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Interstitial cystitis is a condition characterized by chronic pain and discomfort that affects the bladder. It is also called bladder pain syndrome, and not much is known about the condition. There are several theories about its causes, and they span from nerve-related explanations to genetic theories. However, the symptoms of the condition are quite clear. They include pain in the bladder area, increased urinary frequency, and sometimes pain during sex.
Since it causes pain around the bladder region, interstitial cystitis is often associated with other conditions. Some of these conditions cause pain at or around the bladder and are often diagnosed alongside the condition. Some other conditions do not directly cause pain in the affected region but are known to be present in individuals with the condition. Some of them include irritable bowel syndrome and chronic fatigue syndrome.
Like we discussed earlier, there are several theories that attempt to explain what causes interstitial cystitis. While most of them offer plausible explanations, none of them has been proven or generally accepted as the singular cause. However, despite this lack of consensus, these theories can help to understand how the condition works and help to develop appropriate treatments.
One theory suggests that an autoimmune condition is responsible for bladder pain syndrome. This is a little similar to what is seen in other autoimmune disorders like rheumatoid arthritis and systemic lupus erythematosus. In autoimmune conditions, the body’s immune system attacks normal healthy cells, thinking they are antibodies. This theory believes that bladder pain syndrome works the same way and that the immune system attacks the cell in and around the bladder.
Recent research has also shown that people that have bladder pain syndrome have substances in their urine that prevent the growth of the bladder cells. This growth is especially stunted in the bladder’s epithelium. However, the research also shows that stunted growth doesn’t actually cause interstitial cystitis. Rather, infections predispose these people to the condition and the pain that accompanies it.
One theory about the cause of pain in this condition involves the damage of the bladder’s lining. Also called the urothelium, a damaged lining is present in most people with bladder pain syndrome. The theory is that when the surface layer is damaged, by a urinary tract infection, for example, consumption of substances like coffees and sodas can cause urinary chemicals to find their way into the surrounding tissues. This then causes pain.
As mentioned earlier, several conditions are often associated with this syndrome. While some contribute to the pain experienced by individuals that have the condition, some others are simply diagnosed with painful bladder syndrome. The fact that these conditions are usually present in people who suffer from interstitial cystitis makes it more likely that it is caused by some of the factors linked to these other diseases.
Some of the associated conditions include:
In men, painful bladder syndrome is often accompanied by chronic nonbacterial prostatitis.
The majority of symptoms associated with this condition are centered around pain. However, the kind of pain and the frequency of occurrence often vary between individuals. Some of the symptoms include:
Interstitial cystitis was once believed to affect women in menopause. However, recent discovered have confirmed that it affects younger women as well. Studies reveal that the prevalence of interstitial cystitis is between 2.7 Million and 6.5 Million women. For men, between 1.8 Million and 4.2 Million are known to be affected.
Even though the cause of interstitial cystitis is not known, the following factors have been associated with a higher prevalence of the condition
Most individuals who have this condition are over the age of 30
Women are more likely to get interstitial cystitis in men.
Even though the relationship is unclear, having red hair and fair skin predisposes you to have painful bladder syndrome
Part of why interstitial cystitis is so difficult to manage is because so little is known about it. Not much is known about its cause or progression. As a result, there is no specific test that can be conducted to confirm the presence or absence of the condition. The diagnosis usually involves analyzing the signs and symptoms and looking at how well they fit the common symptoms associated with the condition.
Some diagnoses are made based on the lack of better explanations. Sometimes, if a person has pain around the bladder, and there are no identifiable causes, the person is diagnosed with painful bladder syndrome, and treated accordingly.
A process involving history taking, physical and neurological examination, and other tests are usually used in diagnosing the condition.
The history involves asking about the symptoms of the disease, including how severe the symptoms are and how long the individual has been experiencing them. The physical exams include examining the abdomen, prostate and rectum. These are done to rule out other conditions like pelvic pain.
Some other tests, like a cystoscopy, can be conducted to look inside the bladder. The test can rule out conditions like cancer. It can also help to determine the extent of inflammation as well as spot ulcers and bladder stones.
Just like with its diagnosis, there is no singular treatment for painful bladder syndrome, since it’s specific cause is unknown. The management of the condition depends on the symptoms that the individual presents with. And since these symptoms often vary from person to person, their treatment approach will also vary. Additionally, if there are other conditions that accompany interstitial cystitis, these are also addressed in the treatment method that’s used.
The treatment of painful bladder syndrome is often divided into five phases
These treatments are divided into phases because they are implemented that way. The phase one treatments go first, and if those fail to alleviate the symptoms, phase two treatments are used, and on it goes.
The first line of treatment includes education and lifestyle modification. A significant amount of interstitial cystitis resolves on its own without external intervention. So at this first phase, the focus is on
Drugs used in this phase include Amitriptyline and Hydroxyzine. Amitriptyline helps control bladder spasms, while Hydroxyzine is an antihistamine that can help regulate the frequency of urination
In this stage, the individual is usually referred to a specialist. Some of the treatments in phase three include neuromodulations therapy in which electrical impulses are delivered to the nerves around the bladder. These can help modify their actions. If the pain is caused by a nerve, this can also help. Bladder ulcers are also cauterized in this phase.
Phase four includes a drug known as cyclosporine. Cyclosporine is an immunosuppressant and is quite effective in treating the symptoms of interstitial cystitis.
Surgery is the final step in managing interstitial cystitis, and it is reserved for individuals whose pain and symptoms have not responded to all the other forms of treatments. The surgery is offered to people who have limited bladder capacity, or experience severe symptoms. The procedure is to divert urine away from the bladder. Most people do not require surgery for the treatment of bladder pain syndrome.
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