Guest Author - Denise Howard, M.D., M.P.H.

Interstitial Cystitis (IC), also referred to as Painful Bladder Syndrome, is a common cause of chronic pelvic pain in women. The prevalence of this condition is unclear but in general it is often under diagnosed and many women suffer from this condition for 5 years before it is identified.

IC is a chronic inflammatory condition of the bladder that produces pelvic pain, urinary frequency, urinary urgency, and other voiding problems. In addition it can cause pain with intercourse as well as severe menstrual related pain. Other symptoms might also include vulvar or vaginal pain. It is easy to see why this condition is often confused with recurrent urinary tract infections and endometriosis. In many cases women may suffer from both conditions as well as IC.

The exact cause of this condition is unknown. Research indicates that the protective coating of the bladder has been destroyed. As a result, substances in the urine can seep into the deeper layers of the bladder and irritate the nerve endings. This leads to pelvic pain, urinary frequency, and urgency.

The first step in making the diagnosis is to eliminate other potential causes such as a bladder infection, malignancy, endometriosis, and pelvic infection. Diagnostic test for IC exist but are not perfect. The Pelvic Pain and Urgency/Frequency questionnaire ask specific questions that are highly predictive of IC. The potassium sensitivity test (PST) is an in office test that grades the response to instillation of a potassium solution into the bladder. Women with IC have a dramatic response while women with a normal bladder do not experience any change in sensation. Finally, cystoscopy with hydrodistension use to be considered the gold standard however findings of IC are not consistent and similar findings can be seen in women who do not have symptoms of IC. It is valuable in ruling out bladder cancer as the cause of the problem.

Treatment tends to be multimodal. Elmiron is the only oral agent that is FDA approved for the treatment of this condition. It should be taken for 3-6 months in order to be effective. It is thought to work by rebuilding the protective lining of the bladder. Short term relief of symptoms can be obtained by instilling soothing agents into the bladder. Dimethylsulfoxide and a cocktail of heparin, sodium bicarbonate and lidocaine are two examples. They are typically given weekly for 6-8 weeks. Use of oral bladder analgesics and anticholinergic agents are helpful in controlling urinary frequency and urgency. The pain can be controlled with the selective use of analgesics. Tricyclic antidepressant agents (amitriptyline or impramine); antiseizure medications (gabapentin) and selective serotonin reuptake inhibitors may also be helpful.

Avoidance of certain trigger foods such as caffeine, high acidic foods, and potassium rich foods can provide some relief. Stress and seasonal allergies are triggers for some and they find benefit in stress reduction and use of allergy medications. Sacral Nerve stimulation (Interstim) has recently been found to be effective in some women who do not respond to the above listed treatments.
IC is a complex problem and should be managed by a health care provider who is experienced in dealing with chronic pelvic pain in women. You can find more information on this condition at the weblinks below.

http://www.ichelp.org/ Interstitial Cystitis Association

http://www.ic-network.com/ Interstitial Cystitis Network