Interstitial cystitis

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Overview

Interstitial cystitis is a condition that affects the urinary bladder, characterized by chronic inflammation. It is not secondary to an infection. In many cases, because it remains a diagnosis of exclusion, the condition is often diagnosed late in the patient's journey. Patients often describe pain in the bladder region (suprapubic), with a strong sensation to want to urinate (urgency). This sensation is worsened by filling the bladder and is often relieved by passing urine more often (frequency). This may be during the daytime and/or during the night (nocturia). There may also be other symptoms such as pain or discomfort on passing urine (dysuria) and pain or discomfort during sexual intercourse, known as dyspareunia. Due to these symptoms, there is a profound impact on the emotional, psychological and social well-being of the patient.

Anatomy

The urinary bladder is a hollow viscus located in the pelvis and is anterior to the rectum in both sexes and the uterus in females. It is partially covered in peritoneum on the superior surface. There are four layers.

Mucosa, which contains the transitional epithelium, allows for the stretch of the urinary bladder. When stretched, the surface is smooth, but when relaxed, folds form in the mucosa, known as rugae.

Submucosa, which is composed of elastic connective tissue, further assists with the stretch of the bladder.

Muscularis layer (detrusor muscle) is composed of multiple layers of smooth muscle in multiple directions, which assists with the voiding of the bladder when contraction occurs. They also form a small band that encircles the area between the opening of the bladder and the urethra. This is known as the internal urinary sphincter. The autonomic nervous system controls this layer. Another band around the internal sphincter controls conscious voiding, called the external sphincter, which is composed of skeletal muscle and is innervated by the somatic nervous system.

The fibrous connective tissue layer is the outermost layer of the bladder except for the superior surface, with is covered by the parietal peritoneum.

The bladder is also divided into a triangular area called the trigone. This is formed by the openings to each ureter and the opening to the urethra. This forms three apices. The openings of each ureter are also covered by a small flap of mucosa that acts as a valve to prevent reflux of urine into the kidney. The trigone is located at the base, also known as the fundus of the urinary bladder.[

Symptoms

These vary from person to person with IC. They can change every day or week or linger for months or years. They might even go away without any treatment.

Common symptoms:

Bladder pressure and pain that gets worse as your bladder fills up.

Pain in your lower tummy, lower back, pelvis, or urethra (the tube that carries pee from your bladder out of your body)

For women, pain in the vulva, vagina, or the area behind the vagina

For men, pain in the scrotum, testicles, penis, or the area behind the scrotum

The need to pee often (more than the normal 7-8 times daily)

The feeling you need to pee right now, even right after you go

For women, pain during sex

For men, pain during orgasm or after sex


Causes

The exact cause of interstitial cystitis isn't known, but it's likely that many factors contribute. For instance, people with interstitial cystitis may also have a defect in the protective lining (epithelium) of the bladder. A leak in the epithelium may allow toxic substances in urine to irritate your bladder wall.

It’s not clear why it happens, but there are several ideas:


A problem with bladder tissue lets things in your pee irritate your bladder.

Inflammation causes your body to release chemicals that cause symptoms.

Something in your urine damages your bladder.

A nerve problem makes your bladder feel pain from things that usually don’t hurt.

Your immune system attacks the bladder.

Another condition that causes inflammation is also targeting the bladder.


Risk factors

Your sex. Women are diagnosed with interstitial cystitis more often than men. ...

Your age. Most people with interstitial cystitis are diagnosed during their 30s or older.

Having a chronic pain disorder.

Citrus fruits like oranges and lemons

Tomatoes

Chocolate

Caffeinated drinks like coffee and sodas

Carbonated drinks

Alcohol

Spicy foods

Artificial sweeteners

Talk to your doctor about an elimination diet, which could help you figure out what’s affecting your bladder.

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Complications

Interstitial cystitis can result in a number of complications, including:


Reduced bladder capacity. Interstitial cystitis can cause stiffening of the bladder wall, which allows your bladder to hold less urine.

Lower quality of life. Frequent urination and pain may interfere with social activities, work and other activities of daily life.

Sexual intimacy problems. Frequent urination and pain may strain your personal relationships, and sexual intimacy may suffer.

Emotional troubles. The chronic pain and interrupted sleep associated with interstitial cystitis may cause emotional stress and can lead to depression.

Prevention

 avoiding similar foods, such as tomatoes, pickled foods, alcohol and spices. Artificial sweeteners may aggravate symptoms in some people. If you think certain foods may irritate your bladder, try eliminating them from your diet.