Interstitial cystitis (IC) is part of a chronic disease process that can affect the bladder, the urethra, or the prostate in any combination. A person who has IC may have one or more of these symptoms:
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Pain in one or more places anywhere between the belly button and the insides of the thighs, front or back (pelvic pain). It can be mild or severe, chronic or intermittent, and in one or more locations in the pelvis.
Pelvic pain includes pain in the lower abdomen, the lower back, the urethra, the area between the urethra and the rectum, the labia and the vagina (in women), and the scrotum (in men).
Some people with IC urinate often, but they don't necessarily feel the urge to go.
some other facts about IC
IC occurs in both women and men, but women are more likely to have IC than men are.
Three out of every four IC patients -- both women and men -- have pain or symptom flares with sexual activity.
Men who have IC are often diagnosed with prostatitis even though they have bladder symptoms or frequency and urgency. In fact, a number of studies have shown that most men who are diagnosed with prostatitis have IC (or perhaps even both IC and prostatitis).
Diagnosing IC
If you have some of the symptoms mentioned above, and
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you have been diagnosed with endometriosis, vulvodynia or yeast vaginitis, or you have pain with sex, and your symptoms keep coming back in spite of therapy,
fill out the Pelvic Pain and Urgency/Frequency Questionnaire (PUF). Our research has shown that a person who has a PUF score of 5 or higher may have IC.
If you think you may have IC, the next step is to see your primary care doctor or your urologist. You may want to take the PUF questionnaire with you so you can refer to it when you discuss your symptoms and your concerns with the doctor.
In addition to a history and physical examination and perhaps a urine culture, your doctor may have you take a Potassium Sensitivity Test (PST). The PST is a test that your doctor can perform in his or her office. The PST results will help your doctor determine whether or not you actually have IC.
Is IC treatable?
Yes. We have very effective treatments for IC.
Intravesical Therapeutic Solution
A recent study showed that a new IC treatment can provide immediate relief of symptoms. The treatment is a therapeutic solution that is instilled directly into the bladder. The instillation can be done in a doctor's office or by the patient at home.
Dr. Parsons describes this new therapeutic solution in a medical journal article published in Urology in January 2005.
Oral Medications
In many cases, we treat IC by having a person take two or three simple nontoxic oral medications (pills). We list these three medications because our experience has shown that they work particularly well compared to many of the other IC therapies that have been reported.
Pentosan polysulfate sodium helps restore or heal the bladder lining. This medication is very under-utilized and many patients who would respond to it have not tried it. Many are not aware that Elmiron works best over time and that most patients obtain the best results after taking Elmiron for 6-12 months. In fact, a recent study has shown that up to 70% of patients respond to Elmiron after 8 months of therapy.
Allergies like hay fever can make IC worse. We often prescribe an antihistamine (hydroxyzine) for IC patients with allergies.
We may also prescribe an antidepressant, such as amitriptyline (Elavil). Chronic pain can actually cause physical changes in the nerves, and medications like Elavil can help restore the nerves to their normal, healthy state. This, in turn, helps relieve the pain.
It can take many months before the oral medications start to work, so it is important to keep taking them.
This oral treatment plan for IC is also known as multimodal therapy.
A new therapeutic solution, placed into the bladder in your doctor's office or at home, can alleviate the symptoms immediately and temporarily while the other medications allow the bladder to heal (see Intravesical Therapeutic Solution above).
Causes of IC
Normal urine contains salts that can irritate tissue. For this reason, the bladder has a protective lining called a mucus layer. A healthy mucus layer enables the bladder to store urine safely and comfortably until it is emptied. The mucus layer prevents urinary toxins from leaking into the bladder wall and causing symptoms.
There are many theories about what causes IC. Many doctors believe that most people with IC have a problem in their bladder lining. As a result, the bladder is not protected well enough, and the bladder tissue actually suffers damage from the salts in urine -- especially from potassium. Because of this damage, there is urgency or pain or both.
Similar problems can occur in the urethra or the prostate. Because the defective mucus and leaking potassium can also occur and affect various parts of the lower urinary tract, it is also known as lower urinary dysfunctional epithelium (LUDE). Sometimes only one area may be involved, such as the urethra.
Links for More Information About IC