Interstitial Cystitis (IC) is a chronic Bladder condition resulting in recurring discomfort and pain in the Bladder or surrounding Pelvic region. This can cause Bladder Pain Syndrome (BPS) that can lead to unrelenting pain, frequent trips to the bathroom day and night, and curtail activities due to extreme urinary frequency.
What Is Interstitial Cystitis?
Interstitial Cystitis has been called many names, such as Painful Bladder Syndrome, Urethral Syndrome, Trigonitis, and Bladder Pain Syndrome. Some characterize it into Hunner Lesion Interstitial Cystitis, which is described as having irritating lesions on the bladder wall seen with cystoscopy (scope looking into the bladder) or Non-Hunner Lesion Interstitial Cystitis, in which no such lesions on cystoscopy. The cause or etiology of the disease is not known or not clearly recognized.
IC or BPS predominantly affects women with an average age of onset of 40 years or older. It does affect men, but it’s less common, and very rarely would affect children. Prevalence in the United States ranges from 1 to 5 out of every 100,000 people and maybe up to 12% of women having early symptoms of IC.
Symptoms of Interstitial Cystitis
Symptoms of IC have features of inflammation and irritation. These can possibly be autoimmune-related, or nerve-related.
- Pain in the pelvis area between the Vagina and Anus in women or between the Scrotum and Anus “Perineum” in men.
- Chronic pelvic pain.
- Persistent need to urinate.
- Frequent urination, often small amounts throughout the day and night.
- Pain or discomfort while the Bladder fills and relief after urinating.
- Pain during sexual intercourse.
- Symptoms are said to be chronic pain if they persist for 3 months.
Common Causes of Bladder Pain Syndrome
The exact cause of Interstitial Cystitis is unknown, but people with IC may have a defect in the protective lining of the Bladder called the Epithelium, or the lining can be irritated or too thin.
- The Epithelium may leak to allow the urine to irritate the Bladder wall.
- There is the possibility of an autoimmune reaction, genetic component, undiagnosed infection or allergic response.
- Epithelial leak.
- Can cause a potassium leakage from the cells of the Bladder wall into the uterine.
- This can generate symptoms of frequency, urgency, pain or incontinence or just the cells allow for the Bladder to get past the Epithelial wall causing further irritation to the deeper lining of the Bladder.
- Autoimmune reaction – This can be a reaction where the body attacks the Bladder Epithelial cells, causing inflammation and irritation.
- Allergies and infections.
- Allergies to something in food or urine could cause the release of Histamine other chemicals that create inflammation as well.
- Infections can also cause irritation and pain and inflammation, but typically Interstitial Cystitis is characterized by no bacteria grown out in culture from urine sample.
- At the Centeno Schultz clinic we have found Lumbosacral nerve irritation can be a major cause for IC. Pudendal nerve irritation can be a cause as well.
Common Treatment for Bladder Pain Syndrome
Treatment options for Interstitial Cystitis range from conservative lifestyle changes to medications, therapy, injections, and surgeries.
- Changes to lifestyle.
- Sometimes a food elimination can be helpful. Foods you are sometimes told to avoid would be tomatoes, soybeans, spices like pepper, curry, hot pepper, green horseradish paste, etc., high potassium foods, citrus foods, and foods with a strong acid taste like caffeine, carbonic acid and citric acid.
- Stress management techniques are also often tried.
- There are some medications that may be given for pain. Common medications include oral Amitriptyline, Cimetidine, Hydroxyzine.
- Injection-based agents into the Bladder including DMSO, Heparin, Lidocaine or PPS. The oral meds may affect decreasing inflammation and Histamine release. Amitriptyline also can have some properties that help nerve-related pain.
- Therapy. Pelvic floor physical therapy can help relax tight, tender muscles, build strength in the pelvic muscles and work on connective tissue in the pelvis, lower abdomen, thighs, groin and buttocks.
- Injection-based therapies can include Botox injections to relax the muscles as well.
- Trigger point injections can help relax muscles.
- Nerve blocks such as to the Pudendal nerve that can be irritated and that controls Bladder pain.
- Neuromodulation with a stimulator that can be surgically implanted is another last line treatment option.
- Very rarely, Bladder surgery may be required.
Who Is At Risk of Getting This Condition?
Women are at a higher risk to develop this condition, though men can still get it.
- Older in age, over 40
- People that had been diagnosed with Depression have an increased risk for IC.
- People that have more chronic pain conditions, inflammatory disorders, mood disorders, anxiety, and hypothyroidism can be at increased risk for Interstitial Cystitis as well.
When To See a Doctor
You should visit your primary doctor if you are experiencing Bladder pain, urinary urgency, and frequency. It may be time to see a specialist if this has been going on chronically for more than 3 months, is getting worse, causing more day and nighttime urination, and affecting your activity and mood.
Examination and Diagnosis
Doctors will typically take a detailed history, do a physical examination and try to rule out other underlying problems that could lead to similar symptoms. Potentially, more invasive diagnostic measures such as a Cystoscopy, which is a procedure performed under anesthesia where a scope is placed through the Urethra into the Bladder to distend the Bladder, look for ulcers and take measurements, can be used. Here at the Centeno-Schultz Clinic, we would do a detailed neuromuscular evaluation as the diagnosis could potentially be caused by irritated nerves coming from low back problems, Sacral nerve root irritation, or Pudendal nerve root irritation, which can be treated. This may entail obtaining a low back or Sacral MRI as well.
Further Complications if Left Untreated
Patients can have persistent symptoms affecting the quality of life, and increased risk for Depression. You can have continued stiffening of the bladder wall, problems with sleeping, painful and lack of interest in sexual intercourse.
What Can You Do To Prevent Recurrence?
Interstitial Cystitis typically has no known cause and so treatments will vary from person to person. Different treatments can be effective for different patients. At the Centeno-Schultz Clinic, we look for underlying causes of Lumbosacral nerve root irritation that can be treated with our procedures. For instance, if there is an L5-S1 Disc bulge causing irritation to the lower Lumbosacral nerve roots, this can cause symptoms of Interstitial Cystitis. Doing an Epidural using the patient’s own growth factors from their blood platelets has been shown to be effective in reducing pain, improving nerve function, and decreasing or getting rid of the symptoms of Interstitial Cystitis. If that type of treatment is successful, it can prevent reoccurrence by doing maintenance exercise and therapy to protect the low back and avoid any potentially exacerbating activities. Some people may need some periodic treatments several years apart over the course of their life.
Conclusion
Interstitial Cystitis is a Painful Bladder Syndrome characterized by urinary frequency, hard to empty Bladder, painful urination, and pelvic pain that does not have an easily identifiable cause. At the Centeno-Schultz Clinic, we look for an underlying neuromuscular cause that could be treated with our regenerative and reparative injection-type techniques. Otherwise, there are medicines, stress reduction techniques, therapy, and other treatments that can be used to help manage the symptoms of IC/Painful Bladder Syndrome. If you or anyone you know is dealing with this issue and want to see if it could potentially be coming from nerve root irritation, contact the Centeno-Schultz Clinic for a full evaluation to see if a Candidate for any of our therapies.