Interstitial cystitis

Interstitial cystitis, nowadays also called bladder pain syndrome, is a chronic condition whose cause is not yet known. The symptoms resemble those of cystitis, but the urine is sterile: there are no bacteria.

It affects women about 9 times more often than men, on average around the age of 40, but it can also appear at a younger age.

The symptoms

• pain or a feeling of pressure above the pubic bone, in the urethra or in the perineum, which increases as the bladder fills and eases after passing urine
• needing to pass urine often and urgently, including at night
• burning or difficulty passing urine
• pain during sexual intercourse

The symptoms last for months and their intensity varies greatly: from mild to severe enough to affect work, sleep and relationships.

How the diagnosis is reached

There is no specific test: it is a diagnosis of exclusion. It requires urinalysis and urine culture, a voiding diary, ultrasound and cystoscopy, which rules out other diseases and can show the characteristic Hunner lesions (ulcerative form).

Treatment

There is no single cure: several approaches are combined, step by step.

• lifestyle: identifying and avoiding the foods and drinks that make symptoms worse (often coffee, alcohol, citrus fruit, tomatoes, spicy food) and managing stress
• pelvic floor physiotherapy, to relax the muscles, not to strengthen them
• oral medication, chosen according to the predominant symptoms
• intravesical therapies: instillations into the bladder of hyaluronic acid, chondroitin sulphate and other substances
• endoscopic treatment of Hunner lesions
• major surgery, only in extreme and carefully selected cases

Teamwork between urologist, gynaecologist, pain specialist, physiotherapist and psychologist is often needed.