Interstitial Cystitis

What is interstitial cystitis

Interstitial cystitis, also called painful bladder syndrome refers to a cluster of symptoms and signs characterized by a chronic increase in the frequency and urgency of urination, pain in the pelvis or lower abdomen and / or incontinence of urine.

The International Continence Society has defined as pain above the pubis in relation to the filling of the urinary bladder. It is accompanied by other symptoms such as increased urinary frequency day and night, in the absence of proven urinary disease or other infections.

It has been observed that this disease can have significant negative effects on the quality of life for people who suffer. Thus, half of the patients are unable to work full time; three out of four patients have dyspareunia , ie, painful intercourse; 70% have sleep disorders and 9 of 10 patients indicate that the disease affects their daily activities.

Who is affected

Interstitial cystitis is 5 to 10 times more common in women than in men and affects young patients, 25 to 55, with an average age of 42 years. Most patients have mild to moderate stages of the disease so often it goes unnoticed or is confused with other urological or gynecological problems.

We now know that the IC may be present in most young patients (under 50 years) presenting with symptoms of urinary urgency and pelvic pain or who have not been diagnosed with other causes.

What produces

The causes of this disease are probably multifactorial. Include altered epithelial permeability or inner layer of the urinary bladder and an increased activation of the sensory nerves in the bladder.

For many years the causes of this process have been unclear, but now we have different evidence that interstitial cystitis is a breakdown of the inner layer called the urothelium or bladder causing an alteration of the natural defense mechanisms that protect to the bladder, urethra and prostate, in men, to potentially toxic compounds are usually present in urine.

As a result, these substances (primarily potassium) can penetrate the protective layer of the urothelial surface and activate the nerves and muscles of the underlying tissue.

Symptoms of the disease

Although the clinical presentation of the disease is variable, patients with interstitial cystitis usually have symptoms of urinary urgency (uncontrollable urge to go to the bathroom), increased frequency of visits to it, pelvic pain (in the bottom of the abdomen) and / or incontinence or urine leakage, in any combination. Most patients exhibit these symptoms.

The onset of illness is often insidious, ie, appears little by little, and in most cases progresses gradually over years and even decades. Generally, the initial symptom is increased urinary frequency until day 8-10. One manifestation of this problem, present in most patients, is called nocturia, ie, getting up to the toilet at night, sometimes 2-5 or more times.

Later, the patient may begin to experience pain with exacerbation episodes lasting from a few days to several weeks. Pain may occur:

Approximately 75% of patients (men and women) have pain during sexual intercourse (dyspareunia).

Pain is often not always constant in relation to the filling of the urinary bladder. It may also appear to empty the bladder.

Some factors such as allergies or, in women, hormonal changes have been associated with the exacerbations of the disease. Other factors such as physical and emotional stress, sexual activity and some foods such as coffee, citrus fruits, tomatoes, chocolate, fizzy drinks or caffeine, alcohol and spices have also been linked with the onset of pain interstitial cystitis.

• in the urethra or urine pipe
• above the pubic area or lower abdomen
• in the lower back or lumbar or sacral region
• buttocks
• in the upper thigh
• in the groin, vagina or vulva in women or on the penis, testicles or scrotum for men.

How is it diagnosed

Although different diagnostic criteria have been proposed, both clinical and cystoscopic and histological, there is no universally accepted method for proper diagnosis of interstitial cystitis.

The general consensus is that the diagnosis of this disease is mainly clinical and should be suspected in men or women who go to the doctor with symptoms of increased frequency of urination, urinary urgency, pelvic pain or discomfort and exacerbations or worsening sexual symptoms as long as other causes have been ruled out activity.

In addition to good clinical and a complete physical history, they have proposed different tests, such as urinalysis to rule out infection, test sensitivity potassium, cystoscopy and bladder endoscopy and biopsy of this body and even urodynamic testing, but none of them has proved to be particularly specific to diagnose this disease.

Before a diagnosis of interstitial cystitis patient should discard urine infections and effects of radiation or chemical agents on the bladder. This disease should be considered in men and women with chronic pelvic pain and in patients with overactive bladder that is unresponsive to medical treatment.

Symptoms of the disease can become chronic and progressive made. The disease progresses slowly and, in some cases, may stabilize and even may not advance.

Treatment and Prognosis

Most cases of interstitial cystitis can be treated properly, both men and women, through a plan of oral treatment to which you can add an intravesical treatment when deemed necessary. Basically the treatments available today are:

For years it has been using a technique called bladder distention, consisting of delaying the urinary bladder under anesthesia. This treatment alleviates the symptoms of patients in 20% - 90% of cases but only for a period of 3 to 6 months. Another possibility is the intravesical treatment with substances such as pentosan polysulfate.

Finally, in the most serious and where it has failed medical treatment cases, it has been proposed surgery even cystectomy or complete removal of the urinary bladder and the urinary diversion to a new bladder constructed from a loop of intestine. It is a last resort because it is a very aggressive surgery. In skilled hands it can, however, offer good results.

• Treatment with substances called heparinoids most notably sodium pentosan polysulfate that all patients are administered to try to restore epithelial function in the lower urinary tract.
• An oral treatment with a tricyclic antidepressant called amitriptyline used to inhibit nerve activation that accompanies the disease.
• An oral treatment with antihistamines such as hydroxyzine to control allergies that aggravate interstitial cystitis.