Download Interstitial Cystitis/Painful Bladder Syndrome

Interstitial Cystitis/Painful Bladder Syndrome
Interstitial cystitis is condition characterized by chronic pain in the bladder and pelvic region. If
the provider has been unable to attribute the symptoms to other conditions such as urinary
tract infection or urinary stones, the patient may be diagnosed with Interstitial Cystitis or IC. IC
often manifests itself by glomerulations, which are microscopic pinpoint hemorrhages seen on
the bladder wall during a cystoscopy. In 10 percent of the cases, there are also Hunner’s ulcers,
which are patches of broken skin found on the bladder wall. Often the bladder can become
scarred and stiff due to inflammation. If the patient’s symptoms do not fit the strict criteria of
IC, often the patient will be diagnosed with painful bladder syndrome. Many researchers
believe that there isn’t just one, but a variety of diseases that fall into this category.
IC/painful bladder syndrome (PBS), includes symptoms which can be diverse and also range in
severity even with the same patient. This can vary from mild to intense pain and include
frequency and urgency of urination, painful intercourse, pain which intensifies as the bladder
fills and exacerbation with menstruation.
Researchers are not sure what causes IC/PBS but it is not something that can be treated by
antibiotic therapy. There is some correlation to systemic inflammatory responses in some
patients and so it can be more prevalent in people who have chronic conditions such as irritable
bowel syndrome or fibromyalgia.
In order to diagnose IC/PBS, the provider will first try to rule out other conditions that may be
the cause of the symptoms. Diagnosis is based on the presence of urgency/frequency of
urination and pelvic bladder pain in the absence of any other disease that could be causing the
condition. Diagnostic tests to help rule out the other conditions include cystoscopy,
urinalysis/urine culture, bladder or urethral biopsy and bladder distention under anesthesia.
There is no known cure for IC/PBS and it can manifest itself with periods of exacerbation and
remission. Current treatments are aimed at trying to relieve symptoms. Many patients receive
symptom relief from the bladder distention done to help diagnose the condition. Researchers
aren’t sure why this helps but think it may be that this increases the bladder capacity and
therefore reduces pain signals transmitted as the bladder fills. Another treatment that has
been known to provide relief is an instillation of a mixture of Lidocaine, Heparin and Sodium
bicarbonate referred to as Dr. Parson’s IC instillation. This is a series of instillations where the
nurse will insert a catheter into the patient’s bladder to instill the medication approximately
three times a week for three weeks. The patient will retain the mixture in their bladder for 20
minutes before voiding.
Various oral medications can be used either separately or in conjunction with other
medications and treatments. Elmiron, amitriptyline and aspirin and ibuprofen have shown to
reduce painful symptoms of IC/PBS.
Other treatments include physical therapy, bladder retraining, electrical nerve stimulation
(TENS or Interstim), change of diet, stopping smoking and exercise. There may also be surgical
options depending on each patient’s condition that you should discuss with your provider. For
more information visit the Interstitial Cystitis Association website at http://www.ichelp.org/.
Source: National Kidney and Urologic Diseases Information clearinghouse (NKUDIC)
http://kidney.niddk.nih.gov/kudiseases/pubs/interstitialcystitis/
leb 4/30/13
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