Interstitial cystitis

If you are concerned you may have interstitial cystitis, it is recommended that you make an appointment to see a doctor. When you go to your appointment, be prepared to ask any questions you have and to discuss your medical and family history as well as your symptoms. During your appointment, your doctor may also:

• Perform a pelvic exam that will include an examination of your genitals, your internal organs, and possibly your anus and rectum.
• Collect a urine sample to test for a urinary tract infection.

Other diagnostic tests your doctor may perform include:

• Cystoscopy – A tiny tube with a camera attached is inserted into the urethra and moved up to the bladder to get a visual. This may include the injection of liquid into your bladder to get a measurement of your bladder capacity.
• Biopsy – Your doctor may remove a small piece of tissue from your bladder to test for cancer. This will be done during the cystoscopy, and you will be under anesthesia.
• Urine cytology – A urine sample is collected to test for cancer.
• Potassium sensitivity – Your doctor will fill your bladder with water and with a solution of potassium chloride, one at a time. If you feel more pain and a greater need to urinate with the potassium solution, you may have interstitial cystitis.

Treatment

Interstitial cystitis treatment and prevention options depend on the severity of your symptoms and the degree to which they affect your life. Treatment will be done in a series of phases. If one phase is effective, you will not need to move onto the next. The phases are as follows:

Phase 1: Lifestyle changes. Avoiding alcohol, caffeine, and acidic foods; stopping smoking; stress management; and stretching. In addition, physical therapy to strengthen the muscles of the pelvic floor may be effective.

Phase 2: Medication. Doctors may prescribe antidepressants, antihistamine medication, and over-the-counter pain relievers. A prescription medication called pentosan polysulfate improves symptoms in about 30% of people with interstitial cystitis.

Phase 3: Injections, ulcer cauterization, and neuromodulation. There are a number of different treatments here, one of which is nerve stimulation using mild electrical impulses that may improve blood flow to your bladder and decrease pain. In some cases, doctors surgically implant a device that delivers regular electrical impulses to the bladder.

You may also have any ulcers in your bladder cauterized, or have a series of Botox injections every six to nine months to relax the bladder muscles and control symptoms.

Phase 4: Cyclosporine. This is an immunosuppressant medication that comes with a number of side effects. It is important to discuss this option with your doctor.

Phase 5: Surgery. When other treatments have failed to provide adequate relief, doctors may recommend surgery. Surgical treatment of interstitial cystitis includes the removal of ulcers in the bladder and removal (and replacement) of part of the bladder.

Other treatments your doctor might try include:

• Bladder distention: Healthcare providers often stretch the bladder with water or gas while diagnosing interstitial cystitis. Some people find relief after this procedure. If so, doctors may repeat it as a treatment.
• Bladder instillation: During this in-office treatment, doctors put a special liquid medicine into your bladder using a thin tube called a catheter. The medication is held in your bladder for a few minutes before you urinate and release it. Treatments are repeated every week or two for a total of six to eight weeks.

You may also be instructed to do some things at home. These can include:

• Changing your diet to eliminate foods that may contribute to bladder irritation (most commonly caffeine, carbonated drinks, foods high in vitamin C, and citrus)
• Bladder training to control the frequency of urination by regulating how often you go to the toilet (measured by the clock, rather than the urge to urinate)
• Exercising regularly, including stretching
• Wearing loose-fitting clothing
• Minimizing and managing stress
• Quitting smoking

Preparation

You can prepare for your appointment with your doctor by doing the following:

• Write down any questions you have.
• Write down or bring a copy of the medications you are taking.
• Be prepared to discuss your symptoms. Write them down if necessary.
• Bring something to write on or to make an audio recording of the appointment.
• Bring a family member or friend with you.

If your condition warrants bladder surgery, you will be prepared ahead of time by your doctor and healthcare team. They will meet with you to answer all your questions, ensure you know what to expect, and check that you are physically able to undergo surgery. Prior to surgery, you will:

• Be directed to stop eating and drinking at a prescribed time the night before surgery
• Be directed to stop taking certain medications within a few days prior to surgery
• Prepare your home so it is easy to navigate, and prepare meals for when you are discharged after surgery
• Make plans to have someone drive you home and help you after surgery

Recovery

In most cases, full recovery from interstitial cystitis is not possible and treatment will be ongoing or whenever symptoms appear. However, sometimes symptoms get better and disappear over time. For the few who do not respond well to the treatments, pain management can still provide a vast improvement in quality of life.

Complications

Even after treatment, interstitial cystitis can result in a number of complications that may be present throughout your life. These include:

• Lower bladder capacity due to a stiffening of the muscles in the wall of the bladder
• Reduced quality of life due to frequent urination and pain
• Problems with sexual intercourse due to frequent pain and urination
• Emotional health problems that can accompany a chronic condition

The information contained in this article is meant for educational purposes only and should not replace advice from your healthcare provider.