Interstitial cystitis (IC) is a condition that results in recurring
discomfort or pain in the bladder and the surrounding pelvic
region. The symptoms vary from case to case and even in the
same individual. People may experience mild discomfort,
pressure, tenderness, or intense pain in the bladder and pelvic
area. Symptoms may include an urgent need to urinate, a
frequent need to urinate, or a combination of these symptoms.
Pain may change in intensity as the bladder fills with urine
or as it empties. Women's symptoms often get worse during
menstruation. They may sometimes experience pain during
Because IC varies so much in symptoms and severity, most
researchers believe it is not one, but several diseases. In recent
years, scientists have started to use the terms bladder pain
syndrome (BPS) or painful bladder syndrome (PBS) to describe
cases with painful urinary symptoms that may not meet the
strictest definition of IC. The term IC/PBS includes all cases
of urinary pain that can't be attributed to other causes, such as
infection or urinary stones. The term interstitial cystitis, or IC, is
used alone when describing cases that meet all of the IC criteria
established by the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK).
Because symptoms are similar to those of other disorders
of the bladder and there is no definitive test to identify IC/
PBS, doctors must rule out other treatable conditions before
considering a diagnosis of IC/PBS. The most common of these
diseases in both sexes are urinary tract infections and bladder
cancer. In men, common diseases include chronic prostatitis
or chronic pelvic pain syndrome. In women, endometriosis is a common cause of pelvic pain. IC/PBS is not associated with any
increased risk of developing cancer.
The diagnosis of IC/PBS in the general population is based on
the presence of pain related to the bladder, usually accompanied
by frequency and urgency of urination absence of other diseases
that could cause the symptoms.
Diagnostic tests that help rule out other diseases include
urinalysis, urine culture, cystoscopy, biopsy of the bladder wall
and urethra, and distention of the bladder under anesthesia.
Because the causes of IC/PBS are unknown, current
treatments are aimed at relieving symptoms. Many people
are helped for variable periods by one or a combination of
treatments. As researchers learn more about IC/PBS, the list of
potential treatments will change, so patients should discuss their
options with a doctor.
In our clinical practice, bladder hydro-distention under
anesthesia with random biopsy of bladder mucosa would be
done for diagnosis of IC and also for quick relieving of symptoms
for most patients as soon as possible. After that, amitriptyline
or combination with intravesical therapy of sodium hyaluronate
would be the option for our patients. Only for patients failed the
two medications, we would suggest Sacral nerve nuromodulation
(InterStem), it does work for some of patients. For those aging
patients failed all available conservative treatment available in
China, we would suggest total cystectomy with urinary diversion.
So far, 11 patients had received total cystectomy with urinary
diversion, the pain did disappear but life style changed forever.