What is Interstitial Cystitis?


An interstitial space or interstice is an empty space or gap between spaces full of structure or matter.

Inter= between,-Stitial=standing or positioned- Meaning: to stand between.

Cystitis= an inflammation (swelling) of the bladder and/or urethra.

Interstitial cystitis is the bladder in a state of chronic inflammation and rarely involves the presence of infection hence antibiotics are not used in the treatment of it.

Interstitial cystitis may exhibit symptoms similar with other urinary bladder disorders such as: urinary tract infections (UTI), over active bladder, urethritis, urethral syndrome, and prostatitis, epididymitis (in men) and endometriosis and uterine fibroids, (in women).

The symptoms may be also attributed to other conditions which may include: fibromyalgia, irritable bowel syndrome, endometriosis,chemical sensitivity, chronic fatigue syndrome,vulvodynia, allergies, Lupus, Sjogren's syndrome,Lupus erythematosus,and Stress and anxiety disorder. Some of which you not recognise.

People with interstitial cystitis endure a lot of pain and discomfort in their daily lives similar to a patient with joint pain from arthritis, or cancer pain or bladder infections.

Some of the symptoms of interstitial cystitis may exhibit may include:

  • Need to urinate at night (nocturia)
  • Urine that contains traces of blood (haematuria)
  • Smelly urine more than normal
  • Lower back pain or in the groin area
  • Feeling weak or experiencing a fever
  • Pain when bladder filling and improved with emptying.
  • Pain worsens with a certain food or drink.
  • Greater frequency of urinating(as often as every 10 minutes) and urgency with pressure felt in the bladder or pelvic area or both.
  • Flow difficulty which is often caused by pelvic muscle strength or tension),
  • Painful with intercourse , or driving, travelling or working
  • Pressure in the lower pelvis
  • Dysuria or painful or burning feeling when urinating
  • Frequent urination (Polyuria) or urgent need to urinate (urge incontinence

 Causes

There is evidence to show it may be caused by an auto-immune disease with the immune system attacking the bladder.

Regardless of the origin, it is clear that the majority of interstitial cystitis patients struggle with a damaged urotheelium(pronounced uro-thee-lee-um,) which is the lining of the bladder.

This lining is critical and works similarly to the lining of other organs like the stomach. The urothelium is a layer that lines much of the urinry tract, including the , the ureters,bladder and parts of the urethra.

 It’s made up of several layers of cells called glycoproteins. These cells act as a barrier against urine, which is acidic and toxic substances or damaging tissue influences that enter the bladder as urine, from moving into underlying tissue. Something likes the inner lining of a wine carton box. 



When this barrier breaks down as a result of illness or injuries caused by: chronic infection, injury or excessive toxicity in the bladder it can result in the movement of toxins from the bladder into the underlying tissue like muscle or nerves.

This breakdown results in often chronic inflammation of the surrounding area which ends up causing all the urinary symptoms outlined above.

There is literature to support an infection in the area which may then predispose those patients to develop interstitial cystitis. This infection may contribute to the breakdown of the lining.

In addition, recent research shows that interstitial cystitis patients may have a substance in their urine which inhibits growth of cells in the bladder epithelium preventing the healing where the barrier breakdown has occurred.

This may trigger the body's immune system to attack the bladder. The body attacks itself, which is the basis of autoimmune disorders. Part of this whole process may be triggered by chronic anxiety, stress or panic attacks which may in turn trigger the onset of interstitial cystitis.

Diagnosis

It is not surprising the diagnosis of interstitial cystitis is often not straight forward and may require the elimination of other conditions before concluding the diagnosis interstitial cystitis. As a result a comprehensive analysis is performed to eliminate what may be other causes of the condition requiring (1) a complete medical history and physical exam, (2) a urine analysis, (3)an ultra sound scan (4) cystoscopy.

Bladder distention — Sterile water is used to stretch the bladder. Most patients feel worse for a couple weeks after the procedure. After that, 30% to 50% of patients feel better. The effect lasts only three months, and the procedure is done under general anesthesia.

  • Bladder instillation (also called bladder wash) — The bladder is filled with a sterile solution containing one of a number of ingredients that work directly on the bladder wall. The solution is put into the bladder through a catheter placed through the urethra. After a variable period of time, the person is instructed to empty his or her bladder. Several active ingredients have been used in this procedure, but DMSO, heparin and topical anesthetics are the ones tried most frequently. 
  • Treatment

    By firstly: understanding the condition the patient can assist greatly in mitigating his /her condition by: 1. Patient education, 2. Self-care (diet and liquid modification), 3.Stress management.

    Secondly: , oral medications (amitriptyline, cimetidine or hydroxyzine, pentosan polysulfate),

    More recently, the use of pentosan polysulfate or heparin, sodium bicabonate,sodium hyalurate, lidocaine, placed directly into the bladder through a catheter works to repair and help heal the damaged lining, reducing inflammation and allowing in a reduction of symptoms.

    It is reputed to be the first therapeutic intervention used to reduce symptoms with published studies reporting 90% effectiveness in reducing symptoms.

    These treatments may be given on a regular basis for treatment. It is important to note that this is off-label use for both pentosan polysulfate and heparin, as neither medicine, to date has been approved to be used this way.

    Other bladder coating therapies include Cystistat (sodium hyalurate) and chondroitin.

    The treatments assist by replacing the deficient protective layer on the bladder wall which may require the patient to lie for 30 minutes or so, turning every now and then to allow the chemical to coat the entire bladder area, before it is urinated out.

    In doing so the treatment is designed to:

    1. Reduce the inflammation

    2. Provide a coating over the damaged lining of the bladder

    3. Promote the healing of the damaged area in the bladder lining

    4. Avoid further toxins damaging the area.

    The remarkable thing about the human body is that given the opportunity and conditions to heal itself –it will do that. When it is impaired it is unable to perform this process and therefore it is each of our responsibilities to create that healing environment to enable it to do so.



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