By Heather van Raalte, M.D., Princeton HealthCare System
You have all the symptoms of a bladder infection pain, urinary frequency and urinary urgency. It’s possible, however, that an infection isn’t the cause.
Instead, you may have a chronic condition called interstitial cystitis, also known as painful bladder disorder. Interstitial cystitis is a common disease, affecting at least 1 out of every 77 people, according to the Interstitial Cystitis Association. Without proper diagnosis and treatment, this condition can result in debilitating symptoms and lead to isolation, loss of relationships and loss of work.
Help is available at University Medical Center at Princeton.
At this point the underlying cause of interstitial cystitis remains unclear, and as a result there is no cure. But there are a number of treatment options available to relieve the symptoms. These options range from diet changes to medication and, in some cases, minimally invasive surgery.
What Is Interstitial Cystitis?
Interstitial cystitis is a condition characterized by recurring pain, pressure or discomfort in the bladder and pelvic region. This pain is often worsened by sexual intercourse, stress or changes in diet. In addition to pain, other symptoms include the need to urinate frequently and a strong feeling of needing to go. Though most commonly found in women, interstitial cystitis also can affect men and children.
While interstitial cystitis is thought to be an autoimmune disorder, the exact cause of the disease remains a mystery. Researchers have identified a number of different factors that may contribute to the development of the condition. Many believe damage to the bladder or bladder lining such that can occur with surgery, a history of recurrent bladder infections or radiation ultimately leads to the condition.
In fact, when evaluated by cystoscopy (a camera looking into the bladder), 90 percent of patients have pinpoint hemorrhages in their bladder lining and between 5 and 10 percent have small ulcers, according to the Interstitial Cystitis Association.
Common Symptoms Complicate Diagnosis.
Reaching a diagnosis of interstitial cystitis can be frustrating for patients and doctors alike. Given that the symptoms mimic those of a bladder infection and often go hand-in-hand with other conditions that can also cause pelvic pain, such as fibromyalgia and endometriosis, diagnosis is typically made by a careful history of symptoms and by excluding other possible causes for the symptoms.
In some cases, doctors at University Medical Center at Princeton may perform a test called cystoscopy with hydrodistention to help confirm the diagnosis. The procedure involves using a cystoscope to look inside the bladder after slowly stretching it with fluid. This enables doctors to see changes in the bladder walls that may indicate interstitial cystitis. Additionally, some patients report temporary relief from symptoms after the test.
While helpful, cystoscopy may not be conclusive, especially because some patients with interstitial cystitis may not show any damage to the bladder.
Diet Is First Line of Defense.
Because the symptoms and severity of interstitial cystitis vary greatly from patient to patient, treatment is largely based on the individual. What works for one patient, may not work for another.
However, diet is normally the primary approach to treatment, as certain foods can aggravate the condition and cause a flare-up of symptoms. In general, individuals with IC are advised to follow a low-salt, low-acid diet and avoid common dietary irritants such as alcohol and caffeine. The Interstitial Cystitis Association provides an extensive list of bladder-friendly foods and foods to avoid on its website at www.ichelp.org.
Other common treatments for interstitial cystitis include medications, stretching the bladder through hydrodistention, and bladder instillations, in which medicine is inserted directly into the bladder over a period of weeks. Additional treatments, including minimally invasive surgery, may be recommended by your physician, as appropriate.
Self-Help Hints.
Finding the right doctor and getting a correct diagnosis is the first step in managing interstitial cystitis. Once the disease is under control, there are a number of steps you can take yourself to successfully live with the condition. Consider the following tips:
Drink Water Avoid drinks with caffeine, high acid levels, sugar or sweeteners, to help the bladder work in the least irritating environment,
Exercise Though moving around may be the last thing you want to do, gentle exercises such as low-impact aerobics, Tai Chi, pilates, walking and yoga can help you feel better physically and psychologically.
Reduce Stress Stress can exacerbate interstitial cystitis. Reduce stress with basic relaxation techniques, such as meditation and visualization. Seek professional therapy to learn coping skills and stress-reduction tools.
Stop Smoking Cigarettes irritate the bladder and may worsen urinary frequency and urgency.
Wear Comfortable Clothing Loose, non-restrictive clothing can help provide basic relief from symptoms.
Want More Information?
Have additional questions about interstitial cystitis or other urogynecologic conditions? Join me on Monday, Oct. 4, at 7 p.m. for a live Web-chat hosted by Princeton HealthCare System. I will take your questions and discuss new advances in urogynecology that are making a difference in the lives of women.
To participate, go to the UStream Channel at www.ustream.tv/channel/princetonhealth on Oct. 4 at 7 p.m. To pre-register and enter to win a free gift card, visit www.princetonhcs.org.
Heather van Raalte, M.D., is fellowship-trained in urogynecology and a member of the medical staff at University Medical Center at Princeton.

