|What is Interstitial Cystitis?
Interstitial cystitis (IC) is not considered a urinary tract infection (UTI) - although it is frequently misdiagnosed as one. On average there is a 4 year delay before most patients receive a correct diagnosis. It most likely to occur after the age of 30 and is 10 times more common in women than men. IC is a painful condition which arises from inflammation of the bladder wall. It is usually accompanied by an urgent need to urinate frequently which is why it often confused with cystitis. Symptoms can worsen during menstruation and pain may be experienced during sexual intercourse. As IC symptoms vary so much, and in severity, many researchers now believe it is not one condition, but in fact many. For this reason, it is more recently being referred to as bladder pain syndrome (BPS) or painful bladder syndrome (PBS). The term IC/BPS now refers to all urinary pain that cannot be attributed to a specific cause such as an infection or urinary stones. It is estimated that nearly one million American women suffer from IC, and many of those women have other conditions such as fibromyalgia syndrome and irritable bowel syndrome.
The symptoms and signs of IC vary from person to person. It can 'flare up' at any time, most commonly during menstruation, during times of stress, sexual activity or after sitting for a long time.
1. A persistent urgent need to urinate.
Although symptoms appear very similar to cystitis or a UTI, a urine sample or culture will not reveal any bacteria. If symptoms worsen over a few days it may however indicates the presence of a UTI.
The simple answer is, no one knows. Although symptoms of IC/BPS mimic those of a bacterial infection, a urinary culture will reveal no bacteria or organisms. Researchers are studying a possible link to autoimmune reactions and inflammation. Inflammation of the bladder may just be one manifestation of a more general inflammation of the organs and other parts of the body. Another theory is that those with IC have a 'signal mix-up'. When the bladder is full of urine it signals to the brain via the pelvic nerves that it is ready to urinate. People with IC may have a mix up in this signal which causes the need to urinate more frequently. It may also be that they have a defect in the protective lining of the bladder wall (epithelium). If the wall develops little tears, this may allow toxic substances access to the bladder, irritating it. Other theories being investigated include food allergies and genetic links.
There is no doctor test that can absolutely diagnose IC. All a test can do is rule out other possible causes. For example, a urine sample or culture can rule out a bacterial infection and with that, a urinary tract infection (see urinary tract infection diagnosis). Pelvic pain is also associated with endometriosis and pelvic inflammatory disease (PID). If IC is suspected, a patient may be referred to a urologist, for a cystoscopy. This procedure is performed under general anesthesia and is the standard diagnostic test for IC. The bladder is filled with water (or gas) so that it is extended to the maximum (a process called hydrodistention). This allows the urologist to examine the bladder wall with a small fiber optic camera or scope which is inserted up the urinary tract. In 95 percent of IC cases, the doctor will discover tiny hemorrhages called glomerulations. This is generally considered a diagnosis. In a small number of cases lesions, scars or ulcers (known as Hunner's ulcers) on the bladder wall are discovered. A tissue sample will be taken by biopsy and analyzed. It will be analyzed to distinguish between ulcers, possible cancer and mast cells. Mast cells are usually seen in large numbers where IC is present.
What It The KCL Sensitivity Test?
This is a relatively new test which is being utilized more and more by doctors. The big advantage is that it can be carried out in the doctor’s surgery and does not require general anesthetic. Also known as the potassium chloride sensitivity test or Parsons Test, it involves inserting a potassium chloride solution into the bladder via a urinary catheter. It is used to test the so-called glycosaminoglycans (GAG) layer of the bladder, and how permeable it is. During the procedure patients are asked to report on the degree or severity of the need to urinate and pain associated with it. The pain may continue after the test, some patients report side effects for days and even weeks after the event.
However, a cystoscopy with hydrodistention is still considered the gold standard for diagnosis of IC.
There is no cure for IC, primarily because the cause or causes have not been identified. As a result treatment is aimed at relieving symptoms. Even when symptoms reduce or disappear they can always come back: days, weeks, months or even years later. The following is a list of treatments which may help relieve symptoms:
Some women experience temporary relief after the bladder has been expanded during a cystoscopy. If the procedure resulted in long lasting results it may be repeated. Researchers are not sure why it should help, but it may be because it increases the capacity of the bladder to store liquid or it interferes with pain signals transmitted by the bladder.
This procedure involves inserting a liquid into the bladder which is held for 10 or 15 minutes before being released. It is also called a bladder wash or bath the liquid. Liquids used can vary and could include dimethyl sulfoxide (DMSO), lidocaine, sodium bicarbonate, heparin or pentosan. Currently DMSO is the only drug approved by the FDA for bladder instillation. This treatment is usually carried out every week for up to 8 weeks and then every couple of weeks for up to a year.
Nonsteroidal Anti-Inflammatory Drugs
Surgery is rarely used for treating IC patients. The only circumstances it will be considered is where the bladder is too small to hold even tiny amounts of urine or in severe and persistent cases. Even then surgery is a last resort. The possible procedures include bladder augmentation, where a portion of the bladder is removed and replaced with a piece of the colon. Fulguration and resection involves burning or cutting around ulcers which may be present on the bladder and causing symptoms. A cystectomy, complete removal of the bladder is rarely performed.
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For more gynecological problems see the following:
• Urinary tract
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