Interstitial cystitis — also, aptly, known as painful bladder syndrome — is a painful and chronic inflammatory bladder condition. "Interstitial" means "the space between two structures". Because doctors have little idea what causes it and it's frequently initially misdiagnosed, most patients have to wait for years before they finally receive the correct diagnosis.
Women are diagnosed with interstitial cystitis more frequently than men — though more and more men are also found to have it — and the condition often exists alongside other chronic pain disorders like vulvar vestibulitis, irritable bowel syndrome, and fibromyalgia.
Recognizing the symptoms of interstitial cystitis
Interstitial cystitis ranges in severity from patient to patient, and their symptoms can also differ. Here is an overview of symptoms typical for the condition.
Pain around the urethra, genitals (vulva for women, perineum, testicles, and scrotum for men, who may also find ejaculation causes pain), and even pain in the entire lower pelvic area is the most characteristic symptom of interstitial cystitis, which is abbreviated to IC. Sexual intercourse frequently triggers a pain that lasts for much longer than the sex itself in people with interstitial cystitis.
Alarming urinary frequency is another important symptom, especially as it is often the first thing patients will notice. Some patients will only experience this symptom, and no others, but that's bad enough — you may need to pee more than 50 times a day! This particular symptom may be worse either during the day or night for some people.
The feeling that you need to pee right now will be familiar to anyone who has been diagnosed with a urinary tract infection in the past, but for people with IC, it lasts. You may suffer pain, bladder spasms, and experience pressure at the same time.
Pelvic floor dysfunction
IC is sometimes, but not always, accompanied by pelvic floor dysfunction. This means that you lack control over the muscles in that area, which play an important role in continence. If you have it, your pelvic floor muscles are likely to be excessively tense.
How is interstitial cystitis diagnosed?
Though interstitial cystitis is mostly diagnosed clinically, meaning based on your symptoms, some tests can be part of the process, too. They serve to rule out other conditions and include:
- A bladder biopsy
- A urine analysis and culture
- A cystoscopy, which looks at the lining of your bladder
- Video urodynamics, which measure pressure and flow
- Hydrodistention, which looks at bladder capacity
- Urine cytology, examines the cells of found in your urine to check for pathology
Interstitial Cystitis: Treatment options
Because interstitial cystitis is not caused by a bacterial infection — unlike a urinary tract infection, or classic cystitis — antibiotics are not among the treatment options for the condition. Many of the treatment suggestions your doctor will make aren't, in fact, pharmacological at all, though there are medications that can be used in the treatment of IC. They include:
- Pentosan polysulfate sodium (Elmiron®) is FDA-approved to treat IC.
- Painkillers — NSAIDs like ibuprofen or naproxen (Aleve®), and in some cases narcotics like Vicodin® or Percocet®.
- Tricyclic antidepressants are used both to reduce pain and to relax the bladder, withamitriptyline (Elavil®) and imipramine (Tofranil®) being common choices.
- Hydroxyzine (Vistaril®) and loratadine (Claritin®) are antihistamines, used to decrease your feelings of urinary urgency and to deal with allergic reactions.
- Dimethyl sulfoxide, administered directly into the bladder.
Bladder training, physical therapy, the stimulates of your nerves with a TENS (transcutaneous electrical nerve stimulation) machine or through sacral nerve stimulation, and biofeedback may all also help people with interstitial cystitis. Surgical options are reserved for more severe cases, and may involve resection, bladder augmentation, or fulguration.
In addition, patients will want to explore what impact changing their diet has on their symptoms. You may find relief if you steer clear of coffee and other caffeinated drinks, alcohol, fizzy drinks, spicy foods, chocolate, fruit juices, tomatoes, and generally any food high in acid.
Interstitial cystitis and fibromyalgia: The shared features
Fibromyalgia and IC are both more common in women, and specifically middle-aged women. Both are linked to other chronic pain conditions, such as migraine headaches and irritable bowel syndrome, and similar things can worsen the symptoms. In addition, the two conditions share the fact that their root causes remain undiscovered in common, and several of the same treatments are effective for both.
What is the treatment for dual interstitial cystitis and fibromyalgia?
Though there is some overlap in the medications that may be prescribed for fibromyalgia and interstitial cystitis, patients should also be aware that drug interactions are a potential risk whenever they take several medications. Both conditions may call for antidepressants, but while SSRI/SNRI antidepressants are frequently used for fibromyalgia, tricyclic antidepressants are prescribed for IC — and the two cannot be combined. If you're using pregabalin (Lyrica®) for your fibromyalgia, you should also be very careful about using prescription painkillers; talk to your doctor about this.
Luckily, you may be able to reap a double benefit from some treatments:
- Tricyclic antidepressants do work well for some fibromyalgia patients.
- Physical therapy and biofeedback (less scientifically backed up) are used in the treatment of both conditions.
- Though there is no specific fibromyalgia diet, some foods do aggravate symptoms in some patients — the recommended diet for IC may also help your fibromyalgia. You may additionally try a food journal and go on an elimination diet to learn more about foods that trigger symptoms.