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Interstitial Cystitis

Background:

What is Interstitial Cystitis?

Also known as Ulcerative Cystitis or Painful Bladder Syndrome, this is a disease that more commonly occurs in females. It is also associated with other pain disorders such as fibromyalgia and chronic pain. Common symptoms of Ulcerative Cystitis include urinary urgency, increased urinary frequency, pain while urinating, and increased urination at night. Pain is experienced in the pubic and suprapubic areas and the genitals.

Image of Bladder
3D Illustration of Human Urinary System Bladder Anatomy

The pain is triggered during sexual activity in both men and women. On physical exam, tenderness of the genitals and the pubic area can be noted. It is essential to start a diary or journal of urination frequency and volume, which commonly shows the higher rate with lower volume voiding.
On cystoscopy or examination of the bladder via a camera that is inserted through the urethra, ulcerations are seen in the bladder wall. The physician will see reddened mucosa with small vessels and a scar in the center. It is thought that these ulcers are caused by a toxic agent in the urine, causing inflammation and pain response.

Causes of Interstitial Cystitis

The cause of Interstitial Cystitis or Ulcerative Cystitis has not entirely been elucidated. Some reasons that have been proposed include a spinal cord problem or a bladder wall mucosal defect.
Another postulated idea is that the use of Ketamine (also known as Special K) can be a cause of Interstitial Cystitis.

Treatment Options:

At the moment, treatment for Ulcerative Cystitis is still being researched.
The American Urology Association has a treatment regimen that they propose:

  • Education is the most crucial aspect of treatment
  • Pain management
  • Physical therapy and medication are advised, including oral options such as cimetidine, amitriptyline, pentosan polysulfate, and hydroxyzine and intravesical (into the bladder via catheter) medications such as dimethyl sulphoxide (DMSO), heparin, and lidocaine
  • if this does not help, other methods of treatment are proposed such as intravesicular steroids, neurostimulation, or Botox injections into the bladder.
  • Anticancer drugs such as cyclosporine is another line of treatment.
  • finally, surgery is an option for the treatment of Interstitial Ulcerative Cystitis.

Proposed Therapy:

One of the possible therapies being developed is the use of prednisone, a corticosteroid. A study published in The Journal of Urology showed that there was a 38% reduction in symptoms and an 88% decrease in pain in patients who were maintained on prednisone for the treatment of Ulcerative Cystitis.

Updated on January 21, 2019

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