Interstitial cystitis

Interstitial cystitis is a clinical syndrome in which an inflammatory process of a non-infectious nature develops, affecting not the mucous membrane of the bladder, but the tissue located between it and the muscle. Since this layer has many nerve endings, the symptoms of the disease are pronounced and similar to those of ordinary cystitis.

But, if in the case of infectious inflammation, the disease is easily treatable with antibacterial drugs, then with interstitial cystitis, antibiotic therapy does not give a result. At the same time, urinalysis and cytological examination do not reveal any infectious agents, which significantly complicates the diagnosis. As a result, the final verdict is passed to the patient after prolonged and ineffective antibiotic therapy.

This pathology can be observed in both sexes, but women are more susceptible to it - they suffer from its signs 10 times more often. Women of reproductive age are at risk, while in the elderly and in children the likelihood of developing pathology is very low. Usually, the first symptoms of this condition appear in women after 40 years.

Causes of the syndrome

Experts have not yet been able to identify the exact causes of the development of pathology, but they name the factors predisposing to its occurrence. These include:

  • Violations of the barrier function of the epithelial layer, leading to the penetration of toxic compounds found in urine into the wall of the bladder, with its subsequent damage;
  • Failures in the synthesis of mucopolysaccharides - mucous substances secreted in epithelial cells and serving as protection for the muscle layer of the organ;
  • Autoimmune conditions, during which the body enters into battle with its own cells;
  • Infectious lesions of the urinary tract, damaging the epithelial layer and violating its barrier properties;
  • Complex endocrine pathologies that have arisen due to disorders in the work of the thyroid gland, adrenal glands;
  • Urinary incontinence, weakness of the muscles lining the pelvic floor;
  • Deterioration of the blood supply to the bladder;
  • Decrease in the amount of estrogen in the body, which is due to menopause;
  • Lymph stasis.

There are also a number of risk factors that can provoke the development of this syndrome. These include:

  • Gynecological operations;
  • Diseases of an autoimmune nature;
  • A syndrome in which colon tissue is irritated, spastic colitis;
  • An allergic reaction due to high sensitization of the body;
  • Long-term depressive states, mental disorders.

Signs of pathology

In the early stages of the development of the syndrome, its symptoms may be very mild, but over time, their intensity increases. Also, symptoms may intensify due to changes in hormonal levels, during menstruation, with the use of alcoholic beverages, spicy foods, chocolate, coffee, and strong physical exertion.

The most typical manifestations of this type of cystitis are as follows:

  • Uncontrolled urge to urinate, due to which the patient cannot fully rest during a night's sleep;
  • Some pain that increases during the urge to urinate;
  • Spasms, cramps and burning during emptying of the bladder;
  • Increased trips to the toilet with a minimum of urine output;
  • Pelvic pains, as well as pressing sensations arising above the pubic joint;
  • Discomfort and pain during intimate intercourse, decreased sexual desire and, as a result, sexual activity;
  • Sleep disturbance, decreased appetite, decreased physical activity;
  • Deterioration of the emotional state, apathy, irritability.
pain in the lower abdomen with interstitial cystitis

In some cases, an inflamed rupture may occur on the mucous membrane and submucosal layer of the organ, which physicians call Hunner's ulcer. It is this phenomenon that is considered a reliable sign of interstitial or chronic cystitis.

Diagnostics

Interstitial cystitis is a pathology that is detected after other bladder diseases have been excluded. In 1987, the Association of Physicians developed a number of criteria that completely exclude the possibility of developing this pathology. These are the following signs:

  • The patient's age is under 18;
  • Rare urge to urinate (less than 5 times per hour);
  • Symptoms have been observed for less than 9 months;
  • Bacterial cystitis diagnosed within the past three months;
  • Relief during therapy with antibiotics, uroseptics, antispasmodics or anticholinergics;
  • The presence of concomitant diseases of the urinary system (various tumors, vaginitis, stone formation, diverticula, genital herpes, chronic cystitis).

The procedure for diagnosing the syndrome is very laborious and lengthy, since the diagnosis is made by excluding other pathological processes with similar symptoms. Diagnostics includes:

  • A survey, during which the specialist finds out what the severity of pain is, how frequent the urge to empty the bladder, whether there are changes in the process of sexual intercourse, etc . ;
  • Objective examination to detect discomfort or pain during bimanual examination in women and transrectal examination of the prostate in males;
  • Evaluation of the "diary of night and day urination";
  • Examination of all organs of the small pelvis with the help of ultrasound;
  • General analysis, as well as urine culture;
  • In men, sowing of the ejaculate or secretory fluid secreted by the prostate is also practiced;
  • Sowing the secret contained in the vagina of women or in the urethra;
  • PCR diagnostics for the presence of infections transmitted through sexual intercourse;
  • ELISA diagnostics that detects tuberculosis, herpes, and syphilis;
  • Potassium test, rarely used due to lack of specificity;
  • KUDI is a complex type of study, thanks to which the work of the lower urinary tract is assessed;
  • Cystoscopy, thanks to which neoplasms can be excluded, the presence of Gunner's ulcer and glomerulation can be detected;
  • If neoplasms are found, then a biopsy is performed to exclude the presence of malignant neoplasms of the organ.

