Interstitial cystitis (IC), also known as bladder pain syndrome or painful bladder syndrome, is one of the most poorly understood conditions. This condition affects women primarily, and if you have IC, it can cause discomfort and pain in your bladder and pelvic region. Interstitial cystitis is difficult to diagnose due to the lack of a definitive test, and the chronic nature of this condition could make your day-to-day life challenging.
So how do you suspect if you have IC? If you have IC, you may experience symptoms such as severe pelvic discomfort in your lower abdomen, a quick and intense urge to urinate as well as a need to urinate more frequently, lower belly pain that goes away after you urinate, urinary incontinence, difficulty urinating, and blood in the urine. However, since these symptoms are very similar to that of a urinary tract infection (UTI), IC is often misdiagnosed as a UTI.
Why Causes Interstitial Cystitis?
It is unclear what specifically causes IC. Nonetheless, there are a number of possibilities as to what may be the reason. Damage to the bladder lining (epithelium) is regarded as a major cause. This epithelium normally keeps urine from irritating the wall of your bladder. However, if your bladder wall is thin or leaky, this could allow irritating substances present in your urine to penetrate and inflame the bladder wall and surrounding nerves, thereby causing inflammation and pain. According to some studies, IC could be an autoimmune disease in which the body's immune system mistakenly targets and attacks the bladder. Additionally, research indicates that IC could also be due to neurogenic inflammation, in which the bladder's nerves become too sensitive, resulting in discomfort and symptoms. Moreover, problems with the pelvic floor muscles (often referred to as pelvic floor dysfunction), which help in controlling urine, may be an additional contributing cause. Both pelvic discomfort and an increase in the frequency and urgency of urination can result from pelvic floor dysfunction.
Finding Relief: Treatment Options
Effective diagnosis and treatment of IC are challenging due to the lack of a clear cause. Although there isn't a single treatment that works for everyone, there are a number of choices that can help control symptoms and enhance the quality of life of patients. However, in order to find the treatment that works best for you, you might need to try a few approaches.
Role of medicines
The symptoms of IC can be controlled with medication. For example, to reduce discomfort, you could use over-the-counter medicines like ibuprofen and paracetamol. Drugs that target nerve pain, including amitriptyline, gabapentin, or pregabalin, may be used for more severe pain. The need to urinate often can be lessened using medications such as tolterodine, solifenacin, or mirabegron. Administration of pentosan polysulfate sodium (Elmiron), which can help lessen discomfort, is another treatment but is only appropriate for specific patients and requires a specialist's prescription. You may also benefit from prescription medications that inhibit histamine actions in the bladder, thereby helping to reduce inflammation and irritation that contribute to the pain and discomfort.
Bladder instillations
During a bladder instillation, a tiny tube known as a catheter is used to provide medication directly into the bladder. This approach may use a combination of medications, such as steroids, sodium bicarbonate, and heparin, to lower inflammation or a local anaesthetic, such as lignocaine, to numb the bladder. Additional choices include chondroitin sulfate or hyaluronic acid to help in bladder lining healing, and occasionally antibiotics mixed with steroids and anaesthetics to prevent infection and soothe discomfort.
Physiotherapy
A popular approach is physiotherapy with a pelvic floor expert. The goal of physical therapy for IC is to reduce the tension and dysfunction of the pelvic floor muscles, that can lead to discomfort and issues with the urine. Physiotherapy includes exercises to strengthen and stretch the pelvic region, pain management techniques like heat or cold therapy, and pelvic floor therapy to lessen muscular spasms. Biofeedback is another approach that can be done to enhance muscular function and awareness. By placing sensors on your body to measure nerve activity or muscle tension, biofeedback teaches you how to control those body functions to improve muscle function and lessen pain, especially in the pelvic area.
Other supportive therapies
Interstitial cystitis can also be managed with supportive therapy. This includes acupuncture to attain pain relief, as well as counselling and talking therapies to manage symptoms and how they affect day-to-day functioning. Transcutaneous electrical nerve stimulation (TENS) is another pain management technique that employs a tiny device to provide mild electrical impulses to obtain relief from pain and discomfort. A general practitioner may recommend patients to a pain management expert in more severe situations.
Surgical approaches
If the above-mentioned therapies are ineffective or there are apparent issues with the bladder, surgery or other procedures may be advised by your doctor. Botox injections are one possible treatment option for interstitial cystitis. By relaxing the muscles in the bladder, these injections can help lessen frequent urination and bladder discomfort. Other procedures, such as bladder distension involve filling the bladder with fluid to stretch it and give temporary relief, while approach like cauterisation utilises heat to seal any bladder ulcers, reducing discomfort and irritation. Another approach is neuromodulation, in which a device is implanted to stimulate nerves and regulate symptoms. Rarely, a cystectomy—the removal of the bladder—may be required, necessitating the development of a new urine escape mechanism.
Lifestyle modifications
You may make several modifications in your lifestyle to help control the symptoms of IC. Since stress can contribute to the worsening of IC, you could try approaches to reduce stress by engaging in practices like mindfulness, meditation, warm baths, and exercise. Moreover, it is crucial to stay hydrated throughout the day. Because cigarettes include compounds that might irritate the bladder, quitting smoking is also recommended. Putting on comfortable, loose-fitting clothes may also ease strain on the pelvis and bladder.
Can your food trigger IC?
Yes, it has been found that certain foods and drinks you consume can trigger IC symptoms by irritating the bladder, causing nerve inflammation, or heightening pain sensitivity. Some foods may irritate the bladder wall, allowing irritants in urine to leak into sensitive tissues and cause pain. The fundamental causes of this phenomenon are currently being investigated. So how do you decide which food to eat and avoid? An elimination diet can assist you in determining which foods cause symptoms or flare-ups. The approach involves avoiding eating these potentially triggering foods for a month. Some of the well-known foods to avoid include processed meats, chocolate, artificial sweeteners, citrus fruits, alcohol, caffeine, and spicy meals. However, it can vary from person to person. During this period, it is important to record everything you eat and drink, as well as any flare-ups or symptoms, in a food journal. One month later, if the symptoms improve, you can start the reintroduction phase by gradually reintroducing each food one at a time. As you watch for any signs, start with tiny quantities and increase the amount gradually over a few days. However, long-term avoidance of a food is advised if it triggers a flare. Although it may take some time, this technique aids in symptom management and trigger identification. Finally, always seek advice from a physician, particularly if you experience severe flare-ups.
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