Disease Profile of Interstitial Cystitis
Woman's Diagnostic Cyber Disease Profile
Name: Interstitial Cystitis
Synonyms: bladder ulcers, Hunner ulcer, Hunner Syndrome, panmural fibrosis, submucosal cystitis, submucosal ulcer of the bladder, lower urogenital tract epithelial dysfunction
inflammatory disease of the bladder wall of unknown etiology. It mimics urinary tract infection symptoms but bacterial urine cultures are negative and it does not respond to antibiotics. It may be ulcerative or non-ulcerative
Is it common?
Incidence is about 10-500/100000. About 0.01%-0.5% of population (1). (about 450,000 - 700,000 in the U.S.) 90% of cases occur in women and 10% in men. Average age of onset is 40 years old. Differentiating
features The onset of symptoms is subacute building up to a steady level of symptoms. Once that level is reached it does not progressively worsen over time. Urinary frequency during day (up to 50-60 times) and night (up to 20-30 times), pain with urination, all in the absence of laboratory signs of infection. The urinary pain is relieved by voiding. There is general agreement that there are at least two types of presentation - classic disease with ulcerations and non ulcerative disease (2). In the classic presentation, there are ulcers or diffuse glomerulations seen on cystoscopy. Cystoscopy is necessary to confirm and also to rule out carcinoma insitu of the bladder, urethral diverticula, and schistosomiasis. A complete blood count with differential is performed to rule out an eosinophilic cystitis.
In the non ulcerative disease, glomerulations (blood vessel pattern abnormalities may be seen on cystoscopy but the cystoscopy may also be normal. The potassium sensitivity test is also used as a differentiating test although it may also be postive in other causes of pelvic pain such as endometriosis.
Pain with sexual relations, chronic pelvic pain, sleep difficulties, depression , ulcers, scarring and contractures of the bladder wall and urinary leakage/incontinence may be present in a small amount but in general, interstitial cystitis is not associated with urinary leakage. Small bladder capacity (less than 150 cc.s (5 oz.)) is often associated. Cause Cause is unknown. Postulates include infection, anatomical (leaking) defect of bladder lining, (neurogenic) inflammation of bladder nerve endings, autoimmunity and toxic substances in the urine. Unnecessary
studies Magnetic resonance imaging (MRI), CAT scans. Natural history
untreated flares and remissions of pain and voiding problems occur for many years.
Goals of therapy (Rx)
reduction of pain and urinary frequency 1st choice therapy There are not currently any agreed upon gold standard treatments but the following are commonly used by specialists treating this condition:
sodium pentosanpolysulfate (Elmiron®) orally, 100 mg three times a day for at least a 3-6 month trial
antihistamines such as hydroxizine (Atarax® Vistaril®)
antidepressants (for their direct effect on bladder pain fibers) such as amitriptyline HCL (Elavil®, Triavil®) 25 mg - 75 mg each evening, doxepin HCL (Sinequan®) 75 mg at bedtime. imipramine (Trazodone® 25 mg three times a day.
diet alteration avoiding high potassium and acidic foods/beverages
Other therapies used
hydrodistension of bladder
bladder instillations including: dimethyl sulfoxide (DMSO), Heparin, Cystitat, Silver Nitrate and Chlorpactin and Bacillus Calmette Guerin (BCG)
transcutaneous electrical nerve stimulation (TENS), surgery involving substitution cystoplasty
antispasmodics: Anaspaz®, Cystospaz®, Ditropan®, Levsin®, Levsinex®, Urispas®, Urised®
urinary anesthetics: phenazopyridine (Pyridium®, Uristat® Treatments to
avoid Recurrent antibiotic treatment since the urine cultures are usually sterile.
Certain high potassium and acidic foods such as cranberry juice, tomatoes, caffeine, tobacco, chocolate, alcohol and vinegars, and herbal teas should be avoided.
Reason for Rx choices
None of the therapies are more than 50-60% effective, therefore a therapy with the least side effects is usually chosen first. References
- Ratner V, Slade MA, Whitmore KE: Interstitial cystitis: A bladder disease finds legitimacy. J Women's Health 1992. 1(1):63-8
- Thoene JG (ed.): Physicians' Guide to Rare Diseases, 2nd edition. Dowden Publishing Co, Inc., Montvale, NJ. 1995. 697-99.