Interstitial cystitis

Diagnosis

Diagnosing interstitial cystitis typically does not rely on specific tests. Instead, it often entails gathering the patient’s medical history and symptom presentation, coupled with a pelvic examination. In some cases, individuals might need to keep a bladder diary, noting their fluid intake, urine output, and types of fluids consumed. This comprehensive approach aids in getting a diagnosis.

Additional tests may be ordered to rule out other infections and disorders, such as:

• Physical examination: During a pelvic exam, the healthcare provider assesses the external genitals, vagina, and cervix, and palpates the abdomen to evaluate the internal pelvic organs. Additionally, they may also conduct an examination of the anus and rectum. 
• Urinalysis: A urine sample will be examined for blood, and evidence of illness, such as organisms, germs, pus, or white blood cells, which can be signs of a urinary tract infection.
• Cystoscopy: To rule out bladder cancer, this test may be performed. A cystoscope, a small, illuminated tube with an eyepiece on one end is used to check the inside of the bladder. Through the eyepiece, the urethra and bladder are examined. To determine the bladder’s capacity, a liquid may be injected into the bladder. This procedure known as hydrodistention. 

Anesthesia is generally not administered during the procedure. Nevertheless, if a healthcare provider prescribes a bladder biopsy in conjunction with a cystoscopy, anesthesia might be necessary.

• Biopsy: A tissue sample from the bladder wall and urethra is extracted and examined to rule out other illnesses, such as bladder cancer and other uncommon causes of bladder pain.
• Urine cytology: To help rule out cancer, a urine sample is collected, and cells are analyzed. 
• Potassium sensitivity test: During the procedure, two solutions are injected, one at a time, into the bladder: water and potassium chloride. The patient is asked to rate the level of pain and urgency experienced on a scale of 0 to 5 after each instillation. Normally, individuals with normal bladders are unable to distinguish between the two solutions. If the patient perceives significantly more pain or urgency with the potassium solution compared to water, it could indicate a potential diagnosis of interstitial cystitis.

Treatment

There is no one specific treatment for interstitial cystitis. Treatment usually aims to alleviate the signs and symptoms. Even if the symptoms go away, they may recur later. 

Since there is no way of knowing how the body will react to each treatment, one will have to go through a trial–and–error procedure with several treatments to observe how the body responds. In some cases, several treatments may be combined. 

• Physical therapy: The pelvic muscles help control pee by holding the bladder in place. Exercising, stretching, and particularly relaxing the pelvic muscles may help alleviate symptoms. It may help getting rid of pelvic discomfort caused by muscle tenderness, tight connective tissue, or muscle abnormalities in the pelvic floor. 
• Oral medications: These may help treat IC/BPS symptoms:
  • Nonsteroidal anti–inflammatory drugs: Naproxen sodium and ibuprofen may be prescribed to alleviate pain. 
  • Tricyclic antidepressants: A low dose of tricyclic antidepressants such as amitriptyline or imipramine may help reduce pain and urinary frequency. 
  • Antihistamines: These medications can potentially reduce urinary urgency and frequency and alleviate other associated symptoms. 
  • Pentosan polysulfate sodium: With this treatment, it could take two to four months to feel pain alleviation and up to six months to see a decrease in urine frequency. It rebuilds the bladder’s inner surface, which shields the bladder wall from toxins in urine that could irritate it. This is an FDA–approved treatment for interstitial cystitis. 

A full eye check may be required before beginning this treatment. As the treatment progresses, one may require additional eye exams to monitor for eye problems due to the medication’s linkage to macular eye disease.

• Nerve stimulation: Nerve stimulation techniques include:
  • Transcutaneous electrical nerve stimulation (TENS): During the procedure, electrodes positioned either on the lower back or just above the pubic area administer electrical pulses. The duration and frequency of this therapy are adjusted based on what yields the most effective results. Mild electrical pulses used in TENS ease pelvic pain and, in some situations, reduce urine frequency. 

TENS has been shown to enhance blood flow to the bladder. This may strengthen the muscles that help control the bladder or cause the release of pain–blocking chemicals. 

• Sacral nerve stimulation: Throughout the procedure, a thin wire positioned close to the sacral nerves emits electrical impulses directed towards your bladder.

The sacral nerves are the connector between the spinal cord and bladder nerves. Stimulating these nerves may help relieve urinary urgency caused by interstitial cystitis. 

If the procedure relieves the symptoms, a permanent device may be surgically implanted. This treatment does not relieve pain caused by interstitial cystitis. However, it may assist in alleviating some symptoms such as urine frequency and urgency.

• Bladder distention: This treatment involves stretching the bladder with water. During bladder distention, botulinum toxin A (Botox) may be injected into the bladder wall. Some people find temporary alleviation in their symptoms. If long–term improvement is achieved, the procedure can be repeated if necessary. 

However, this treatment approach may result in incomplete bladder emptying during urination. Consequently, one might require self–catheterization, which involves the ability to insert a tube into your bladder to facilitate urine drainage following this treatment. 

• Bladder instillation: During the procedure, a catheter will be inserted into the urethra and extended to the bladder. A medication mixture that may contain dimethyl sulfoxide (DMSO) and a numbing agent is filled in the bladder. DMSO is a steroid that helps relieve symptoms. This is often given weekly for six to eight weeks, then maintenance treatments as needed. 

The solution may be combined with other medications, including a local anesthetic, and is left in the bladder for approximately 15 minutes. Afterward, one expels the solution by urinating. 

An alternative method of bladder instillation involves using a solution containing medications such as lidocaine, sodium bicarbonate, and either pentosan or heparin. 

• Surgery: People with severe symptoms and do not respond to treatment may be recommended a more invasive surgical option. In such cases, they may consider performing a cystectomy, which involves the removal of part or all the bladders. However, this is rarely suggested because removing the bladder does not reduce discomfort and can lead to other issues. 

Surgical options include:

• Fulguration: Ulcers that could be present due to interstitial cystitis can be cauterized. This less invasive procedure entails inserting instruments through the urethra to perform the procedure. 
• Resection: A minimally invasive procedure that involves inserting devices into the urethra to cut around any sores.
• Bladder augmentation: This is only done in extremely particular and uncommon cases. The treatment does not relieve pain, and some patients must empty their bladders with a catheter several times per day. Bladder augmentation involves placing a patch of intestine on the bladder to expand the capacity of the bladder.