During the diagnosis in order to detect interstitial cystitis, the following diseases should be excluded:

  • Cystitis, which has a viral, radiation, bacterial or chemical nature;
  • Diverticulum of the urethra;
  • The presence of formations of both malignant and benign nature in the pelvic organs, including the bladder;
  • Skineitis;
  • Urethritis;
  • Bartholinitis;
  • Violations in the work of organs located in the small pelvis (pathologies of a gynecological nature, vesiculitis, prostatitis);
  • The presence of stones in the lower third of the ureter;
  • Maloplakia;
  • Tuberculosis of the bladder.

Therapeutic activities

Treatment of interstitial cystitis is prescribed for each of the patients individually. In the treatment of this pathology, five lines can be distinguished, the first of which is home treatment. It involves controlling the symptoms of the disease, as well as changing eating and other habits. In about half of the cases, the syndrome goes away on its own if the following recommendations are followed:

  • Engage in bladder training, going to empty it not immediately after the urge, but after a while;
  • Try to minimize the occurrence of stressful situations, regularly relieve nervous tension;
  • Wear comfortable clothing that does not compress the bladder;
  • To carry out non-intense physical exercises (stretching);
  • Minimize the use of foods that provoke the appearance of symptoms of pathology (chocolate, citrus fruits, carbonated drinks, alcohol, overly spicy foods, tomatoes, coffee, tea and cola, artificial sweeteners);
  • Get rid of nicotine addiction.
Seeing a Doctor for Interstitial Cystitis

If these measures do not lead to improvement, they move on to the second line of therapy, which includes the following:

  • Carrying out physiotherapy procedures, as a result of which relaxation of the pelvic muscles occurs;
  • Treatment with amitriptyline, a drug that controls spasms in a diseased organ;
  • Restoration of the mucous membrane lining the bladder with Pentosan (Elmiron);
  • The use of hydroxyzine, which provides significant assistance in the fight against constant nighttime urge to urinate.

The third therapeutic line is prescribed by a specialist if there is no relief after the second line measures. In this case, the urologist may recommend:

  • Distension of the bladder, carried out with the help of a special fluid. The effect of this type of therapy lasts for six months.
  • The use of steroids aimed at the treatment of ulcerative lesions of the walls of the bladder, if they are detected.
  • Introduction to the organ using a dimethyl sulfoxide catheter. This compound can relieve inflammation and block pain.

The fourth line of therapy for the syndrome is prescribed if the above procedures did not help get rid of its symptoms. Fourth line activities include:

  • Neurostimulation - the impact of an electric current of small force on the nerve endings in order to change their functioning;
  • Injections of botulinum toxin (Botox) for a chemical effect on the nerve endings of the organ. This procedure temporarily eliminates the hypersensitivity of the bladder, paralyzing muscle tissue and relieving pain.

The fifth line is provided if the previous measures did not give the desired result. It includes:

  • The use of cyclosporine - a drug that suppresses the immune system.
  • Surgical intervention is a method used in cases where conservative therapy has not yielded results. The operation is considered quite complicated, it is carried out in different ways.

One of the methods involves excision of the affected area of the bladder, followed by its replacement with a portion of the intestine. This intervention is performed in order to increase the volume of the bladder. The second method is the complete removal of the organ, followed by the creation of a new one, the tissue for which is taken from the intestine.

Complications

If the patient ignores the signs of pathology and is in no hurry to contact a specialist, then there is a risk of developing the following complications:

  • The formation of stones in the body;
  • The occurrence of hemorrhages;
  • Narrowing of the ureter due to the formation of scars on its surface;
  • Expansion of the ureter;
  • Throwing urine from the organ into the cavity of the ureter;
  • kidney failure;
  • Shrinkage of the bladder;
  • Decreased libido and lack of orgasms in women;
  • The occurrence of ulcerative neoplasms of the bladder.

Preventive actions

In order to eliminate the risk of developing pathology as much as possible, it is necessary to adhere to the following rules of prevention:

  • Do not disregard allergic reactions;
  • Timely treat inflammatory processes affecting the bladder;
  • Reduce the intake of salt, fatty foods and protein foods;
  • Eat a balanced diet, take vitamin complexes;
  • Observe the rules of intimate hygiene;
  • Practice sexual intercourse with one partner;
  • Strengthen the body with the help of hardening and simple physical exercises;
  • Try to avoid stressful situations;
  • Regularly, at least twice a year, undergo a complete preventive examination in a medical institution.

Interstitial cystitis is a pathology that still causes difficulties for specialists in the diagnostic process, since it may take several years to reach a final verdict. The process of therapy for this syndrome is also complicated and requires an individual approach to each patient.