Doctor's Notes on Interstitial Cystitis
Interstitial cystitis (IC) is inflammation of the bladder without any infectious cause. Signs and symptoms may vary in individuals but usually one or more of the following may be present: urinary frequency and/or urgency, urinary incontinence, pain (lower back, abdomen, urethra, pelvic and/or perineal areas), depression and sleep problems. Some people have increased severity of symptoms after exposure to food and drinks like tomatoes, spices, high-acidic foods, chocolate, alcohol or stressful situations. Men may have pain in the scrotum, testicles or penis and painful orgasms; women may have pain in the vulva or vagina and painful intercourse – pain can increase during her periods.
The cause(s) of IC are not known but there are theories. They include autoimmune, hereditary, mast cell abnormalities (these cells are associated with inflammation development), defective bladder epithelial cells and nerves that carry information to and from the bladder. Some researchers suggest the cause may be an undetected infectious agent.
Interstitial Cystitis Symptoms
The symptoms of IC are similar to those of a urinary tract infection. They vary from person to person. Most people have some of the following symptoms:
- Frequency: People with IC need to urinate more often than normal. A person with good health urinates a maximum of seven times a day and does not have to get up at night to urinate. A person with IC urinates frequently, both during the day and night. In early or very mild cases, frequency is sometimes the only symptom.
- Urgency: As frequency becomes more severe, it leads to urgency. Urgency may also be accompanied by pain, pressure, or spasms. Some people with IC feel a constant urge to urinate that never goes away, even right after urinating.
- Pain: People with IC may have bladder pain that gets worse as the bladder fills. Some people feel the pain in other areas besides the bladder. The pain may be felt in the lower abdomen, lower back, urethra, or the pelvic or perineal area. Men may feel pain in the scrotum, testicles, or penis. Women may experience pain in the vulva or vagina. The pain may be continuous or intermittent.
- Sexual difficulties: Women may have pain during intercourse, and men may have painful orgasm.
- Sleep difficulties
- Urinary incontinence (leakage)
Symptoms of some people with IC become worse after consumption of certain foods or drinks. They include tomatoes, spices, alcohol, chocolate, caffeinated and citrus beverages, and high-acid foods. Many people also find that symptoms become worse if they have stress (either physical or mental stress). In women, symptoms may vary with the menstrual cycle; symptoms often get worse during periods.
Interstitial Cystitis Causes
Although many theories have been put forward, the cause of IC is unknown. The theories for the cause of IC include the following:
- Autoimmune: An autoimmune response is a physical response in which cells and antibodies of a person's body are directed against that person's own tissues. An autoimmune response to a bladder infection destroys the lining of the bladder wall. An unexplained association of IC has been found to exist with other autoimmune diseases such as inflammatory bowel disease, systemic lupus erythematosus, scleroderma, Sjogren syndrome, fibromyalgia, and atopic allergy. IC has a very high association with disorders of the bowel such as inflammatory bowel disease.
- Hereditary: Studies of mothers, daughters, and twins who have IC suggest a hereditary risk factor. However, no gene has yet been implicated as a cause of IC.
- Mast cell abnormalities: In some people with IC, special white blood cells called mast cells (associated with inflammation) are found in the bladder lining. Mast cells release histamine and other chemicals that cause inflammation of the bladder.
- Defect in bladder epithelium: The bladder has a specialized natural lining called the epithelium. The epithelium is protected from toxins in the urine by a layer of protein called glycosaminoglycan. In people with IC, this protective layer breaks down, allowing toxins to irritate the bladder wall and cause inflammation of the bladder.
- Neurogenic: The nerves that carry bladder sensations are inflamed, so pain is caused by events that are not normally painful (such as filling of the bladder).
- Infectious: Although no causative infective agent has been found in the urine of people with IC, an unidentified infectious agent may be the cause.
Probably, different processes occur in different groups of people with IC. It is also likely that different processes may affect each other, for example, a defect in the bladder epithelium may start the inflammation and stimulate mast cells to release histamine.
Urinary incontinence refers to a loss or leaking of urine due to faulty bladder control. An estimated 25% to 33% of people in the United States suffer from urinary incontinence. That means millions of people live with the condition. There are many different types of urinary incontinence. Although both men and women suffer from the condition, several factors unique to women increase the risk of urinary incontinence in females. It’s a common misconception that this is a normal part of aging. It is not. Thankfully, there are lots of ways to manage urinary incontinence and minimize the effect it has on your life.
Urinary incontinence is more than a health concern. It affects people on a social, psychological, and emotional level. People who have urinary incontinence may avoid certain places or situations for fear of having an accident. Urinary incontinence can limit life, but it doesn’t have to. The concern is treatable once the underlying cause is identified and addressed.
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.