Dr. MJ Bazos MD,
What is interstitial
Interstitial cystitis is a chronic bladder
problem. About 750,000 Americans have interstitial cystitis. Most of them are
women. People with interstitial cystitis have a bladder wall that is inflamed
and irritated (red and sore). This inflammation can scar the bladder or make it
stiff. A stiff bladder can't expand as urine fills it. In some cases, the walls
of the bladder may bleed slightly. A few people get sores in the bladder
People with interstitial cystitis may have the
- An urgent need to urinate, both in the daytime
and during the night
- Pressure, pain and tenderness around the bladder,
pelvis and perineum (the area between the anus and vagina or the anus and the
scrotum). This pain and pressure may increase as the bladder fills and decrease
as it empties in urination.
- A bladder that won't hold as much urine as it did
- Pain during sexual intercourse
- In men, discomfort or pain in the penis or
In many women, the
symptoms get worse before their menstrual period. Stress may also make the
symptoms worse, but it doesn't cause them.
What causes interstitial
Doctors don't know what causes interstitial
cystitis. They know that it isn't caused by infections with bacteria or viruses.
It might be caused by a defect in the lining of the bladder. Normally, the
lining protects the bladder wall from the toxic effects of the urine. In about
70 percent of the people with interstitial cystitis, the protective layer of the
bladder is "leaky." This may let urine irritate the bladder wall, causing
Other possible causes may be an increase of
histamine-producing cells in the bladder wall or an autoimmune response (when
antibodies are made that act against a part of the body).
How does my doctor know I have
You may have interstitial cystitis if any of the
- You have to urinate often or urgently
- You have pelvic or bladder pain
- A urologist (a doctor whose specialty is problems
of the urinary tract) finds bladder wall inflammation, pinpoint bleeding or
ulcers during an exam with a special scope (called a cytoscope) that looks
inside your bladder
- Your doctor has ruled out other diseases such as
urinary tract infections, vaginal infections, bladder cancer, sexually
transmitted diseases and, in men, chronic
interstitial cystitis treated?
There is no cure for interstitial cystitis. Many
treatments can help your symptoms. Most people feel better after trying one or
more of the following treatments:
- Diet. Your doctor may tell you to change what you
eat. You may need to avoid alcohol, acidic foods and tobacco.
- Bladder distention. Sometimes people feel better
after having bladder distension. Under anesthesia, a doctor overfills your
bladder with fluid. This stretches the walls of the bladder. Doctors don't
know why distension helps. It may make your bladder be able to hold more urine.
It may also interfere with the pain signals sent by nerves in the bladder.
- Medicine. Your doctor may have you take an oral
medicine called pentosan polysulfate (brand name: Elmiron). This medicine helps
to protect the lining of the bladder wall from the toxic parts of urine. Another
oral medicine used to treat interstitial cystitis is an antihistamine
called hydroxyzine (two brand names: Vistaril and Atarax). This medicine reduces
the amount of histamine that is made in the bladder wall. Another medicine that
may help is amitriptyline (brand name: Elavil). It blocks pain and reduces
bladder spasms. This medicine can make you sleepy, so it is usually taken at
- Bladder instillation. During a bladder
instillation, a catheter (a thin tube) is used to fill your bladder with liquid
medicine. You hold the medicine inside your bladder for a few seconds to 15
minutes. Then the liquid drains out through the catheter. Treatments are given
every one to two weeks for six to eight weeks. The treatment can be repeated as
can I do to help my symptoms?
- Diet. Alcohol, tomatoes, spices, chocolate,
caffeine, citrus drinks, artificial sweeteners and acidic foods may irritate
your bladder. That makes symptoms worse. Try removing these things from your
diet for a couple of weeks. Then try eating one food at a time to see if it
makes your symptoms worse.
- Smoking. Many people with interstitial cystitis
find that smoking makes their symptoms worse. Because smoking is also a main
cause of bladder cancer, people with interstitial cystitis have another good
reason to quit smoking.
- Bladder training. Many people can train their
bladder to urinate less often. You can train your bladder by going to the
bathroom at scheduled times and using relaxation techniques.
- Physical therapy and biofeedback. People with
interstitial cystitis may have painful spasms of pelvic floor muscles. If you
have muscle spasms, you can learn exercises to help strengthen and relax your
pelvic floor muscles.
- TENS (this stands for "transcutaneous electrical
nerve stimulation"). You can use a TENS machine to put mild electrical pulses
into your body through special wires. Some doctors think that electrical pulses
increase blood flow to the bladder. The increased blood flow strengthens the
muscles that help control the bladder. It also releases hormones that block