Interstitial Cystitis: A Cause of Chronic Pelvic Pain

If you think your on going pelvic pain is due to a chronic bladder infection - you might want to think again. Don’t let these symptoms go untreated and undiagnosed.
Interstitial Cystitis is one of the least understood and miss diagnosed causes of chronic pelvic pain. This mysterious condition which consists of sever inflammation of the bladder walls often takes up to four years to identify from the onset of symptoms because diagnosis main consists of ruling out other possible causes such as STIs, bladder cancer and bladder infection.
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Symptoms include chronic pelvic pain defined as pain below the belly button which lasts for six months or more. Chronic pelvic pain can be caused by many things which is why IC is often one of the last conditions ruled out. Pain during intercourse can also be caused by IC. Urinary symptoms, which often lead to confusion for doctors and patients include discomfort, frequency (up to 60 times a day in sever cases) and urinary urgency. Because these symptoms can be caused by bladder infection or bladder cancer, Interstitial Cystitis can go undiagnosed until these concerns are ruled out.
If you are presenting with chronic pelvic pain and your doctor is beginning to suspect CI there are a number of diagnostic test they may recommend.

·         Bladder biopsy – where a small sample of the bladder tissue is take for lab exams.

·         Cystoscopy (endoscopy of bladder) – where a tiny camera is inserted into the bladder to visually examine the bladder walls.

·         Urine analysis – a chemical analysis to make sure that signs of infection are diagnosed and treated.

·         Urine culture – which is where a sample of urine is placed in a medium and bacteria are allowed to grow to show signs of bacterial infections needing treatment.

·         Urine cytology – where a sample of urine is examined under a microscope to identify if abnormal cells are present.

·         Video urodynamics (shows how much urine must be in the bladder before you feel the need to urinate)

Unfortunately there is no cure of Interstitial Cystitis – but there are treatments which can lesson your discomfort and improve your life.
Elmiron is the only medication taken by mouth that is specifically approved for treating IC. This medicine coats the bladder like Pepto-Bismol coats the stomach.
Other medicines which are sometimes prescribed to help with symptoms of IC are:

·         Opioid painkillers for severe pain

·         Tricyclic antidepressants such as Elavil (amitriptyline) to relieve pain and urinary frequency

·         Vistaril (hydroxyzine pamoate), an antihistamine that causes sedation, helps reduce urinary frequency

Sometimes medication can be used in combination with dietary changes which reduce inflammation and irritation to the bladder - reducing symptoms and greatly improving your quality of life. 
Dietary modifications include avoiding the following:

·         Aged cheeses

·         Alcohol

·         Artificial sweeteners

·         Chocolate

·         Citrus juices

·         Coffee

·         Cranberry juice (Note: Although cranberry juice is often recommended for urinary tract infections, it can make IC symptoms worse.)

·         Fava and lima beans

·         Meats that are cured, processed, smoked, canned, aged, or that contain nitrites

·         Most fruits except blueberries, honeydew melon, and pears

·         Nuts except almonds, cashews, and pine nuts

·         Onions

·         Rye bread

·         Seasonings that contain MSG

·         Sour cream

·         Sourdough bread

·         Soy

·         Tea

·         Tofu

·         Tomatoes

·         Yogurt

Experts suggest that you do not stop eating all of these foods at one time. Instead, try eliminating one at a time to see if that helps relieve your symptoms.
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Other more invasive treatments include:

·         Bladder hydrodistention (expanding the bladder by over filling it with fluid while under general anesthesia)

·         Bladder training (using relaxation techniques to train the bladder to go only at specific times)

·         Instilled medications - medicines are placed directly into the bladder. Medicines that are given this way include dimethyl sulfoxide (DMS), heparin, Clorpactin, lidocaine, doxorubicin, or bacillus Calmette-Guerin (BCG) vaccine.

·         Physical therapy and biofeedback (may help relieve pelvic floor muscle spasms)

·         Surgery, ranging from cystoscopic manipulation to bladder removal (cystectomy)

Often treatment is a combination medications, behavior modification and possibly surgery. However, it is worth the effort to find a way to reduce your symptoms and elevate your pain.