We speak of interstitial cystitis to designate an inflammation of the bladder whose origin is not infectious. It is to be distinguished from “classic” cystitis and manifests itself by pain above the bladder, in the lower part of the abdomen or in the pelvis.
A bladder examination using a flexible fiber-optic tube (cystoscopy) is necessary to validate the diagnosis, often accompanied by a bladder biopsy.
If interstitial cystitis is considered an incurable disease, the symptoms can be treated: a change in diet may be advised, a change in urination patterns or rhythms, and medication may be prescribed to calm the pain.
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Interstitial cystitis: definition, causes, symptoms
Interstitial cystitis is therefore characterized by inflammation of the bladder in the absence of an infectious cause. For a long time, it was thought to be a relatively rare condition.
More recently, doctors have speculated that interstitial cystitis is more common than previously thought, and that it could be the cause of other disorders, such as chronic pelvic pain.
In 90% of cases, it affects women, although men and children can sometimes be affected.
The cause of interstitial cystitis is still unknown to this day. The main hypothesis is that damage to the cells of the bladder wall, present in the urine, could irritate the bladder.
The exact role of mast cells (cells generally responsible for allergies) is also unclear.
Initially, interstitial cystitis may not have any symptoms. Over the years, symptoms may appear gradually and worsen as the bladder wall deteriorates.
Pain in the bladder, pelvis or lower abdomen is associated with compression, the main consequence of which is the need to urinate frequently and urgently.
This need to urinate, without being able to hold back, can occur several times an hour. Symptoms worsen as the bladder fills and regress when urinating and emptying the bladder.
More rarely, in very severe cases, cystitis even forces some people to spend hours in the toilet, with continual urine loss. Several factors are also likely to worsen the symptoms:
- During physical or emotional stress;
- Certain foods high in potassium: chocolate, citrus fruits, tomatoes or caffeinated drinks;
- Or even during sex;
The diagnosis is based on the doctor’s evaluation and the medical examination including a cystoscopy (possibly with a biopsy).
Symptoms of cystitis usually lead to this diagnosis, with a complete exam, very often pelvic, with a digital rectal exam. Blood and urine tests are also necessary to verify the absence of other pathologies (even not directly related to cystitis).
The search for a urinary tract infection is systematic. Cystoscopy (exploration of the bladder) is performed using a flexible fiber-optic tube to examine the bladder wall. A biopsy can also be done to rule out the possibility of cancer.
Potassium contained in a solution can also be placed inside the bladder, in order to observe a possible allergic reaction of the bladder wall (or other possible irritants).
What are the treatments for interstitial cystitis?
Most often, treatments can provide relief for up to 90% of people with interstitial cystitis. Unfortunately, total eradication of symptoms is rarer. Prevention is based on paying attention to the risk factors that can trigger an episode of cystitis.
The treatments are based on several points:
- First, a modification of the diet can be proposed (taking care to hydrate well);
- Pelvic exercises are usually performed with the patient;
- Reducing stress or anxiety;
- Medicines (analgesics) to reduce pain;
- As a last resort, surgery, when the previous ones have not been effective;
This is the first step in treatment. In particular, it is recommended to avoid consuming spicy foods with a high potassium concentration. This is because they can further irritate the bladder.
Tobacco and alcohol should also be avoided.
Stress reduction, Kegel exercises, bladder training …
The Kegel exercises performed are often very helpful in the treatment of cystitis, in addition to reducing stress or anxiety.
People with cystitis will also need to change their urination habits in order to train their bladder. This bladder training will be based on a technique that engages patients to follow a fixed schedule of urination when they are awake.
A program of urination every 2 or 3 hours will be set up with the help of the doctors in order to remove in particular the urgency (the fact of not being able to restrain) of the urination. Relaxation and breathing exercises can help achieve this goal.
Over time, the patient will be able to space the time of urination more and more.
Drug treatments and surgery
Pain relievers are often needed to calm and reduce the pain of interstitial cystitis. Sometimes antidepressants can also be used to reduce psychological pain, but also to allow the bladder to relax.
Regarding the urgency of urination, antihistamines are sometimes prescribed to allow better intervals between urination. Pentosan is also useful for the restoration of the bladder wall.
When the latter treatment fails, a solution of pentosan can be placed directly into the bladder using a catheter. The patient must then keep the solution for about fifteen minutes, before urinating to evacuate the product.
Other techniques can be used by doctors, including:
- Stimulation of the nerves coming from the spinal cord: these nerve roots control the bladder and their stimulation can help reduce the pain and urgency of cystitis;
- The dilation of the bladder using gas or a liquid: this is called bladder hydrodistension; this treatment can relieve symptoms;
All of these treatments are generally combined. However, when these combined treatments prove ineffective, surgery may be considered.
Interstitial cystitis: what to remember
Unlike bacteriological cystitis (which can be treated with antibiotics), interstitial cystitis is not a bacterial infection: it is a chronic disease, which can last over time, the causes of which are poorly understood, with a significant risk of recurrence.
The emphasis is therefore now placed on the importance of quality multidisciplinary care, to reduce symptoms as much as possible during episodes of cystitis. Interstitial cystitis is probably underdiagnosed and its prevalence varies by country.
In the United States, the prevalence of interstitial cystitis is estimated at 1 in 1,500 people. In 90% of cases, women are affected.
In all cases, being a chronic condition, it is important to be medically monitored during periods of relapses and remissions; relapses are common but symptoms can be greatly reduced with adequate treatment.
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Interstitial cystitis or the symptom of painful bladder
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