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Many patients with interstitial cystitis (IC) also have irritable bowel syndrome (IBS), both of which occur overwhelmingly in women, are characterized by pain, and worsen under stress. Bladder and colon biopsies of a female patient with both IC and IBS were evaluated immunohistochemically. There were 40 +/- 10 mast cells (MC)/mm2 (normal, less than 10) in the bladder, which were degranulated. The colon contained 148 +/- 11 MC/mm2 (normal, less than 50), mostly close to numerous substance P (SP)-positive nerves. Histamine, methylhistamine, and the unique MC enzyme tryptase were evaluated in 24-hour urine during two flare-ups. These results may help explain the concurrent presentation and the painful nature of these syndromes.
Interstitial cystitis (IC) is a chronic bladder disorder of unknown aaetiology. Although several investigators have attempted to identify an infectious cause for IC, none has yet been found. Our own studies to search for an infectious cause discovered instead, a toxic factor in the urine of approximately 95% of IC patients that is made by and inhibits, the normal proliferation of bladder epithelial cells. Additional research is necessary to determine whether this factor is encoded by the eucaryotic cells themselves or an unidentified intracellular microorganism.
Treating interstitial cystitis (IC) is one of the greatest challenges facing physicians and other health care providers who manage patients with this condition. The symptoms of urinary frequency and urgency, dysuria, and chronic pelvic pain characterize IC, but it is the debilitating pelvic pain associated with IC that is most difficult to control. The pathophysiology of IC pain is poorly understood, but is thought to be a complex entity including nociceptive, visceral, and neuropathic components. There are currently no universally effective therapies available. Oral treatments, however, are frequently used, including nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, gabapentin, and pentosan polysulfate, all of which have shown varying degrees of efficacy. Recognition that IC pain is multifactorial, and probably has a neuropathic component, has led to the use of some of these agents, previously prescribed for other neurologic conditions associated with chronic pain. Intravesical and surgical options are also available, which expands the armamentarium for those who treat pain secondary to IC. Treating IC requires managing all of the symptoms of this disease. This review aims to cover standard and novel treatment options, while concentrating on the management of pain.
BACKGROUND AND OBJECTIVES: Interstitial cystitis (IC) is characterized clinically by lower abdominal pain, pain during urination, and increased frequency of urination. Treatment of the symptoms in IC remains challenging. We report effective treatment using lumbar sympathetic block for 2 patients with IC. CASE REPORT: A 63-year-old and 78-year-old woman were diagnosed with IC. Medical therapy with nonsteroidal anti-inflammatory drugs (NSAID), anticholinergics, and hydrodistention of the bladder failed to improve their symptoms. Subsequently, a continuous lumbar epidural block using 1% mepivacaine was used in these patients. A transient reduction of the symptoms in both patients was achieved. A lumbar sympathetic block with a neurolytic agent produced almost complete, and long-lasting relief of their symptoms. CONCLUSION: Lumbar sympathetic block using a neurolytic agent produced long-lasting pain relief in 2 patients with IC. Reg Anesth Pain Med 2001;26:271-273.
Interstitial cystitis (IC) is a sterile bladder condition occurring primarily in females. It is characterized by frequency, nocturia, and suprapubic pain. IC symptoms are exacerbated during ovulation and under stress, thus implicating neurohormonal processes. The most prevalent theories to explain the pathophysiology of IC appear to be altered bladder lining and increased number of activated bladder mast cells. A defective bladder glycosaminoglycan (GAG) layer could allow penetration of allergic triggers, as well as chemicals, food preservatives, drugs, toxins, and adherent bacteria, all of which can activate bladder mast cells. Vasoactive, nociceptive, and proinflammatory molecules released can lead to immune cell infiltration and can sensitize neurons to secrete neurotransmitters or neuropeptides that can further activate mast cells. Mast cell-derived proteases can directly cause tissue damage, and it is noteworthy that urine tryptase is elevated in IC. Bladder mast cells are located close to neuronal processes, which are increased in IC, and they can be activated in situ by acetylcholine (ACh) and substance P (SP). Such activation is augmented by estradiol, which acquires significance in view of the fact that human bladder mast cells express estrogen receptors, but few progesterone receptors, which may explain the worsening of IC symptoms during ovulation. Finally, acute psychological stress in rats leads to mast cell activation that can be reduced by depletion of SP or neutralization of peripheral immune corticotropin-releasing hormone (CRH). These findings suggest that IC could be a syndrome with neural, immune, and endocrine components, in which activated mast cells play a central role.
Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder wall, characterized by pelvic pain, urinary urgency, and frequency. Its etiology is unknown. There are an estimated 700,000 cases of IC in the United States. IC remains a diagnosis of exclusion. Although there are no uniformly effective therapies, many treatment options are currently available. Current research is focused on the cause, diagnosis, and treatment of IC.
Interstitial cystitis (IC) is a chronic pain syndrome that affects close to a million people in the United States. The syndrome presents differently in many individuals, with the unifying factor being chronic pelvic pain and disruption of daily life activities. Many etiologies have been proposed as causative factors for IC, although it is likely triggered by more than one process. Treatment for many individuals revolves around symptom management and improving quality of life; however, it is imperative to remove aggravating factors such as food and daily stressors. Treatment will vary for individuals, as symptoms and etiology will differ. This article discusses nutritional and other non-toxic approaches to treating IC.
Interstitial cystitis (IC) is a painful bladder condition. Because of a reported link between exercise and pain reduction, a case study analysis was conducted to explore exercise effects on IC. Exercise was provided 3 days per week for 6 months. Two subjects appeared to have benefitted from the program. Implications for future research are dis-.
PURPOSE OF REVIEW: Interstitial cystitis is a chronically progressive, severely debilitating, heterogeneous syndrome affecting the urinary bladder, mainly associated with urgency, frequency and pain. Though known for over a century, its etiology is poorly understood and universally effective treatments are lacking. This review focuses on recently published literature on the disorder. RECENT FINDINGS: Appropriate diagnostic tests for interstitial cystitis remain uncertain. The diagnostic criteria developed by the US National Institutes of Health represent research definitions which are subject to controversial debate for their overenthusiastic clinical application. The diagnosis is made clinically and by cystoscopy with hydrodistention and sometimes biopsy when other pathologies have been excluded. In symptomatic patients, glomerulations upon bladder distension are indicative but not pathognomonic for nonulcerative interstitial cystitis. Patients with ulcerative disease represent a separate subgroup with distinct characteristics and treatment implications. The role of bladder permeability tests remains controversial. Promising noninvasive markers for interstitial cystitis have been described but are not yet clinically available. Validated symptom scores are appropriate to assist in diagnostics and to monitor disease course and treatment efficacy. Lately investigated hypotheses for causative factors include occult or resistant microorganisms, urothelial hyperpermeability, neurogenic or hormonal pathomechanisms, and mast cell activation. Increasing evidence for a genetic susceptibility is emerging. SUMMARY: Among the multitude of oral, intravesical, interventional and complementary treatments suggested few studies have high levels of evidence. Newly proposed agents must await further controlled studies. Treatment remains empiric until radical surgical procedures should ultimately be considered for severe refractory cases.
Interstitial cystitis patients often have a history of allergies, and frequently, a history of gynecological or obstetric operative procedures. Silk is a potent antigen, and so it is suggested that the symptomatology of interstitial cystitis is an allergic reaction to buried silk sutures.
Although interstitial cystitis is a fairly uncommon cause of cystitis in patients, it is one that is frequently misdiagnosed as either bacterial, urological or gynecological in origin. Interstitial cystitis is a chronic inflammatory condition of unknown etiology, involving the bladder wall. The patient is usually a middle-aged female with presenting symptoms of 1) subacute development of pain on bladder filling, 2) urinary frequency unrelieved at night and 3) urgency. Patients complain of a varying degree of symptoms over several months or years without complete relief at any time, regardless of antibiotic treatment. The urine culture is negative and the only physical examination finding may be some urethral/vaginal tenderness. With careful attention to the symptom complex and accurate diagnostic testing, the diagnosis can be confirmed. This article summarizes the etiology, signs and symptoms, diagnostic criteria and treatment modalities for interstitial cystitis; patient-counseling suggestions are provided.
Psychological factors related to interstitial cystitis were studied in 31 women. The control group consisted of 24 women with acute bacterial cystitis. The subjects were tested with psychological methods. Results showed that traditional signs of psychic pathology were not related to the symptoms of interstitial cystitis but psychic helplessness and inadequacy in coping with problems was found in the patients. Sexual problems were prominent. Results do not refer to the psychological origin of interstitial cystitis but stress that psychological factors have to be taken into consideration in the treatment of these patients.
