Interstitial cystitis

Diagnosis of interstitial cystitis might include:

Medical history and bladder diary. Your health care provider may ask you to describe your symptoms and to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass.

Pelvic exam. During a pelvic exam, your provider examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. Your provider may also examine your anus and rectum.

Urine test. A sample of your urine is analyzed for signs of a urinary tract infection.

Cystoscopy. Your provider inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. Your provider may also inject liquid into your bladder to measure your bladder capacity. Your provider may perform this procedure, known as hydrodistention, after you've been numbed with an anesthetic medication to make you more comfortable.

Biopsy. During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. This is to check for bladder cancer and other rare causes of bladder pain.

Urine cytology. Your provider collects a urine sample and examines the cells to help rule out cancer.

Potassium sensitivity test. Your provider places (instills) two solutions — water and potassium chloride — into your bladder, one at a time. You're asked to rate on a scale of 0 to 5 the pain and urgency you feel after each solution is instilled. If you feel noticeably more pain or urgency with the potassium solution than with the water, your provider may diagnose interstitial cystitis. People with typical bladders can't tell the difference between the two solutions.

No simple treatment eliminates the signs and symptoms of interstitial cystitis, and no one treatment works for everyone. You may need to try various treatments or combinations of treatments before you find an approach that relieves your symptoms.

Physical therapy

Working with a physical therapist may relieve pelvic pain associated with muscle tenderness, restrictive connective tissue or muscle abnormalities in your pelvic floor.

Oral medications

Certain medicines that you take by mouth (oral medications) may improve signs and symptoms of interstitial cystitis:

Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), to relieve pain.

Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax your bladder and block pain.

Antihistamines, such as loratadine (Claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms.

Pentosan polysulfate sodium (Elmiron), which is approved by the Food and Drug Administration specifically for treating interstitial cystitis. How it works is unknown, but it may restore the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It may take two to four months before you begin to feel pain relief and up to six months to experience a decrease in urinary frequency.

Macular eye disease has been associated with use of this medication in some people. Before starting this treatment, you may need a comprehensive eye exam. You may also need additional eye exams to monitor for eye disease as you continue therapy.