Interstitial Cystitis

What is Interstitial Cystitis?

Commonly referred to as painful bladder syndrome, interstitial cystitis (IC) is a puzzling urological condition that is associated with burning during urination, increased urinary and frequency, urgency, pelvic pain, and discomfort. These symptoms are common among other urogenital conditions as well, including urinary tract infections, yeast infections, and STIs, making the condition difficult to diagnosis. IC is however, medically defined as chronic inflammation of the bladder with no known pathological or bacterial cause. IC presents all the known symptoms of a traditional urinary tract infection (UTI), but unlike a UTI, it is not caused by a certain bacteria or virus. Therefore, it is not treatable with antibiotics or similar medication. Although IC is not a sexually dimorphic syndrome (syndrome affecting only one sex), females are more commonly affected by this syndrome than males. Currently, researchers estimate that 3 to 8 million females experience interstitial cystitis in the United States today as opposed to 1 to 4 million males.1 Because interstitial cystitis is a urogenital condition (a condition involving both the genital and urinary structures), it tends to have detrimental effects on a female’s sexual functioning.2                       

What Causes Interstitial Cystitis?

            The chronic inflammation of the bladder linked to interstitial cystitis is caused by an initial trauma to the lining of the bladder. Trauma increases the permeability of the membrane lining the bladder and, in turn, makes the bladder more susceptible to inflammation. Initial trauma can range from a previous urinary tract infection (UTIs), an ulcer, or other urogenital conditions. Patients who suffer from interstitial cystitis often have trouble holding in urine and subsequently feel the need to urinate often (in extreme cases up to 40 or more times a day). This condition can therefore have detrimental effects on an individual’s quality of life. Chronic pelvic pain or lower back pain can also interfere with daily activities.

            Symptoms of interstitial cystitis (although chronic) are often exacerbated by “triggers.” Triggers include, but are not limited, to certain types of food (those high in acidity), female menses, stress, and sexual activity. Sexual activity can trigger an episode (flair) of interstitial cystitis, increasing the already- present symptoms.  Females experience more problems with sexual intercourse than males (approximately 90% of all patients) with this condition. The Interstitial Cystitis Association has recommended the following guidelines to prevent painful sexual intercourse:

·         Side-facing positions are recommended because there is less pressure applied on the urethra and the bladder.

·         Drink plenty of water after sexual intercourse and urinate shortly afterward to clean out the urethra and avoid an interstitial cystitis flair.

·         Postpone sexual activity until the bladder and stomach are empty, if possible.

·         Take any prescribed medication before engaging in sexual intercourse (pain medication, muscle relaxants, bladder instillations, or any other prescribed medicine) to ensure maximum comfort.

·         Try outercourse techniques or manual stimulation if penetration is painful.

·         Test out any new lubricant or contraceptive product before using sexual intercourse to ensure that it does not cause a flair.

·         Use a cool icepack on the vulva or perineum to reduce the burning sensation that may accompany sexual intercourse. Internal cooling packs(ice packs that may be placed inside the vagina) may also be used as recommended by a physician. 

How is Interstitial Cystitis Treated?

It is important to visit a physician if you are experiencing any of the symptoms associated with interstitial cystitis. Although the syndrome is not “curable,” it is treatable and a physician can create a treatment plan that it right for you. Common forms of treatment involve the following options:

·         Pain medications, such as antihistamine, that reduce inflammation of the epithelial lining of the bladder

·         An internal dye pill generically called phenazopyridine; this dye coats the inner lining of the urethra reducing symptoms of dysuria (painful urination). 

·         A cystoscopy with hydrodistention procedure done under anesthesia, which fills the bladder to maximum capacity and slowly releases the liquid that has permeated the bladder lining; this method gives temporary relief of pain and is also often used to diagnose interstitial cystitis.3

·         Tricyclic antidepressants, which exhibit side effects that alleviate urinary urgency by increasing bladder retention as well as increasing certain neurotransmitters that help alleviate pain.

·         In the most severe cases, surgical procedures can be done with the referral of a physician and can include an implantation of an electrical nerve stimulator that helps relieve symptoms.

             It is also important for the patient to adopt a new interstitial cystitis “lifestyle.” This includes recognizing possible triggers (which vary for every person) and avoiding them or accommodating them to reduce interstitial cystitis pain. This new lifestyle can be developed by initially keeping a journal of your symptoms. When symptoms are more severe, it is likely that you are experiencing an IC flair from a certain trigger. Keeping a food- intake journal can help you recognize your specific food triggers and subsequently allows you remove them from your diet. Exercise is vital for the maintenance and function of your organs and is crucial for people with IC. Gentle exercises such as yoga, walking, and Tai Chi should be incorporated into your new lifestyle.4  Patients who follow their specific treatment plan, avoid smoking and drinking, manage their stress and accommodate their lifestyle accordingly have less interstitial cystitis flairs and ultimately a more enjoyable sex life.

References

1. http://www.ichelp.org/page.aspx?pid=917

2. Bogart, Laura et al. “Prevalence and Correlates of Sexual Dysfunction Among Women with Bladder Pain Syndrome/Interstitial Cystitis.” NIH Public Access 77.3 (2011): 576-580. PubMed. Web. 14 May 2013

3. Marinkovic, Serge et al. “The Management of Interstitial Cystitis or Painful Bladder Syndrome in Women.” British Medical Journal 339.7716 (2009): 337-342. JSTOR. Web. 13 May 2013.

4. Aihara, K et al. “Hydrodistention Under Local Anesthesia for Patients with Suspected Painful Bladder Syndrome /Interstitial Cystitis.” International Journal of Urology 16.2 (2009): 947-952. Academic Search Complete. Web. 18 May 2013.

5. http://www.ichelp.org/

 

Last Updated 22 May 2014.

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