Chronic Cystitis, Submucous Cystitis, Hunner's Ulcer
What is it?
Interstitial cystitis is an inflammation of the urinary bladder in which the bladder becomes small, scarred, and less able to expand. The bladder wall experiences pinpoint areas of bleeding (hemorrhages). Resulting scar tissue may cause the bladder to stiffen and contract, reducing its capacity from twelve ounces to two ounces. It is much less common than cystitis from a bacterial urinary infection.
The exact cause of interstitial cystitis is unknown. Possible causes include autoimmune disorder (in which the body's own immune system mistakenly attacks the bladder), an allergic reaction, a hormonal disturbance, a defective mucous lining that would normally protect the bladder, the presence of toxic substances in the urine, or an abnormality of the spine.
Interstitial cystitis might also be related to scarring from endometriosis (condition in which fragments of the uterine lining are found in other parts of the pelvic cavity) or a hysterectomy (surgical removal of uterus), since both are common in women with interstitial cystitis. Once considered a rare disease affecting elderly women, interstitial cystitis is now being identified more frequently among women in their twenties and thirties. The exact incidence is unknown, but it is estimated that up to half a million people in the US have it and 90% of them are women.
Interstitial cystitis can evolve into chronic pain in the pelvic and bladder areas, accompanied by the constant urge to urinate. Up to 50% of individuals with interstitial cystitis report symptoms so severe that they cannot keep full-time jobs.
How is it diagnosed?
Symptoms of Interstitial cystitis
- Pelvic pain and pressure.
- Urgent need to urinate (sometimes 60 to 80 times a day) and burning during urination.
- Sensation of incomplete emptying of the bladder.
- Pain during sexual intercourse.
- Vaginal and rectal pain (sometimes).
History: Symptoms include pain with urination, frequent urination, and feeling pressure to urinate. The pain increases as the bladder fills, causing an uncontrollable urge to urinate. In most cases, a course of antibiotics has failed to resolve the symptoms. In severe cases, individuals may urinate more than sixty times a day and up to ten times a night. Two-thirds report pain during sexual intercourse. Coffee, tea, carbonated drinks, alcohol, and spicy or acidic foods may aggravate the symptoms.
Physical exam: A pelvic exam is done to rule out vaginal infection or visible signs of endometriosis.
Tests: Urinalysis, urine culture, and culture of vaginal secretions is done to rule out infection. A laparoscopy (examination of abdominal cavity using a thin viewing tube) may be used to rule out endometriosis (condition in which fragments of the uterine lining are found in other parts of the pelvic cavity). Once other diagnoses have been ruled out, cystoscopy (under anesthesia a thin viewing tube is inserted into the bladder through the urethra) may be done to inspect the bladder wall for small hemorrhages or ulcers. The bladder is then filled, and a cystometrogram is done to measure pressures and volumes within the bladder.
How is it treated?
A cure is not yet known, so treatment is aimed at relief of symptoms.
- Oral pain relievers, including narcotics, may lessen painful symptoms. Tricyclic antidepressants can also help reduce the pain. Oral medications are available that line the bladder with a protective substance.
- Another option involves delivering a solution directly into the bladder through a urethral catheter. Aimed at inhibiting painful inflammation, this technique involves at least six to eight weeks of biweekly treatments.
- Stretching the bladder by filling it with fluid under pressure (hydrodistention) can bring temporary relief from symptoms.
- Surgery is possible to expand bladders that have shrunken due to the disease process.
- Dietary changes focus on avoiding irritating substances such as spicy foods, citrus fruits, tomatoes, coffee, tea, chocolate, alcohol, and tobacco.
- Alternative approaches include acupuncture for pain relief, biofeedback to relax the muscles of the pelvic floor, and bladder re-training to gradually lengthen the intervals between urination.
- Elimination of caffeine-containing beverages, alcohol, artificial sweeteners, spicy foods, citrus fruits and tomatoes in the diet may help relieve symptoms.
- A bland diets helps some patients.
What might complicate it?
Scar tissue from chronic inflammation may cause the bladder to stiffen and contract, reducing bladder capacity from twelve ounces to two ounces. Other complications include reflux of urine (urine is forced back up the ureter to the kidney), chronic pelvic pain, and depression (resulting from decreased quality of life due to constant urinary symptoms and pain).
Although a cure is not yet available, new treatment options are proving effective in long-term relief of bladder pain and discomfort associated with interstitial cystitis.
Urologist, internist, gynecologist, and infectious disease specialist.
Last updated 25 November 2011