Bladder health

Interstitial cystitis

Also called painful bladder syndrome: symptoms, possible causes, and treatment options.

What is the pelvic floor?

The pelvic floor is a set of muscles that spread across the bottom of the pelvic cavity like a hammock. Three openings run through it: the urethra, the vagina, and the rectum. Its functions include:

• Supporting the pelvic organs, specifically the uterus, the bladder, and the rectum
• Helping provide sphincter control for the bladder and bowel
• Withstanding increases in abdominal pressure such as coughing, sneezing, laughing, straining, and lifting
• Enhancing the sexual response

What is interstitial cystitis?

Interstitial cystitis, also called painful bladder syndrome, is a chronic inflammatory condition of the bladder. The bladder is a hollow, muscular organ that collects and stores urine from the kidneys. Once full, it releases urine through the urethra and out of the body.

Signs and symptoms

Symptoms and their severity vary between individuals, but include:

• Urinary urgency, the sensation of having to urinate immediately
• Urinary frequency. Many people urinate 60 or more times a day, often at night.
• Painful urination
• Pain as the bladder fills with urine
• Pain in the lower abdomen
• Pain in the perineum
• Painful intercourse
• Symptoms that may worsen with menstruation, seasonal allergies, and stress

Interstitial cystitis is a chronic condition that usually has a delayed diagnosis. You are in chronic pain for prolonged periods, which can lead to psychological and social problems such as anxiety, depression, difficulty traveling, and less participation in community activities. Frequent nighttime voiding may also cause chronic fatigue.

What causes it?

The cause is currently unknown. Recent research has shown that many women with interstitial cystitis have a substance in their urine that prevents growth of the cells lining the inside of the bladder. A normal bladder has a protective layer that keeps toxins in the urine from damaging it. In interstitial cystitis this layer is defective, allowing toxins into the bladder wall, causing extensive damage. The damage causes severe irritation and can result in scarring of the bladder wall, with some instances of bleeding and ulcers.

Other factors that are often discussed but not proven include an autoimmune reaction, heredity, and allergies.

Other conditions that commonly occur with interstitial cystitis:

• Irritable bowel syndrome
• Fibromyalgia
• Endometriosis
• Food allergies
• Seasonal allergies
• Asthma
• Sinusitis
• Migraines
• Lupus
• Rheumatoid arthritis
• Incontinence
• Vulvodynia or vulvar vestibulitis

How is it treated?

No one treatment works for all patients, but a combination of the following may help:

Bladder distention

Usually done as part of the diagnostic process, but it often helps improve symptoms. The bladder wall is stretched using water or gas.

Bladder instillation with dimethyl sulfoxide

A medicated solution is placed inside the bladder and held for 15 minutes before being released. It can decrease bladder inflammation and prevent the muscle contractions that cause urgency, frequency, and pain.

Oral medications

Medications often prescribed include pentosan polysulfate sodium (Elmiron), the only drug approved by the FDA for interstitial cystitis, which usually takes 2 to 4 months for pain relief and 6 months to decrease frequency; ibuprofen and other nonsteroidal anti-inflammatories to relieve pain; tricyclic antidepressants, which can help relax the bladder and decrease pain; and some antihistamines, which can decrease urgency and frequency.

Transcutaneous electrical nerve stimulation (TENS)

Mild electrical pulses are sent through the body for a short time twice a day, with electrodes placed above the pubic bone, over the sacrum, or in the vagina or rectum. TENS often decreases both pain and urinary frequency.

Sacral nerve stimulation

A small device is surgically implanted in the low back under the skin, stimulating the sacral nerves involved in bladder function. This often decreases urgency and frequency.

Diet modifications

Eliminating bladder irritants can help. Eliminate the foods for two weeks, then reintroduce them one by one to identify which irritate your bladder. Common irritants include carbonated beverages, caffeine (including in tea and chocolate), citrus, foods rich in vitamin C, tomatoes, alcohol, artificial sweeteners, and spices.

Bladder training

Bladder training involves learning to delay the urge to urinate. You breathe deeply, relax, and distract yourself with another activity when you feel the urge. The initial goal is to delay urination by 10 minutes, increased in intervals until trips to the toilet are reduced to once every 2 to 4 hours. It may also involve learning to completely empty the bladder, often with double voiding: urinating, waiting a minute, and then urinating again.

Pelvic floor massage

The pain from interstitial cystitis can cause the pelvic floor to spasm and develop trigger points. Massage and trigger point release to the pelvic floor muscles, performed vaginally or rectally, can help decrease pain.

Pelvic floor muscle re-education with biofeedback

Special computer equipment measures muscle activity. You use the feedback while exercising to learn to contract and relax the pelvic floor muscles properly.

Naturopathic treatment

Care from a naturopathic physician, who is knowledgeable in herbal and homeopathic remedies, can also ease pain.

Surgery

Surgery is rarely performed for interstitial cystitis. It often does not decrease the pain and can worsen symptoms.