Interstitial cystitis (Bladder pain syndrome)

The origin of interstitial cystitis is not known with certainty. Some people relate its onset to surgery, childbirth or severe urinary tract infection. However, it can often occur without triggering cause. Interstitial cystitis is probably a multifactorial disease.

- Alteration of the bladder wall.
For some unknown reason, the protective layer lining the inside of the bladder appears to be impaired. This layer normally prevents irritating substances in the urine from coming into direct contact with the bladder wall.

- Intravesical protective layer less effective.
In people with interstitial cystitis, this protective layer would act less effectively. Urine could irritate the bladder and cause inflammation and a burning sensation.

- Autoimmune disease.
Inflammation of the bladder may be due to the presence of harmful antibodies attacking the bladder wall (autoimmune reaction).

- Hypersensitivity of the nerves of the bladder.
The pain experienced by people with interstitial cystitis could be "neuropathic" pain, that is to say caused by the disordered nervous system of the bladder. Thus, a tiny amount of urine would be enough to "excite" the nerves and trigger painful signals rather than just a feeling of pressure.

It is essentially a diagnosis of exclusion that is difficult to establish. It can only be confirmed once all other possible causes have been eliminated. It can be confused with, among other things, a urinary tract infection, endometriosis, a chlamydia infection and an overactive bladder.

• Analysis and urine cultures
• They are usually normal.
• Cystoscopy with hydrodistension of the bladder.
• The presence of glomeruli which are fine cracks or small haemorrhages. They are very characteristic of interstitial cystitis in the majority of cases. Less frequently Hunner's ulcers can be seen.
• Urodynamic study.

In the case of interstitial cystitis, it is found with these examinations that the bladder capacity is decreased. The urge to urinate and pains appear for a rather early volume.

Symptoms can occur by "crises" with periods of less intense ache. Some people suffer from moderate pain, while others will complain of unbearable pain and urge to urinate almost permanently. In the same person, the intensity of symptoms can also vary enormously from one week to another or from one day to another.

Bladder pressure pain
- The bladder pain people feel with IC can range from a dull ache to piercing pain. - The fuller the bladder, the more intense the pain. The pain may radiate to the lower back, as well as the vagina, urethra and rectum. It is constant or intermittent, and may decrease after urinating.

Persistent urge to urinate
- The need to urinate is felt day and night, to evacuate a few drops of urine each time. In addition to being frequent, the urge to urinate is painful and urinating.

A burning sensation
- Pains intensified at the time of sex or just after.

- Food modifications
- If the diet increases the degree of acidity of the urine, the pains of interstitial cystitis are increased. Also, people with interstitial cystitis notice that their pain worsens from 2 to 4 hours after eating certain foods. Thus, up to 6 out of 10 people with interstitial cystitis can clearly identify harmful foods that cause increased pain. - All soft drinks, sodas and colas, caffeine, chocolate, Alcohol, hot peppers and spicy dishes. - Foods and juices very acidic (several fruits, but especially citrus fruits and tomatoes). - Some fruits and vegetables: beans, beans, pineapple, citrus, banana, rhubarb ... - Most nuts, Meat and smoked fish, tofu. Vinegar (and food pickled in vinegar), mustard, soy sauce. - Avoid cranberry juice

- Transcutaneous electrical neurostimulation (TENS) - This treatment is mostly used when symptoms predominate during the night. It is done using a device generating a low voltage electric current. This device is connected to electrodes affixed to the lower back, pubic, in the perineal region. In some people, TENS reduces pain and frequency of urination. It may do so by increasing blood flow to the bladder, strengthening the bladder muscles or causing the release of natural painkillers.

There is still no cure for interstitial cystitis. That said, several medications and treatments can be offered to relieve symptoms. It should be noted that there is still little data on the efficacy of these treatments and that some of them are used experimentally. Since each person responds differently to the treatments, it can take several months to find the right one (s).

Oral medication for pain - This is often the first relief treatment suggested by the doctor. The choice of the drug depends largely on the type of symptom that predominates. - Pentosan Sodium (Elmiron®) is the only oral medication that is specifically indicated for the relief of pain caused by interstitial cystitis. It is therefore the most used. This medication will adhere to the lining of the lining of the bladder, protecting it from the irritating components of the urine. The optimal therapeutic effect only appears after 6 to 12 months of treatment. About 30% to 60% of people report a decrease in pain after 3 months of treatment. - Analgesic drugs (anti-pain) or nonsteroidal anti-inflammatory drugs - Antispasmodic drugs, muscle relaxants can also be used to relax the bladder as much as possible. - Anticonvulsants such as Gabapentin, a drug used to treat chronic pain, - Antidepressant drugs. Amitriptyline (Elavil®) is often used to relieve pain in about two thirds of people with interstitial cystitis. - Antihistamine drugs (antiallergic) such as hydroxyzine, a drug used against allergies, is sometimes used.

Bladder instillations (No longer available in Canada) - Their goal is to temporarily replace the superficial layer of the inside of the bladder so that it is less irritable. Several drugs can be used. - The most commonly used drug is dimethyl sulfoxide (DMSO). - Cystistat® composed of sodium hyaluronate (hyaluronic acid salt). - Uracyst® contains chondroitin sulfate.

The most commonly used drug is dimethyl sulfoxide (DMSO). Heparin can also be used alone. It reinforces the protective layer that lines the inside of the bladder. Installations are usually weekly, but relief is obtained less quickly than with DMSO.

Intravaginal platelet-rich plasma injection (for bladder pain or urethral link treatment woman) is an innovative, promising but experimental treatment that has improved the pain of several patients with associated vaginal and urethral pain.