(See also Overview of Voiding.)
Incidence of interstitial cystitis is unknown, but the disorder appears to be more common than once thought and may underlie other clinical syndromes (eg, chronic pelvic pain). White people are more susceptible, and 90% of cases occur in women.
Cause is unknown, but pathophysiology may involve loss of protective urothelial mucin, with penetration of urinary potassium and other substances into the bladder wall, activation of sensory nerves, and smooth muscle damage. Mast cells may mediate the process, but their role is unclear.
Symptoms and Signs of Interstitial Cystitis
Interstitial cystitis is initially asymptomatic, but symptoms appear and worsen over years as the bladder wall is damaged. Suprapubic and pelvic pressure or pain occurs, usually with urinary frequency (up to 60 times/day) or urgency. These symptoms worsen as the bladder fills and diminish when patients void; in some people, symptoms worsen during ovulation, menstruation, seasonal allergies, physical or emotional stress, or sexual intercourse. Foods with high potassium content (eg, citrus fruits, chocolate, caffeinated drinks, tomatoes) may cause exacerbations. Tobacco, alcohol, and spicy foods may worsen symptoms. If the bladder wall becomes scarred, bladder compliance and capacity decrease, causing or worsening urinary urgency and frequency.
Diagnosis of Interstitial Cystitis
Clinical evaluation
Cystoscopy with possible biopsy
Diagnosis is suggested by symptoms after testing has excluded more common disorders that cause similar symptoms (eg, urinary tract infections, pelvic inflammatory disease, chronic prostatitis or prostatodynia, diverticulitis).
Cystoscopy is necessary and sometimes reveals benign bladder (Hunner) ulcers; biopsy is required to exclude bladder cancer
Treatment of Interstitial Cystitis
Lifestyle modification
Bladder training
Surgery as a last resort
Lifestyle modification
Up to 90% of patients improve with treatment, but cure is rare. Treatment should involve encouraging awareness and avoidance of potential triggers, such as tobacco, alcohol, foods with high potassium content, and spicy foods.
Choice of treatment
In addition to lifestyle modification, bladder training, drugs, intravesical therapies, and surgery are used as needed. Stress reduction and biofeedback (to strenghten pelvic floor muscles, eg, with Kegel exercises) may help. No treatment has been proved effective, but a combination of ≥ 2 nonsurgical treatments is recommended before surgery is considered.
Drug therapies
Surgical and other procedures
Bladder hydrodistention, cystoscopic resection of a Hunner ulcer, and sacral nerve root (S3) stimulation help some patients.
Surgery (eg, partial cystectomy, bladder augmentation, neobladder reconstruction, and urinary diversion) is a last resort for patients with intolerable pain refractory to all other treatments. Outcome is unpredictable; in some patients, symptoms persist.
Key Points
Interstitial cystitis is noninfectious bladder inflammation that tends to cause chronic pelvic pain and urinary frequency.
Diagnosis requires exclusion of other causes for symptoms (eg, UTIs, pelvic inflammatory disease, chronic prostatitis or prostatodynia, diverticulitis), cystoscopy, and biopsy.
Cure is rare, but up to 90% of patients improve with treatment.
Surgery is a last resort for patients with intolerable pain refractory to all other treatments.
