What is it?

Intestitial cystitis is a chronic inflammatory condition affecting the bladder wall. The condition is characterized by pain in the bladder, pelvic region, urethra area and is accompanied by urgency and frequency. People with IC may experience nocturia (the need to urinate frequently at night) dysuria (burning during urination) and dypareunia (painful sexual intercourse).

Researchers still do not know what causes it. In a 1997 article in Infections in Urology, Michel A. Pontari, MD, of Temple University Hospital in Philadelphia, reviewed current thinking on IC and noted that it may result from multiple causes. Some evidence suggests it may be an autoimmune disorder. Other researchers speculate that bacteria may play a role, althought studies haven't confirmed it yet. (Although urine cultures of people with IC dont show evidence of the common bacteria that cause urinary tract infections, a negative urine culture doesn't rule out unusual forms of bacteria that might contribute to the disease). Another theory postulates that IC is caused by a deficiency in certain kinds of proteins that line the bladder.

How is it Diagnosed?

There is no definitive test to diagnose IC, so a doctor must rule out other conditions such as urinary tract infections. ONce that's done, a urologist may perform a cystoscopy--an examination of the bladder with a cystoscope, a hollow tube with a camera that allows the urologist to see inside the bladder. DUring the cystoscopy, performed under regional or general anesthesia, the doctor stretches the bladder by filling it with water (a procedure called hydrodistention) then looks for glomerulations (pinpoint areas of bleeding found in 90 percent of people with IC), a stiff bladder wall, or Hunner's ulcers (found in only about 5 to 10 percent of people with IC), all of which suggest IC.

How is it treated?

Cystoscopic hydrodistension is useful not only for diagnosis but for treatment: it sometimes provides temporary relief from symptoms and is often the first therapy doctors employ. Researchers dont know why it works for many people with IC, and in fact it doesn't provide relief for everyone.

Oral medications are the least invasive treatment for IC and some doctors prefer to prescribe them before trying other therapies. Medications tha tmay help those with IC range from antidepressants such as Elavil (used to block pain) to antihistamines such as hydroxyzine.

In 1996, the FDA approved the first oral drug for IC, called PENTOSAN POLYSULFATE SODIUM (Elmiron). Again, physicians don't know exactly how it works--they believe it may repair leaks in the bladder lining--but it improved symptoms in 38 percent of patients in clinical studies. The recommended dosage is 100 milligrams three times a day, and it may take several months before there is any improvement in IC symptoms.

Another treatment is instillation, or a bladder wash, which involves using a catheter to fill the bladder, with a medicinal solution for a period of time ranging from 10 to 15 minutes. Patients then void the solutioin. The only drug that's FDA-approved for this procedure is dimethylsulfoxide (DMSO). Treatments are given every one or two weeks for six to eight treatments and since patients are catheterized, must be performed in a doctor's office. THe main side effect is a garlicy odor for 24 to 48 hours.

Two other experimental medications are on the horizon. Both sodium hyaluronate (Cystistat) and bacillus Calmette Guerin (BCG) are instilled into the bladder. Trials of Cystistat are scheduled to begin later this year, and clinical trials of BCG are currently underway. For patients with severe pain who does not respond to standard treatment codeine, percocet or MS contin may be prescribed.

Other treatment options include transcutaneous electrical nerve stimulation, in which special devices worn by people with IC give off electrical pulses that may increase blood flow to the bladder, strenthen pelvic muscles and cause the release of pain-blocking hormones; diet modification (alcohol, acidic foods, caffeine, and spices may make symptoms worse); and gentle exercise. Also, sacral nerve stimulation devices are currently undergoing clinical trials for symptoms of urgency, frequency and pain. In cases where all other available treatments have failed and pain is severe, surgery may be considered. Surgical options include enlarging the bladder. Such procedures can involve serious complications. Some patients show no improvement after surgery, so doctors are reluctant to perform it except as a last resort. Laser surgery is indicated only for treating Hunner's ulcers. Since the cause of iC isn't known, treatments can only relieve symptoms, not provide a cure. No single treatment works for everyone. If you have IC, or suscept you have it discuss it with your doctor.