Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder that causes frequent, urgent, and painful urination with or without pelvic discomfort. The natural lining of the bladder (epithelium) is protected from toxins in the urine by a coating of enzymes (mucopolysaccharides) called the GAG (glycoaminoglycan) layer. In IC, this protective layer is defective causing severe irritative voiding symptoms and bladder pain. No infectious agent has been found in IC. Unfortunately, IC is not curable. However, IC is treatable and most patients find relief with treatment and lifestyle changes.

Classic symptoms include urinary frequency, pelvic or abdominal pain and urinary urgency. For men, symptoms may include pain and inflammation of the prostate (e.g., prostatitis). Women may suffer increased vulvar pain, which is thought to be of neurogenic origin. Both men and women may experience pain in the perineum (space between the vagina or scrotum and the anus) and painful or uncomfortable sex, including intercourse and touching. For some men, ejaculation may be painful. Patients with IC typically experience periods of symptom flare, or intensification, followed by periods of remission, when symptoms abate but rarely disappear.

Cystoscopy with hydrodistention, performed under general anesthesia, is the standard diagnostic procedure for IC. The bladder is filled to capacity with water. This allows a urologist to examine the epithelium with a small, telescopic fiber-optic camera, or scope, that is inserted through the urethra to the bladder. Glomerulations (tiny hemorrhages that are the telltale sign of IC) are revealed only following bladder distention. These petechial hemorrhages are present in 95% of IC cases. Hydrodistention can be therapeutic in up to 50% of IC cases.

Unfortunately, there is no cure for IC; the goal of treatment is to relieve symptoms. Often, trial and error with medications are warranted.  Most patients who suffer from IC find relief, usually with multiple, complementary treatments.

The medications for IC include:

Hydroxyzine (Vistaril®, Atarax®) is an antihistamine and mild anti-anxiety drug. It prevents mast cell degranulation, which is thought to play a role in IC, particularly in patients who have a history of allergies, migraine, and irritable bowel syndrome. Hydroxyzine decreases nighttime urination (nocturia), frequency, pain, and bladder pressure. Side effects include dry mouth and sedation.

Overactive bladder medications such as Oxybutynin chloride (Ditropan XL®), Detrol®, and Urised (combination of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid) may reduce bladder spasms that cause frequency, urgency, and nighttime urination. 

Pentosan polysulfate sodium (Elmiron®) to help rebuild the epithelium by coating the bladder wall. It may take up to 6 months to provide relief from symptoms, although 25% of patients experience significant symptom relief in as few as 4 weeks. Elmiron must be taken on a long-term basis to keep symptoms from recurring. Side effects include gastrointestinal discomfort and reversible hair loss, but these are uncommon.

Amitriptyline (Elavil®) is a tricyclic antidepressants that help to block pain, calm bladder spasms, and reduce inflammation; they may be useful in small doses. Valium and other muscle relaxants may also be used to reduce spasms associated with IC. 

Dimethyl Sulfoxide (DMSO, Rimso-50®) may be instilled (intravesical) through the urethra and directly into the bladder via a catheter. It is the only FDA-approved instillation treatment for IC. It enters the bladder wall and reduces inflammation, pain, and painful muscle contractions; it may be mixed with heparin, steroids, or other local anesthetics. It may leave a garlicky taste and smell on the skin and in the breath for up to 72 hours. 

Dietary changes are critical when treating IC. Certain foods can be irritating to a person's bladder causing the IC to flare.

The following foods should be avoided:

Beverages – hard liquor, beer, wine, carbonated drinks, coffee, tea, cranberry juice
Carbohydrates and grains – rye and sourdough bread
Condiments – seasonings, mayonnaise, miso, soy sauce, salad dressings, vinegar
Dairy products – aged cheese, sour cream, yogurt, chocolate, milk
Fruits – apples, apricots, avocados, bananas, cantaloupes, citrus fruits, cranberries, grapes, nectarines, peaches, pineapples, plums, pomegranates, rhubarb, strawberries, fruit juices, tomatoes
Meats and fish – aged, canned, cured, processed, or smoked meats and fish, anchovies, caviar, chicken liver, corned beef, meats containing nitrates or nitrites (e.g., ham, bacon)
Nuts
Others substances – tobacco, caffeine, diet pills, junk food, cold and allergy medication containing ephedrine or pseudoephedrine, vitamins that contain fillers (especially aspartate), tofu
Preservatives and additives – benzol alcohol, citric acid, monosodium glutamate, aspartame (Nutrasweet®), saccharine, artificial ingredients and colors
Vegetables – fava beans, lima beans, onions

Most IC patients have the least amount of trouble with rice, potatoes, pasta, vegetables, and chicken.

Foods from the groups below may be tolerable include the following:

Beverages – decaffeinated and acid-free coffee and tea, certain herbal teas
Carbohydrates and grains – breads other than rye and sourdough, rice
Condiments – garlic
Dairy products – cottage cheese, white chocolate
Fruits – melon other than cantaloupe, pears
Nuts – almonds, cashews, pine nuts
Vegetables – fresh, homegrown potatoes

Some find that over-the-counter dietary aids such as Prelief®, which helps to make food less acidic, allow them to eat many foods that would otherwise be intolerable.

Smoking worsens symptoms for some people; symptoms improve for many after quitting smoking.

The following are respected websites that discuss IC:

http://www.ichelp.org

http://www.ic-network.com

The following are respected books about IC:

Along the Healing Path: Recovering from Interstitial Cystitis by Catherine M. Simone

Solving the Interstitial Cystitis Puzzle: A Guide to natural healing by Amit Willis

Recipe Book for I.C. by E. Murphy

A Taste of the Good Life: A Cookbook for an Interstitial Cystitis Diet by Beverly Laumann

adapted from www.urologychannel.com

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