The Interstitial cystitis is a disease characterized by an increased urinary frequency , urgency , and abdominal or perineal pain, all in the absence of urinary infection or disease known urinary tract. It is also called painful bladder syndrome.

Interstitial cystitis was initially described in 1887, and over the years it has undergone changes in its definition and criteria. The current criteria were adopted by consensus in 1987.

General facts about interstitial cystitis

The disease cannot be cured, but it can be controlled with medical treatment . Furthermore, its exact cause is not known. Various mechanisms have been proposed to explain its origin and establish a definitive treatment, however, so far they are only theories.

The disease is more common in women than men in a 10: 1 ratio. More frequent in whites, even higher in redheads. It appears most frequently between the ages of 30 and 40.

It does not occur in children. There is a disease in children called: Infant urinary frequency syndrome, which is the closest equivalent in childhood.

The incidence increases 10 times if there is a history of urinary infections or diseases in childhood.

It has been seen that 50% of the cases remit the symptoms in 8 months, without treatment.

Incidence figures vary widely between scientific studies. They range from 50 to 60 per 100,000 inhabitants in the United States to 239 per 100,000 inhabitants in Finland.

How is cystitis classified:

Interstitial cystitis is classified according to the cystoscopy appearance of the bladder:

  • Ulcerative: 10% of cases.

They are called Hunner’s ulcers and can cause bleeding or hematuria.

  • Non-ulcerative: 90% of cases.

In the case of non-ulcerative interstitial cystitis, petechiae or small non-ulcerative lesions may be seen on the bladder wall. However, there are no lesions that are unique to this disease. Therefore, its diagnosis is made based on basically clinical criteria.

Cystoscopy or endoscopy of the urinary bladder makes it possible to rule out other causes and thus corroborate the diagnosis of interstitial cystitis by excluding other pathological entities that can generate similar symptoms.

Diagnostic criteria

At present, there are well-defined diagnostic criteria for Interstitial Cystitis (Taken from the European Consensus on Interstitial Cystitis and the NIADDK)

  1. Inclusion criteria (both must be present):
    • Pain associated with the bladder or urination.
    • Hunner’s ulcer or glomerulations (seen by cystoscopy) after bladder distention.
  2. Exclusion criteria:
    • Bladder capacity greater than 350 in a filling cystometry.
    • Absence of urinary urgency with bladder filling of 150 cc of water during cystometry, using a filling flow of 30 cm / min.
    • Presence of voluntary detrusor contractions in cystometry.
    • Duration of symptoms less than 9 months.
    • Absence of nocturnal frequency.
    • Daytime urination frequency less than 8 times a day.
    • Symptoms that improve with antimicrobials, antiseptics, anticholinergics, or antispasmodics.
    • Diagnosis of cystitis or bacterial prostatitis in the last 3 months.
    • Bladder or ureteral stones.
    • Active genital herpes.
    • Urethral diverticulum.
    • Tuberculous cystitis.
    • Post radiation cystitis.
    • Chemical or cyclophosphamide cystitis.

Origin and cause of interstitial cystitis  

Its origin is considered to be multifactorial. So far, no precise cause or direct link to any factor causing this disease has been determined.

The most likely origin is believed to be an increased permeability of the bladder wall, resulting in a loss of its protective capacity.

Infections have been proposed but germs that specifically cause this type of cystitis have not been isolated. All that is known is that UTIs double the risk of interstitial cystitis.

Clusters of inflammatory cells and lymphocytes have also been seen in biopsies of the affected mucosa, however, the only outstanding finding is the increase in cells called mast cells, which are involved in allergic-type phenomena in other organs of the body. It is still necessary to study or demonstrate if they have any participation in the origin of this entity or is the result of the local inflammatory process.

Autoimmune mechanisms have been proposed. Also that it is due to toxic agents to the mucosa of the urinary bladder, which generate the damage directly

Another phenomenon observed in these patients is the decrease in blood perfusion at the bladder level, which leads to damage to the mucosal tissues due to relative hypoxia.

Risk factor’s

  • Sex: it is women is more frequent.

In the case of men, it seems to be related to prostatitis.

  • Race: white skin, more in red hair.
  • Age: over 30 years old.
  • Suffering from a painful disorder type: irritable bowel syndrome or Fibromyalgia.
  • Urinary diseases in childhood.

Symptoms

The primary symptom of interstitial cystitis is pain.

Pain varies from person to person in intensity and location. The most frequent is that the pain is in the belly (hypogastrium) . In women, pain can occur at the vulvar, vaginal and groin level. In men, there may be scrotal, perineal, groin pain, up to the thighs. In both sexes it can present as anal pain.

An important characteristic is that the pain increases during the filling of the bladder and improves when urinating (emptying the bladder).

Changes in urinary habit are also variable and multiple. There may be an increase in the frequency of urination or a feeling of urgency to urinate or a permanent need to urinate. The regular number of urinations per day is between 4 and 7 times.

In interstitial cystitis, more than 8 times a day is considered for diagnosis, although the average is 16 voids per day in these patients, reaching up to 40 times, in more severe cases.

Night urine (nocturia) is present in 90% of patients, with a frequency of 2 times during the night.

There may also be pain during sexual intercourse.

Psychological symptoms associated with a poor quality of life: insomnia, anxiety, depression and irritability.

Although there is no cure, the different medical treatments proposed have improved the condition in 90% of the cases.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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