The diagnosis of interstitial cystitis is best based on the techniques necessary to elicit the criteria established at the conferences of the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases (NIDDK). Essentially, this requires a thorough patient history, urodynamic evaluation, and cystoscopy carried out under anesthesia with hydrodistention of the bladder and bladder biopsy. Diagnosis of interstitial cystitis is tightly linked to its definition, and until the latter is crystal clear, the former will continue to be murky.
The treatment of interstitial cystitis is difficult and at time frustrating--both for the patient and for the physician. Treatment is hampered by the lack of a clear understanding of its pathophysiology, which makes it difficult to objectively assess disease severity and/or progression. Intravesical therapy appears to be the most successful approach to the relief of symptoms. Clearly, there are drawbacks to intravesical therapy, particularly Clorpactin lavage. Responses to intravesical lavage are variable in duration, unpredictable, and unamenable to objective measurement. Multiple treatments are frequently needed, as with DMSO, and multiple anesthetics may be required for Clorpactin therapy. There have been no double-blind, placebo-controlled studies comparing the mainstays--Clorpactin and DMSO--of intravesical treatment. It is hoped that current research into the pathogenesis and causation of interstitial cystitis will lead to an improved understanding of this disease or syndrome. The introduction of newer, more specific intravesical therapies will surely follow such advances.
Thirteen patients with interstitial cystitis (IC), whose predominant symptom was pelvic or urethral pain, were treated with a series of lumbar epidural local anaesthetic blocks over an 18-month period. Response was evaluated by interview and with voiding diaries and visual analogue scales (VAS) for pain. Of the 55 injections given, immediate pain relief (lasting longer than 24 h) was obtained from 41 (75%). The duration of subsequent pain relief varied considerably, ranging from 2 to 75 days (mean 15.1). Pain relief was accompanied by significant improvement in sleep habit and quality of life. A good correlation was noted between verbally expressed pain and the recorded VAS pain scores. Urinary frequency and average voided volumes were unaffected by treatment. Two patients failed to obtain any relief. Apart from minor transient backache at the injection site, there were no complications from the procedure. Lumbar sympathetic epidural blockade is an excellent means of providing pain relief in interstitial cystitis.
PURPOSE: Clinical case series suggest that the impact of interstitial cystitis on quality of life is severe and debilitating, however, little epidemiologic information is available. We examined the impact of interstitial cystitis on quality of life in a population based cohort of United States women. MATERIALS AND METHODS: We collected multidimensional measures of quality of life from 159,419 participants in the Nurses' Health Study I and II using a validated instrument, the Medical Outcome Study Short-Form 36 Health Survey Instrument. This instrument measures physical function, role limitations due to physical and emotional problems, bodily pain, vitality, social function and mental health. Quality of life measures were collected on 99 women with prevalent self reported interstitial cystitis confirmed by medical record review. RESULTS: After adjusting for age and co-morbid conditions, women with interstitial cystitis had significantly lower quality of life scores in 4 of the 7 quality of life dimensions, including role/physical (beta -13.1, p <0.001), bodily pain (beta -9.8, p <0.001), vitality (beta -7.7, p <0.001) and social function (beta -7.2, p <0.001) compared to women without interstitial cystitis. Women with interstitial cystitis experienced less decrement in physical function compared to women with rheumatoid arthritis but more compared to women with hypertension. In addition, they experienced greater differences in vitality and mental health than women with rheumatoid arthritis or hypertension. CONCLUSIONS: The quality of life among women with interstitial cystitis was especially limited in the psychosocial dimensions, such as vitality and mental health. Future research on interstitial cystitis should incorporate multidimensional measures of quality of life, especially with respect to response to the various treatments.
Interstitial cystitis is a chronic benign disease of the bladder that causes bothersome and debilitating symptoms and mainly affects women. Since interstitial cystitis (IC) might result from a defective glycosaminoglycan layer of the bladder epithelium, we conducted a trial of hyaluronic acid (HA), used intravesically, to test its activity in the treatment of this disease. A total of 10 patients with typical findings of IC were included. Following bladder catheterisation, the patients received a dose of 40 mg, weekly for 6 weeks, and then monthly. Response to therapy was evaluated by comparing the pre-treatment and post-treatment symptom scores and voiding diaries. There was a 30% positive response rate at week 6, which was maintained until week 24. No significant local or general side-effects were noted during the course of treatment. Although we recorded a low incidence of success in our group of patients, the results of our limited study were satisfactory in the group of responsive patients (30%), who had no relapses during the observation period of 6 months. The intravesical administration of HA was well tolerated in all cases.