Interstitial Cystitis

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Bladder pain is often caused by a condition called Interstitial Cystitis. You may have this condition if you have any of the following symptoms:

    • Pain in your pelvis or in the vaginal area
    • A persistent, urgent need to urinate
    • Frequent urination, often of small amounts, throughout the day and night
    • Pain or discomfort while the bladder fills and relief after urinating
    • Pain during sexual intercourse
    • Burning with urination
    • Symptoms of a urinary tract infection but negative urine cultures

Experience From The Hubbard Clinic

Since 2000 one of the main illnesses we treat at the Hubbard Clinic is Interstitial Cystitis with over 1900 patients treated. We have learned a lot about the condition. Statistically, it is believed 4-6% of all women suffer from it. If you take Louisville and the surrounding 8 counties in Kentucky plus the 4 counties in southern Indiana, a total of 27,580 ladies over 18 years old have some symptoms from the illness. Men can also be affected but much less so than women.

We find the most important diagnostic tool is getting a good history from the patient. CT Scans, urine cytology, and cystoscopies under local are expensive and add little information. The most common person we treat has been on antibiotics for long periods with negative urine cultures and minimal relief of symptoms.

It is rewarding to tell a patient "at their wits end" that we feel we know what is causing the symptoms, it is treatable, it has nothing to do with cancer or fertility and it will not take one day off their life but can drive them crazy. Step one is gaining the patient's confidence that we will be  there for them to get things better. There is no magic pill that will get people well immediately. Diet, allergies, and water intake are always step one. For those with worse symptoms a cystoscopy under conscious sedation is done in the office. The important findings are the stretchability of the bladder plus degree of pain with distension. Bladder biopsies are taken to test the role allergies may be playing.

The Condition

Interstitial Cystitis (IC) is a chronic bladder syndrome that is usually characterized by excessive urinary urgency and frequency day and night, pressure above the pubic area, pelvic pain and pain during or after sexual intercourse. The most typical symptom of IC is pelvic pain. The course of the disease is usually marked by flare-ups and remissions. Many report even having some of these symptoms as a child. 

IC is an engima because we really don't know what causes it, nor do we currently have a cure.  However, it is a chronic condition that can be controlled with the proper guidance. The most widely held theory at present is that clinical IC begins with the development of an injury to the bladder epithelium (lining).  This injury  may have occurred following a bladder infection, childbirth, pelvic surgery or a traumatic sexual assault.  In addition, IC is also seen in patients with other chronic conditions such as fibromyalgia, IBS, migraine headaches and endometriosis.  Many believe that IC has an autoimmune component but this theory is still being researched.  The variation seen in both the range of symptoms and patient responses to different therapies suggest that multiple factors are involved in this disease process.  

Due to this uncertainity, IC is often either undiagnosed or improperly diagnosed. A patient many times consults with multiple specialists before a diagnosis is made. Yes, there are doctors in this area who do not believe IC exists.

The diagnosis of IC is often one of exclusion- other conditions such as chronic bacterial infections, vulvar vestibulitis, endometriosis, and bacterial prostatitis must first be ruled out. Presumptive diagnosis may be made based on a thorough patient history, pelvic exam, and bladder diary. Confirmation diagnosis is then made with cystoscopy with hydrodistension under conscious sedation. At the Hubbard Clinic we want to make sure the symptoms are indeed from IC then start treatment right away.

The Treatment

The goal of treatment for IC includes repairing epithelial dysfunction, reducing neurogenic inflammation, and stabilizing mast cells. Given the possible multiple causes of IC, it is unusual for patients to respond to a single treatment. 

It is crucial in the treatment of IC to establish a multimodal (more than one method) treatment strategy. Diet modification has proven quite effective. Multimodal drug therapy using antihistamines, antidepressants, urinary analgesics, Elmiron (for severe cases) and/or bladder pain cocktails are all part of the treatment strategy. Once this is accomplished Physical Therapy can then become quite helpful. Because each patient is unique and symptoms vary, each patient must receive an individualized treatment plan to get IC in remission.