criteria for the diagnosis of interstitial cystitis(IC)

The bladder can be surgically replaced

The syndrome of interstitial cystitis consists of chronic urinary frequency, associated with urethral, pelvic or bladder pain and often painful urination.

The ethology of this condition is probably multi factorial and may represent a common end point of many disease processes.

Among the many theories proposed as etiologies are: (1) autoimune disease, (2) Infection, (3) Bladder ischemia, (4) Presence of toxic substances in the urine, (5) Defect in the protective Glycosamino glycan (GAG) layer of the bladder.

This later theory has gained wide acceptance. This GAG defect could lead to the absorption of potentially toxic substances across the bladder epithelium and set up an inflammatory reaction in the subepithelial layers of the bladder.

The National Institute of Diabetes and Degenerative Kidney Disease has developed a consensus criteria for the diagnosis of IC which includes a cystoscopy under general or preferably spinal anesthesia, possibly with biopsies of the bladder.

Bladder capacity is measured under anesthesia and uro dynamics studies (studies of bladder function) are indicated to assess bladder sensation and irritability.

Treatments(Oral and Intravesical Medications, Surgical Therapy)

At the present time there is no cure for IC. There are many treatment scheme's that may help patient cope and significantly improve their quality of life.

Elmiron¨ has recently been approved for the treatment of IC. Amytriptyline and Vistaril, Atarax are also widely used for the management of Pain; L-Arginine has also proven helpful.

DMSO is the most widely used intraversical medication both alone and in combination with other agents. It is effective in 1/2 - 2/3 of patients. Other medication used are: Heparin, Silver Nitrate, Chlorpactin, Interferon and BC6.

The most common surgery performed for IC is bladder distinction under general or spinal anesthesia. This can produce significant relief in patients who have failed to respond to more conservative treatments.

On patients with visible bladder lesions, laser or electric current can be used to eradicate them with improvement of symptoms. The bladder can be surgically replaced or enlarged but most authorities consider these options a last resort.

Biofeedback, pelvic electric stimulation, hypnosis, behavior modification, reflexology and massage therapy all have a place in the comprehensive treatment of this condition.

The treatment of chronic pain is an integral part of IC patients overall care and close contact with a pain specialist is imperative.

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