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 dysfunctionGeneral
description 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.
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
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 Rxchoices 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.
Interstitial Cystitis Association
Interstitial Cystitis Network
