Interstitial Cystitis (Painful Bladder Syndrome)

This painful, chronic inflammation of the bladder varies considerably in its severity and symptoms, depending upon the form of the disease. Nonulcerative interstitial cystitis -- by far the most common type -- develops mostly in young to middle-aged women, and is marked by intermittent episodes of abdominal and bladder pain, urinary urgency, and painful sexual intercourse. Bladder capacity remains constant or perhaps slightly increased, in marked contrast to the more severe ulcerative form, which occurs mostly in older women and accounts for only 5 to 10 percent of cases. In this latter type, the bladder holds less urine than normal, and cracks, scars, and star-shaped sores called Hunner's ulcers, which sometimes bleed when the bladder is full, develop in the muscular wall. In time, the bladder wall becomes thickened and stiff.

The incidence of interstitial cystitis is unknown, but it's been estimated that it afflicts 500,000 Americans, 90 percent of them women. Unlike ordinary cystitis, which is usually caused by a bacterial infection, interstitial cystitis has no known cause. Possible predisposing factors are under study, including frequent childhood urinary tract infections, bladder damage from surgery, and toxic substances in the urine. Stress appears to trigger flare-ups.

Diagnostic Studies and Procedures

There is no single test to diagnose interstitial cystitis, but a doctor suspects it when a patient describes symptoms of cystitis but a urine culture fails to grow bacteria and antibiotics do not alleviate discomfort. Before concluding that a patient has interstitial cystitis, however, a doctor must rule out other conditions, including urinary tract or genital infections, cancer, kidney or bladder stones, and neurological disorders.

The doctor may inspect the bladder by cystoscopy, in which a lighted viewing device is inserted into the urethra and bladder. In non-ulcerative cystitis, the bladder may appear normal. In the ulcerative form, cystoscopy usually reveals the characteristic scarring and ulcers. Even if the bladder appears normal, tiny areas of pin-point bleeding called glomerulations are often revealed after the organ is distended by filling it with water or gas. Both cystoscopy and bladder distention are painful procedures that are performed after administering local anesthesia.

Medical Treatments

A doctor may start with aspirin or ibuprofen and move to stronger nonsteroidal anti-inflammatory agents such as naproxen (Naprosyn) or piroxicam (Feldene). Sodium pentosanpolysulfate (Elmiron), an experimental drug used for bladder washes, may restore the bladder lining. Another experimental drug called nalmefene (Incystene) may block off pain receptors, thus alleviating this symptom. Amiiripiyline (Elavil), an antidepressant drug, may also alleviate pain and night voiding.

In some cases, bladder distention may be tried, as some patients have noticed an improvement in symptoms following the procedure.

Another approach involves periodically instilling R1MSO-50, a compound made from the industrial solvent DMSO, into the bladder. (This is the only FDA-approved medical use of DSMO.) The substance passes into the bladder wall, reducing inflammation and perhaps hailing painful muscle contractions. Its major drawback is that it produces a strong, garlic-like breath and skin odor for up to 72 hours.

In severe cases, surgery may be considered. However, the results vary and symptoms sometimes recur. Laser surgery may be used to seal off ulcerated areas. Alternatively, resection consists of removing ulcers by cutting around them. In intractable cases, approaches may include; denervation, in which some nerves to the bladder are cut to alleviate pain; augmentation, which enlarges the bladder, usually by adding a section of the patient's small intestine; and cystectomy, in which all or part of the bladder is removed. After a cystectomy, a stoma is needed to reroute urine. Or the bladder may be replaced with a pouch made from a piece of the large intestine.

Alternative Therapies

Although alternative therapies cannot cure the syndrome, some can alleviate its most troublesome symptoms.

Acupuncture and Acupressure. These techniques may be helpful in alleviating chronic pain.

TENS. In this approach, which stands for transcutaneous electrical nerve stimulation, mild electrical impulses are sent into the skin, creating a sensation that distracts from the pain impulses.

Yoga and Meditation. These and other relaxation techniques can help reduce sikss, which aggravates symptoms.

Self-Treatment

Bladder retraining sometimes helps. For 1 to 2 weeks keep a careful diary of how often you urinate daily. Then try to extend the typical time between voidings by 10 or 15 minutes.

Experts recommend experimenting with the diet to identify foods that provoke symptoms. Acidic and highly spiced foods often cause problems. Keep a food diary, then eliminate likely offenders, returning them one at a time.

Abstain completely from smoking, alcohol, and artificial sweeteners. Reduce or eliminate caffeine. Also, use caution when taking supplements, especially vitamin C, which irritates the bladder.

Other Causes of Bladder Inflammation

A bacterial urinary tract infection is the most common cause of bladder inflammation. Symptoms may also be produced by bladder stones, urethritis, or an enlarged prostate.