Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
About 750,000 people in the U.S. (about 90% of whom are women) suffer from a chronic condition of the bladder known as interstitial cystitis. Interstitial cystitis (IC) refers to a clinical syndrome characterized by symptoms including chronic urinary urgency (feeling the need to urinate immediately) and frequency (frequent urination). Pelvic pain may or may not be present. The term cystitis refers to any inflammation of the bladder. Since the wall of the bladder is inflamed, this can lead to pain and soreness in the bladder and pelvic areas. The inflammation can also lead to scarring of the bladder wall that can sometimes reduce the capacity of the bladder to hold urine. In many cases of interstitial cystitis, small hemorrhages and ulcers are present on the inner lining of the bladder wall.
Interstitial cystitis is diagnosed when the symptoms occur without evidence for another cause of the symptoms, such as an infection of the bladder. Sometimes doctors use the term painful bladder syndrome (PBS) to describe cases of pelvic pain that do not meet the strict criteria for interstitial cystitis established by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) for inclusion in research studies relating to interstitial cystitis and its causes.
Doctors do not understand exactly what causes interstitial cystitis. Although the symptoms of interstitial cystitis are similar to those of a urinary tract infection, cultures do not identify bacteria or viruses in the urine of people with interstitial cystitis, and antibiotic therapy does not improve the condition. Some researchers believe that interstitial cystitis occurs because of a defect in the bladder wall, while others suggest that an autoimmune process (a disease in which the immune system of the body malfunctions and targets the body's own tissues for destruction) may be responsible for the condition. Another theory is that some component of urine itself may be toxic to the bladder in susceptible people.
People with interstitial cystitis vary greatly in their symptoms and in the severity of their condition, leading many doctors to theorize that IC and/or PBS may represent a spectrum of several different conditions. In general, the signs and symptoms of interstitial cystitis include one or more of the following:
- urinary frequency (having to urinate often);
- pain and/or pressure in the bladder area and pelvis, ranging from mild to severe;
- urgency (feeling an urgent need to urinate);
- pain and pressure that increase as the bladder fills and are relieved by urination;
- pain during sexual intercourse;
- in men, pain around the penis or scrotum; and
- worsening of symptoms before menstrual period (menstruation).
There is no definitive way to diagnose interstitial cystitis, so your doctor must rule out other causes of the above symptoms before making a diagnosis of interstitial cystitis. Tests that can help rule out other conditions and suggest a diagnosis of interstitial cystitis are
- cystoscopy (visual examination of the bladder via a probe inserted through the urethra) along with testing of the capacity for bladder distension,
- urinalysis and culture of the urine, and
- culture of prostatic secretions in men.
While there is no known cure for interstitial cystitis, symptom relief can be achieved through medications, procedures such as biofeedback and physical therapy, lifestyle alterations, or a combination of these procedures and treatments.