Interstitial cystitis (IC), a chronic bladder disease with a long and complicated history, is slowly changing from a difficult, life-altering disorder to a treatable condition. Patients are being identified earlier, and successful targeted therapies are in research stages to slow disease progression. Learn about the basics of IC and how its development and symptoms vary from other common bladder problems.
Diagnosis
IC consists of symptoms like frequent urination, urgency, and pain during urination. Although these symptoms are associated with many common bladder disorders, IC is quite unlike other bladder conditions; since the early 1900s, doctors have differentiated between the symptoms of urinary tract infections, for example, and the severe and recurring symptoms of IC. However, there is still no definitive, efficient method of diagnosing patients with IC except by exclusion of other disorders.
When patients repeatedly present with the triad of frequency, urgency, and pain complaints, and when no bacterial cause is found, an IC diagnosis is considered. Often, patients undergo a potassium sensitivity test or a visual bladder exam that identify irritation at the bladder wall, or mucosa. This irritated wall is a primary confirmation of IC.
Progression
IC is also referred to as painful bladder syndrome, because the bladder wall irritation slowly develops into inflamed areas that scar. These areas of scar tissue then become painful ulcers and cause pinpoint bleeding, which are focused areas of bleeding throughout the bladder wall. Eventually, the scar tissue stiffens and causes decreased capacity, which worsens the frequency and urgency symptoms. The bleeding, called glomerulations, and the ulcers, called Hunner's ulcers, are unique to IC among all known bladder conditions.
Speculative Causes and Mechanisms
Although IC has been described in the medical literature for more than a century, the cause is still unknown. Bacterial testing is always negative, and---although IC may occur randomly in relatives---no genetic factors have been identified yet. An autoimmune theory that irritating substances or bacterial infection triggers an overactive response by the body has been postulated, in part because IC may be more common in patients with histories of other autoimmune disorders, like irritable bowel syndrome.
In the 21st century, research advances have identified a substance in the urine that is specific to patients with IC, called antiproliferative factor (APF). It is possible that APF present in the bladder blocks cell growth in the mucosa, and future trials likely will focus on ways to block or reduce APF effects.
Triggers and Irritants
Once IC develops, patients usually can identify substances or activities that worsen their symptoms. common triggers in women include menstruation and sexual intercourse. Foods, and acidic products in particular, are frequent sources of irritation. Some vitamins, such as vitamin C and the B-complex vitamins in one formulation, have been known to trigger IC as well.
Resources
For more information about the research on IC causes, the diagnosis, and the most common triggers, check out the IC Association network of pages.
References
Interstitial Cystitis Association: Treatment/Drug Discovery (updated 8/26/09)
NIDDK Diseases: Interstitial Cystitis/Painful Bladder Syndrome
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