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Bruce Robertson, MD, FACS, CPE, AME
Henry Robertson, ATP, CFI
Interstitial Cystitis
What is Interstitial Cystitis?
Interstitial cystitis (also known as bladder pain syndrome or IC/BPS) is a condition that causes pain in the pelvis which seems to be centered in the bladder. It affects women more than men and can often be difficult to diagnose. IC/BPS often starts early in life, occasionally in childhood but more often in young adults. It sometimes happens along with irritable bowel syndrome or fibromyalgia.
What Causes IC/BPS?
We still don’t know for sure what causes IC/BPS. There are many theories such as inflammation of the bladder due to an overactive immune system. There is some evidence that it may be caused by defects or “cracks” in the lining of the bladder that allow urine to leak into the wall of the bladder. Some people with IC/BPS actually form ulcers on the inside of the bladder. It may be a type of allergic reaction. Other experts think it may be due to problems with the small nerves that go to the bladder.
How Do I Know if I Have IC/BPS?
The hallmark of IC/BPS is pain in the pelvis along with urinary problems. The pain is often a severe, sharp, crampy pain but may be a feeling of constant pressure and/or need to urinate. Pain is often felt in the low back or vagina in women or in the penis, testicles or prostate in men. The pain may be constant or it may come and go. Certain things such as stress, some foods or drinks, environmental factors, etc. can trigger a flareup of IC/BPS. Other symptoms that some people notice include:
⦁ Frequent urination, often with a strong urge to get to the bathroom
⦁ A constant sensation of the need to urinate even though you do not
⦁ Pain with sexual activity
⦁ Painful urination
⦁ Pain with bladder filling that may be relieved or partially relieved with urination
IC/BPS can be a serious medical condition that dramatically impacts some people’s lives. It can cause problems with work, social activities, family relations, etc. Some people suffer from lack of sleep or depression and have trouble just getting through the day.
How is IC/BCPS Diagnosed?
It can be difficult because many of the symptoms of IC/BPS can mimic other conditions such as bladder infections, overactive bladder or bladder cancer. In fact, many people with IC/BPS are misdiagnosed for many years as having recurrent bladder infections. Sometimes it becomes what we call a “diagnosis of exclusion”. In other words, once we have eliminated everything else, we are left with IC/BPS. There are, however, some specific things that your urologist will do if IC/BPS is suspected.
⦁ He or she will talk to you about your symptoms and overall health to better understand your particular situation.
⦁ A physical exam is always important.
⦁ A few lab tests such as a urine test to check for infection, a special urine test to check for bladder cancer or an ultrasound to see if you empty your bladder well are usually a good idea.
⦁ Sometimes a special test called a urodynamics study is necessary to see how your bladder functions.
⦁ We often take a look in the bladder (called cystoscopy) using a tiny, fiberoptic scope to look for ulcers and to be sure you don’t have bladder cancer.
How is IC/BPS Treated?
Unfortunately, we cannot cure IC/BPS. However, with treatment, it often gets better over time and may eventually go away. Treatment must be individualized. There is no one thing that always works for everyone. Some of the options include:
⦁ First and foremost, lifestyle changes such as weight loss, smoking cessation, attention to diet and exercise, stress reduction, etc. are always important.
⦁ Physical therapy for the bladder and pelvis or acupuncture
⦁ There are oral medications that are quite helpful for many people.
⦁ There are other medications that can be placed into the bladder on a periodic basis to control the symptoms.
⦁ For people who have ulcers in the bladder, cauterizing these ulcers can be effective.
⦁ Occasionally, we use medicines that suppress the immune system.
⦁ Botox injections into the wall of the bladder have been helpful for some.
⦁ Nerve stimulation techniques that can help settle the bladder down.
⦁ Some people have found certain supplements or herbal remedies such as glucosamine, Quercetin, aloe capsules, etc. to be helpful. Be careful though, vitamin C, for instance, often makes things worse.
⦁ Filling the bladder with water under anesthesia to stretch it (called hydrodistention)
⦁ As a last resort, there are some surgical options.
As you can see, IC/BPS can be a serious medical condition with impacts on life and well–being. Although treatment can be a matter of trial and error, there is almost always something that helps. Don’t be afraid to discuss this with your family doctor or urologist.
Call Gallatin Urology (406-551-2306) for an appointment if you would like more information or may be having problems with IC/BPS.