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An inflamed bladder is medically called interstitial cystitis, or painful bladder syndrome (PBS). It is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region.

An inflamed bladder is medically called interstitial cystitis, or painful bladder syndrome (PBS). It is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region.

The symptoms vary from case to case, and even in the same individual with time. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Most female patients report that their symptoms worsen during menstruation. They may also experience pain with vaginal intercourse. Several experts now believe that this disorder is not one, but several diseases because it varies so much in symptoms and severity. People with severe cases of an inflamed bladder may even urinate as many as 60 times a day, including frequent nighttime urination (nocturia). Although no treatment completely eliminates the signs and symptoms of interstitial cystitis, some medications and therapies offer relief. [1]

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Incidence of Interstitial Cystitis

Interstitial cystitis affects between 700,000 and 1 million Americans. This disorder can have a long-lasting adverse impact on a patient's quality of life and is far more common in women than in men. Of the estimated 1 million Americans with bladder problems, up to 90 percent are women. [2]

Possible Causes of Interstitial Cystitis

No one knows what causes this condition, although there are many theories. Some of the most common theories suggest that interstitial cystitis is an autoimmune, hereditary, infectious, or allergic condition, but none of these ideas have been proved. Although some of the symptoms of this disease are similar to those of a bacterial infection, medical tests reveal no organisms in the urine and patients do not respond to antibiotic therapy. It is interesting that, in recent years, a substance found almost exclusively in the urine of people with interstitial cystitis has been isolated, and named “antiproliferative factor” because it appears to block the normal growth of cells that line the inside wall of the bladder. [3]

Diet

There is no scientific evidence linking diet to interstitial cystitis, but many doctors and patients find that alcohol, tomatoes, spices, chocolate, caffeinated and citrus beverages, and high-acid foods may contribute to bladder irritation and inflammation. Also, many patients feel that smoking makes their symptoms worse. [4]

Possible Symptoms of Interstitial Cystitis

Although symptoms vary significantly among patients, people with interstitial cystitis may have some of the following common symptoms [5]:

  • An urgent need to urinate
  • Pressure, pain, and tenderness around the bladder, pelvis, and perineum  
  • A bladder that won't hold as much urine as it did before
  • Pain during sexual intercourse and painful ejaculation
  • Discomfort or pain in the penis or scrotum
  • Chronic pelvic pain
  • In many women, the symptoms get worse before their menstrual period.

Interstitial Cystitis Risk Factors

There are several risk factors associated with interstitial cystitis. Some of the most common risk factors are [6]:

  • Sex – Women receive a diagnosis of interstitial cystitis far more often than men or children do.  
  • Age – Most people with interstitial cystitis are diagnosed in their 30s or 40s
  • Other chronic disorders - Irritable bowel syndrome, vulvodynia, fibromyalgia, and endometriosis.  

Diagnosis

It can be difficult to detect interstitial cystitis because signs resemble those of many other disorders [7].

  • Patient’s history: The first step in the diagnosis of interstitial cystitis should be taking a medical history and asking the patient to describe symptoms.
  • Urinalysis and Urine Culture: Examining urine under a microscope and culturing the urine can detect and identify the primary organisms known to infect the urinary tract. White and red blood cells and bacteria in the urine may indicate an infection of the urinary tract, which can be treated with an antibiotic. 
  • Cystoscopy: This test, sometimes used to rule out other causes of bladder pain, involves an examination of the bladder through a thin tube with a tiny camera – a cystoscope. This procedure is generally performed with general or regional anesthetics to reduce discomfort. During cystoscopy under anesthesia, a sample of tissue may be removed from the bladder and the urethra for examination under a microscope to check for bladder cancer and other rare causes of bladder pain. 
  • Biopsy: A tissue sample examination under a microscope.

Possible Complications

Interstitial cystitis can result in a number of complications, including [1]:

  • Lesser bladder capacity   
  • Reduced quality of life
  • Relationship troubles
  • Emotional troubles

Treatment

Unfortunately, there is no simple treatment to eliminate the symptoms of interstitial cystitis, and no one treatment works for everyone. 
 
Medications

Most commonly doctors prescribe an oral medication called pentosan (Elmiron®). Elmiron is the only oral drug approved by the FDA specifically for interstitial cystitis. Some say that the drug may restore the inner surface of the bladder, which protects the bladder wall from substances in the urine that could irritate it. It takes two to four months before a patient begins to feel pain relief, and up to six months to experience a decrease in urinary frequency. There are also several possible side effects such as minor gastrointestinal disturbances and possible hair loss. Not for use by pregnant women, Elmiron may cause bleeding and loss of pregnancy. [8]

Other oral medications that may improve the symptoms of interstitial cystitis include ibuprofen (Advil®, Motrin®, others) and other non-steroidal pain medications. [8]

Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil®), may help relax the bladder and block pain. [8] 
 
Nerve root modulation

Sacral nerves, which run from the lower spinal cord to the bladder, pelvic floor, and lower bowel, regulate bladder and bowel control. A method of nerve stimulation called sacral nerve root modulation can be very helpful for people with interstitial cystitis. 

A small wire is placed next to the sacral nerves to determine if bladder symptoms will respond to neuromodulation. If the results are positive, a small battery-operated device is surgically implanted in the patient’s upper buttocks. [8] 
 
Bladder distention

Some patients notice a temporary improvement in symptoms after undergoing cystoscopy with bladder distention, or stretching of the bladder with water or gas. [8]
 
Medications instilled into the bladder 

Although this is a very old method of treatment, it is still considered very helpful. The prescription medication dimethyl sulfoxide, or DMSO, is placed into the bladder through a thin, flexible tube. The solution is sometimes mixed with other medications, such as a local anesthetic or bicarbonate to change the pH levels of the DMSO. After remaining in the bladder for 15 minutes, the solution is expelled through urination. However, DMSO can adversely affect the patient’s liver. [8] 

Surgery

Doctors rarely use surgery to treat interstitial cystitis because partial or complete removal of the bladder doesn't relieve pain. Besides, it can lead to several other complications. [9]

Surgical options include:

  • Bladder augmentation: During this procedure, surgeons remove the damaged portion of the bladder and replace it with a piece of colon, but the pain still remains and most women need to empty their bladders with a catheter multiple times a day.
  • Fulguration: This is a minimally invasive method which involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
  • Resection: Another minimally invasive method, also involving insertion of instruments through the urethra to cut around any ulcers.

Useful Dietary Habits

The foundation of therapy is a modification of diet to help patients avoid food which will further irritate the damaged bladder wall. Common bad diet habits include caffeine, herbal and green teas, sodas, concentrated fruit juice, multivitamins, monosodium glutamate, chocolate, and potassium-rich foods such as bananas. [10] A patient should cut out all these, leaving just the basics, and then introduce new food one step at a time, to find out his or her trigger-foods.

Some patients are particularly concerned about preservatives. However, at this point, there is no evidence that preservatives trigger bladder flares and cause interstitial cystitis. The same goes for citric acid, which the most commonly found additive in foods because the amount of citric acid used as a preservative is so little it may be insignificant. However, if you find preservatives problematic, you should eliminate them from your nutritional habits.