Interstitial Cystitis By: Gari Dee Glaser

What is it? It is a chronic pelvic pain disorder. It includes a recurring discomfort or pain in the bladder and the surrounding pelvic region. Bladder Pelvic Region

Pathophysiology. The symptoms resemble a bacterial infection, but medical tests reveal no organisms in the urine. In recent studies, researchers have isolated a substance found almost exclusively in the urine of people with IC. They have named the substance antiproliferative factor, or APF.

What is APF? APF appears to block the normal growth of the cells that line the inside wall of the bladder. Without the protective mucosal lining, urine is allowed to seep through the bladder wall and into the interstitial spaces. This seeping causes pain, inflammation, and small vessel bleeding.

Clinical Manifestations. Similar to those of cystitis – dysuria, urinary frequency, microscopic bleeding. Patient will complain of discomfort over the bladder, frequency and nocturia along with pain when urinating.

How is it diagnosed? Symptoms are similar to those of other disorders of the urinary bladder and because there is no definitive test to identify IC, doctors must rule out other treatable conditions before considering a diagnosis of IC. The diagnosis of IC in the general population is based on: presence of pain related to the bladder, usually accompanied by frequency and urgency. absence of other diseases that could cause the symptoms.

Diagnostic Tests. Urinalysis – A urine sample is obtained either by catheterization or by the "clean catch" method. White and red blood cells and bacteria in the urine may indicate an infection of the urinary tract, which can be treated with an antibiotic. If urine is sterile for weeks or months while symptoms persist, the doctor may consider a diagnosis of IC. Cystoscopy/Biopsy - The doctor may perform a cystoscopic examination in order to rule out bladder cancer. Samples of the bladder and urethra may be removed during a cystoscopy. A biopsy helps rule out bladder cancer.

Medical Management. Scientists have not yet found a cure for IC nor can they predict who will respond best to which treatment. Symptoms may disappear without explanation or coincide with an event such as a change in diet or treatment. Even when symptoms disappear, they may return after days, weeks, months, or years. Scientists do not know why. Because the causes of IC are unknown, current treatments are aimed at relieving symptoms.

Medical Management. Medications are prescribed for inflammation and pain. Low dose cyclosporine (Neoral, Sandimmune) or doxycycline (Vibramycin) may relieve symptoms. Surgical intervention includes Sacral nerve root stimulation via implantation of electrodes. This blocks the pain response to the brain.

Nursing Interventions. Focus on pain control and comfort measures. Check for side effects of all medications given. Teach patient to contact doctor with any unusual side effects with over the counter meds. Pelvic floor exercises may help decrease urgency and nocturia. Teach patient to keep a daily bladder diary with information on foods/activities that aggravate their symptoms. This may be used to make treatment decisions.

Prognosis. Only half of IC patients with find full recovery from this disease. Much more research needs to be done in order to find a cure. Until researchers find a cause and effective treatment, symptoms will continue.