC are poorly understood.  Causes may include:infections of the bladder, damage to the cells which line the bladder, irritants in the urine, nerve disorders, auto immune diseases .

The diagnosis is based upon excluding other possible causes such as infection. IC condition is mainly diagnosed in women (9 out of 10 sufferers).

What are the main symptoms of PBS/IC?

Patients may experience some or all of the following symptoms:

  • FREQUENCY - of urination.
  • URGENCY - The sensation of having to urinate immediately may also be accompanied by pain or pressure.
  • PAIN/PRESSURE or SPASM - Lower abdominal or pelvic pain – sometimes extending to the lower part of the back/groin and thighs.  Both men and women may experience pain in the urethra with associated pain during or after intercourse

Etiology:

In the normal bladder the epithelium is covered with a mucus lining called the glycosaminoglycan layer (GAG layer).  It provides an impermeable barrier which protects the lining of the bladder.  In sufferers of PBS or IC this GAG layer breaks down allowing leakage and exposure of cells to urinary constituents.  Ongoing exposure of the bladder wall to urine causes inflammation and pain. 

How is interstitial cystitis diagnosed?

There is no simple test available to diagnose IC.  Instead your specialist may perform several investigations to rule out other conditions such as overactive bladder, endometriosis, infection, and cancer.

How can PBS/IC affect an individual's life?

Many IC patients find that their life revolves around knowing where the nearest toilet is. Therefore, any trip away from home may require thought and planning. Some severe sufferers can find themselves virtually housebound, which can lead to other problems such as social isolation and depression. Severe tiredness can also occur if the sufferer has to get up repeatedly during the night.   

Some sufferers may also be in constant pain which can affect relationships and work.  Anti-depressants prescribed as a pain moderator may also help improve your psychological state. 

Many find that certain foods or drinks, and even clothing can aggravate their condition.

Interstitial Cystitis Diet:

The relationship between diet and IC can be a confusing issue for sufferers.   Unfortunately there are no hard and fast rules. Every person has different tolerances to foods that will irritate their bladder.  The amount of food consumed before bladder irritation starts can also vary from one person to another.  Others may find that their diet does not seem to influence IC symptoms at all. 

Identifying which foods trigger or worsen symptoms can take some effort but can be revealing and helpful.  Keeping a food diary to help you identify when your flare-ups occur and what you have consumed may assist you to identify the triggers.  Alternatively stopping certain foods and drinks and then adding them back in one at a time can help to identify the causes.

Possible Trigger Foods for IC/PBS Sufferers

There is no definitive list.  However certain foods  have been implicated:

  • Alcohol
  • Caffeinated Tea and Coffee
  • Carbonated Drinks
  • Acidic Fruit Juices (other than blueberry or pear)
  • Fruit – particularly berry fruits i.e. strawberries
  • Spicy Foods
  • Chocolate (contains caffeine)
  • Cheese
  • Sour Cream
  • Yogurt
  • Mayonnaise
  • Nuts
  • Onions
  • Tomatoes

Flare-ups:

Symptoms may only occur in attacks known as “flares” and may be exacerbated just before or during menstruation, during ovulation, whilst taking contraceptive pills or going through Menopause.

General information to assist with symptom management:

  • Increase fluid intake (especially water)
  • Reduce stress
  • Gentle and regular exercise
  • Cotton underwear

Intravesical Treatments

Instillation of medication into the bladder may provide relief from symptoms. Several solutions are available including Dimethyl sulfoxide (DMSO); a combination of lignocaine, heparin and bicarbonate and the newest solution, sodium hyaluronate (Cystistat). The solutions are administered by insertion of a urethral catheter then injection of the solution down the catheter. The solution is then held in the bladder for a period of time.

Cystistat

Cystistat is a clear, colourless, sterile solution that contains 40mg of Sodium Hyaluronate.  This is a substance which occurs naturally in your body.  Cystistat is inserted into your bladder (via a catheter – bladder installation) and works by coating the lining with a protective layer, which assists to reduce the symptoms of pain, urgency and frequency thus providing temporary relief.

How is the treatment given?

The nurse will pass a thin tube called a catheter through the urethra and up into the bladder.  This will be lubricated with gel to assist insertion and ease discomfort.

Any urine will be drained away, and then 50mls of Cystistat solution will be inserted via the catheter into your bladder, which is then removed.  You will then be required to keep the solution in your bladder for a minimum of one hour – so it is important that you do not go to the toilet to pass urine during this time. 

NB:  The first installation must be done in the clinic and you will be required to stay until the solution has been passed out into the toilet after the hour wait time is over.

Preparation:

Try not to drink a lot of fluids for four hours prior to the treatment –this will improve the effect of cystistat on your bladder lining.  You will need to get a urine test the week prior to the treatment to check for infection.

How many treatments will I have?

You will be given one treatment each week for six weeks.  After this time, treatments are usually given once a month until your symptoms resolve.

Are there any side effects?

There are no specific side effects noted for this treatment.  However, the catheter insertion can cause minor discomfort and a temporary increase in urinary frequency and urgency.

Advice following the installation:

  • Men should sit down on the toilet when passing the solution as this will avoid it splashing on exposed skin.
  • If skin contact does occur, you should wash it off immediately with warm soapy water.
  • Sexual intercourse should be avoided for the first 24 hours following treatment as this will help to prevent irritation.