Interstitial Cystitis

Dimitris Papadopoulos MD Fellow Of Interventional Pain Practice (FIPP)

Updated 09 March, 2011

GENERAL

Interstitial cystitis, or else known as “Painful Bladder Syndrome”, is a rare, chronic, painful disorder characterized by urgency and frequency of urination and chronic pelvic pain. The disorder mainly occurs in women but may also occur in children and men. The chronicity of the disorder and the high difficulty of finding an effective treatment may cause mental disorders, depression and significant decline of the patient’s quality of life.

CONCLUSIONS

The most commonly reported symptoms are:

  • Urinary urgency (the patient has the constant feeling that s/he needs to evacuate the urinary bladder)
  • High frequency of urination, with small quantities of urine throughout day and night (patients at the advanced stage of the disease may urinate up to even 50 times during 24 hours)
  • Suprapubic pain, or pain in the area between the vagina and annus in women or between the testes and annus in men.
  • Chronic pelvic pain
  • Pain during sexual intercourse

The urine of patients with interstitial cystitis contains no microbes but in case a urinary infection is involved, the symptoms of interstitial cystitis become worse.

AETIOLOGY

The urinary bladder is a hollow organ with a muscle wall coated inside with the bladder epithelium. The urine accumulates in the bladder and, when the bladder dilates enough due to a sufficient urine volume, the pelvic nerves send the message to the brain that it is time for urination.

However, when the patient suffers from interstitial cystitis, the brain receives the wrong information by the pelvic nerves (due to some dysfunction of unknown aetiology) that the bladder is totally full. As a result, although in fact the content of the bladder is small in volume, the patient has constantly an urgent feeling for urination.

In several patients with interstitial cystitis, there is a disorder in the continuity of the epithelium and, therefore, the bladder wall gets stimulated by toxic elements of the urine.

Another possible cause of interstitial cystitis is the disfunction of  pelvic muscles.

DIAGNOSTIC EXAMINATIONS

  • Microbiological urine tests for ruling out the case of urinary infection
  • Clinical workup of the pelvic organs
  • Cystoscopy (endoscopic examination of the interior of the bladder)
  • Bladder biopsy
  • Potassium Sensitivity Test The physician injects potassium chloride solution and water within the bladder separately within a short time distance inbetween.  The patient evaluates and scores the degree of pain and urgency of urination induced by each solution separately, based on a scoring scale 0-5. Healthy subjects do not report pain and urgency for urination with either of the two solutions, whereas patients with interstitial cystitis report symptoms induced by pottasium chloride.

TREATMENT

A. PHARMACOTHERAPY

  • Non steroid anti-inflammatory drugs for pain relief.
  • Tricyclic antidepressants, such as amitriptyline, for bladder relaxation and pain relief.
  • Antihistamines, for reducing urgency and frequency of urination
  • Pentosan is the only drug approved by FDA (Food and Drug Administration) specifically for the treatment of interstitial cystitis.  Its action mechanism is unknown but it may somehow restore the inner surface of the bladder, protecting in this way the bladder wall from stimulating agents that are contained within the urine. It may take 2-4 months until the patient starts feeling improvement of symptoms and 6 months until the urgency and frequency of urination are reduced.

B. INVASIVE THERAPY

  • Another potential treatment is the electrical stimulation of sacral nerves with a system of electrodes and a generator fully implanted under the skin. This specific treatment is a neuromodulatory therapy which is implemented once and for all only after going through a successful testing stimulation with an external generator for a period of about one week to one month. During this period of time the patient has the opportunity to find out the efficacy of the therapeutic technique.

MEDICAL INFORMATION SOURCES

1. PAIN PRACTICE JOURNAL

2. BONICA”S MANAGEMENT OF PAIN

3. PAIN PHYSICIAN JOURNAL

4. INTERVENTIONAL PAIN MANAGEMENT BOOK

5. NEUROMODULATION JOURNAL