Interstitial Cystitis

Causes

No one is 100% sure of what causes Interstitial Cystitis (IC). But experts who study IC do have several theories to help explain why some people develop IC and other do not.

• The GAG theory
  The most widely held theory about what may cause IC involves the protective mucous lining of the bladder – or the glycosaminoglycans (GAG) layer. The job of the GAG layer is to act as a barrier to keep urine from irritating the bladder wall and prevent urine from leaking out of the bladder into the blood stream.

• The bacterial infection theory
  Medical tests do not reveal any organisms in the urine of patients with IC – and those affected do not respond to antibiotic therapy. It is possible that bacterial may be presented in bladder cells, but not detectable through routine urine tests.

• Other theories
  • Body releases substances that cause inflammation
  • Allergic response to the body’s own chemicals or to foods

Symptoms

• Pressure or pain occurs in the urethra, vagina, pubis, inner thighs, lower abdomen, lower back, groin, or combinations of the above
• Sexual dysfunction due to pain
• Daytime urinary frequency and nocturia, sometimes painful when urinate, or even have blood in urine
• Flare-ups associated with menstruation, certain foods, allergies or stress

Investigation

• Urine Analysis and Culture
  To rule out genuine bacterial infection which may mimic symptoms of IC.

• Cystoscopy
  Many patients with IC have changes seen in the bladder but some have not.

Treatment

Non-surgical:

Non-medical measures

• Some people find that the heating pad on the lower abdomen helps. Others find that a cold pack may help.

Changing the diet

the patients should review what they are eating by recording in a food diary. Some patients will experience flare-ups of their IC for as long as 3 days after they have eaten certain foods, which include:

• Foods and drinks that contain caffeine, such as chocolate, coffee, tea and soft drinks
• Fermented foods and drinks, including cheeses and alcohol
• Aged, canned, cured, processed, and smoked meats and fish (e.g. anchovies, caviar, animal livers, corned beef and meats that contain nitrates or nitrates)
• Foods with high potassium ion content (e.g. bananas, strawberries and dark green vegetables)
• Fava beans, lima beans, onions, rhubarb and tofu
• Rye and sourdough breads
• Most nuts except for almonds, cashews and pine nuts
• Spicy foods, especially Mexican, Indian and Thai foods
• Acidic items, such as oranges, tomatoes and cranberry juice
• Foods and drinks containing some artificial sweeteners, such as aspartame or saccharin
• Preservatives and MSG

Intravesical Therapy

• With intravesical therapy, normal saline or medication is instilled directly into the bladder. In intravesical therapy for IC, the bladder is filled with a solution that is held for varying periods of time, averaging 10-15 minutes, before it is then emptied.

Medical Therapy

• Pentosan Polysulfate Sodium (Elmiron) is one of oral medication. The most common side effects would be blood in stool, diarrhea, nausea, hair loss, headache, rash, upset stomach, abdominal pain, liver function abnormalities and dizziness. When side effects occur, they would be generally be mild and usually do not interfere with continuing treatment.

Surgical:

• e.g. Hydrodistension

Extended Reading：

The Hong Kong Urogynaecology Association (HKUGA)