Interstitial Cystitis (cont.)
What are the signs and symptoms of interstitial cystitis?
The symptoms of interstitial cystitis vary greatly from
one person to another but have some similarities to those of a urinary tract
infection. They include:
- decreased bladder capacity
- an urgent need to urinate frequently day and night
- feelings
of pressure, pain, and tenderness around the bladder, pelvis, and perineum (the
area between the anus and vagina or anus and scrotum) which may
increase as the bladder fills and decrease as it empties
- painful sexual intercourse
(dyspareunia)
- discomfort or pain in the penis and scrotum.
Most people suffering from interstitial cystitis have
both urinary frequency/urgency and pelvic pain, although these symptoms may also
occur singly or in any combination. In most women, symptoms usually worsen
around the time of their periods. As with many other illnesses, stress also may intensify the symptoms, but it does not cause them.
The symptoms usually have a slow onset, and urinary frequency is the most common
early symptom. As interstitial cystitis progresses over a few years, cycles of pain (flares) and
remissions occur. Pain may be mild or so severe as to be debilitating. Symptoms
can vary from day to day.
How is interstitial cystitis diagnosed?
Because the symptoms of interstitial cystitis are
similar to those of other disorders of the urinary system and because there is
no definitive test to identify interstitial cystitis, doctors must exclude other
conditions before making a diagnosis of interstitial cystitis. Among the
disorders to be excluded are urinary tract or vaginal infections, bladder
cancer, bladder inflammation or infection caused by radiation to the
abdomen, eosinophilic and tuberculous cystitis, kidney stones, endometriosis,
neurological disorders, sexually transmitted diseases, urinary tract infection
with small numbers of bacteria, and, in men, chronic bacterial and nonbacterial
prostatitis.
Medical tests that help identify other conditions include a
urinalysis, urine
culture, cystoscopy, biopsy of the bladder wall and, in men, laboratory
examination of prostatic secretions.
Physical examination
Physical examination of an individual with interstitial
cystitis may reveal tenderness of the bladder either when pushing on the abdomen
over the bladder (just above the pubic bone) or
during the pelvic examination in women. No specific physical findings are
associated with interstitial cystitis.
Laboratory Tests
Urinalysis and Urine Culture. These tests
can detect and identify the most common bacteria in the urine that may be
causing interstitial cystitis-like symptoms. A urine sample is obtained either by catheterization
or by the "clean catch" method. For a clean catch, the patient washes the
genital area before collecting a sample of urine "midstream" in a sterile
container. White and red blood cells and bacteria in the urine suggest an
infection of the urinary tract that can be treated with antibiotics. If urine is
sterile for weeks or months while symptoms persist, a doctor may consider a
diagnosis of interstitial cystitis
Culture of Prostatic Secretions. In men, the doctor can obtain a
sample of prostatic fluid. This fluid is examined under the microscope for
signs of an infection such as red and white blood cells and also can be cultured
for bacteria. Prostatic infections can be treated with antibiotics.
Potassium Sensitivity Test.
A test known as the intravesical potassium sensitivity test (PST) has been
developed to evaluate the leakiness of the protective lining of the bladder.
Many people with interstitial cystitis have an abnormal PST suggesting an overly leaky
urothelium (bladder lining). In the PST test, two different solutions (sterile
water and a solution of potassium) are instilled separately into the bladder.
The patient rates the severity of pain and/or urgency that occur when each
solution is instilled. Using a scale of 0 to 5, the test is considered abnormal
(positive) if the potassium solution induces at least a pain level of "2" and
causes more pain than the sterile water.
Studies using the PST have shown that
78% of people suffering from interstitial cystitis have an abnormal test, while only 2% of women
without interstitial cystitis have an abnormal test. An abnormal test can be considered as proof
that a person has interstitial cystitis if there are no other identifiable conditions that may be
causing the symptoms; however, a normal test does not exclude the possibility
that interstitial cystitis is present.
Cystoscopy Under Anesthesia with Bladder Distension. During
cystoscopy, the doctor uses a cystoscope--an instrument made of a hollow tube
about the diameter of a drinking straw with several lenses and a source of
light--to look inside the bladder and urethra. The doctor will also distend or
stretch the bladder to its capacity by filling it with a liquid or gas. Because
bladder distension is painful in interstitial cystitis patients, before the doctor inserts the
cystoscope through the urethra into the bladder, the patient must be given
either regional or general anesthesia. Cystoscopy with distension of the bladder
with fluid can detect inflammation, a thick and stiff bladder wall, and Hunner's
ulcers. After the fluid has been drained from the bladder, small red spots,
called glomerulations, that represent enlarged blood vessels and pinpoint areas
of bleeding can be seen in the bladder's lining.
The doctor may also determine a patient's bladder capacity--the maximum amount of liquid or gas the bladder can
hold under anesthesia. (Without anesthesia, capacity is limited by either pain
or a severe urge to urinate.) Most people without interstitial cystitis have normal or large
maximum bladder capacities under anesthesia. A small bladder capacity (due to
scarring) under anesthesia helps to support the diagnosis of interstitial
cystitis.
Before the
relatively recent development of the PST, cystoscopy was the best diagnostic
test available for interstitial cystitis. However, cystoscopy has its limitations. Ulcers are
generally not observed in mild or early cases of interstitial cystitis, and glomerulations have
been observed in normal individuals without symptoms of interstitial cystitis. Studies also have
shown that cystoscopy has a 60% rate of underdiagnosing interstitial cystitis. Because of these
limitations, cystoscopy is recommended only to exclude other possible causes of
symptoms and not as the definitive diagnostic measure in interstitial cystitis.
One important note
is that the distension often performed with cystoscopy leads to relief of
symptoms in 20-30% of people with interstitial cystitis, which generally lasts for three to six
months following the procedure.
Biopsy. A biopsy is a microscopic examination
of a small sample of tissue. Samples of the bladder and urethra may be removed
during cystoscopy and examined with a microscope later. A biopsy helps to
exclude bladder cancer. It also may confirm the presence of mast cells or
inflammation of the bladder wall that are consistent with a diagnosis of
interstitial cystitis.
Nevertheless, there is nothing on the biopsy that can make an absolute diagnosis
of interstitial cystitis.
Next: What is the treatment of interstitial cystitis? »
- hydroxyzine, Vistaril, Atarax - Specifies the medication hydroxyzine (Vistaril, Atarax), a drug used for the relief of nasal and non-nasal symptoms of various allergic conditions such as seasonal allergic rhinitis.
- Urinalysis - Learn about the urinalysis test. Diseases and conditions such as urinary tract or kidney infection, kidney stones, kidney failure, diabetes, or high blood pressure can be diagnosed or monitored.
- Urinary Tract Infection (UTI In Adults) - Learn about urinary tract infection causes, symptoms, signs, diagnosis and treatment of UTIs in men and women. Antibiotics may be used to treat recurrent bladder infections.
Latest Medical News
Infectious Disease RSS