Interstitial Cystitis

What Is Interstitial Cystitis?

Interstitial cystitis, also known as bladder pain syndrome or painful bladder syndrome, is a chronic, non-microbial inflammatory disease of the bladder characterized by pain in the bladder and pelvic region, a constant feeling of urgency and frequent urination. 90% of patients are women, and symptoms most often begin between the ages of 30 and 50.

Symptoms

The typical symptoms are bladder pain, frequent urination and a constant urge to urinate. The pain usually becomes more noticeable as the bladder fills and eases after urinating. Flare-ups and periods of improvement in symptoms are typical of this disease. Sexual intercourse is often painful for both women and men. Fibromyalgia, musculoskeletal pain, constipation, irritable bowel syndrome, autoimmune diseases, depression, allergies and migraine are also seen more often in these patients.

Causes

Although it has been studied extensively in many respects, the exact cause of this disease is not known. However, the generally accepted view is that it does not have a single cause and is a syndrome in which many factors play a role together, including immunological, allergic, neurovascular, infectious, and even environmental and genetic factors.

Diagnosis

The diagnosis is made by ruling out other diseases with similar symptoms. The following tests and steps are used for this purpose.

Detailed History

Physical Examination

Urinalysis and Urine Culture

Questionnaires and Voiding Diary

Potassium Sensitivity (Parsons) Test

Urodynamics

Cystoscopy

Treatment

Step: Conservative Approach

– Informing the patient about the disease

– Lifestyle changes: avoiding stress, exercising, learning to relax the pelvic floor muscles, warm showers and baths, etc.

– Diet: It is known that onions, tomatoes, legumes, bananas, apples, apricots, citrus fruits such as oranges, tangerines and lemons, peaches, nectarines, yogurt, mayonnaise, ketchup, mustard and especially spicy foods, vinegar, some salad dressings, artificial sweeteners, alcohol, caffeinated drinks such as coffee and colas, some fruit juices and tea increase patients' symptoms. It is helpful to try these one by one individually and remove those that worsen symptoms from the diet.

Step: Medication

Oral: Amitriptyline, pentosan polysulfate sodium (PPS) and antihistamines are the most commonly used oral medications and are recommended in the European Association of Urology Guidelines.

Intravesical (into the bladder): Dimethyl sulfoxide (DMSO), lidocaine + sodium bicarbonate, hyaluronic acid, chondroitin sulfate, pentosan polysulfate sodium (PPS) and heparin are used for this purpose.

Step: Cystoscopy + Hydrodistension and Resection of Hunner Ulcers

Step: Intravesical Botox Injection and Sacral Neuromodulation

Step: Cyclosporine A and intramural onabotulinumtoxinA injections.

Step: Urinary Diversion + Cystectomy