| Homepage | Imprint |
|
||
 |
Interstitial cystitis
ICD9 = 595.1| ICDO = | Image = | Caption = | OMIM = | MedlinePlus = 000477 | eMedicineSubj = med | eMedicineTopic = 2866 | DiseasesDB = 30832 | }} Interstitial cystitis (commonly abbreviated to "IC") is a urinary bladderdiseaseof unknown cause characterised by pelvic and intense bladder pain, urinary frequency (as often as every 10 minutes), and pain with urination. It is not unusual for patients to experience nocturiaand pain with sexual intercourse. IC is also known as painful bladder syndrome (PBS), particularly outside of the USA. IC affects men and women of all cultures, socioeconomics and ages. Previously believed to be a condition of post menopausalwomen, growing numbers of men and women are being diagnosed in their twenties and younger. IC is not a rare condition. Recent research suggests that IC prevalence ranges from 1 in 100,000 to 5.1 in 1,000 of the general population. New epidemiological data for the United States should be released in 2006. It is not unusual for patients to have beeen misdiagnosed with a variety of other conditions, including: overactive bladder, urethritis, urethral syndrome, trigonitis, prostatitisand other generic terms used to describe frequency/urgency symptoms in the urinary tract.
CausesThe cause of interstitialcystitis is unknown, though several theories have been put forward (these include autoimmune, neurologic, allergicand genetic). Regardless of the origin, it is clear that IC patients struggle with a damaged mucin, aka the GAG layer, aka bladdering lining. When this protective coating is damaged (perhaps via a UTI, excessive consumption of coffees or sodas, traumatic injury, etc.), urinary chemicals can "leak" into surrounding tissues causing pain, inflammation and urinary symptoms. Oral medications like Elmironand medications which are placed directly into the bladder via a catheterwork to repair and hopefully rebuild this damaged/wounded lining, allowing for a reduction in symptoms. Recent work by the University of Maryland, Baltimoreindicates that genetics are a factor in, and may even (in some cases) be the cause of IC. Two genes, FZD8and PAND, are associated with the syndrome. FZD8, at gene map locus 10p11.2, is assocated with an antiproliferative factor secreted by the bladders of IC patients which "profoundly inhibits bladder cell proliferation," thus causing the missing bladder lining. PAND, at gene map locus 13q22-q32, is associated with a constellation of disorders (a "pleiotropic syndrome") including IC and other bladder and kidney problems, thyroid diseases, serious headaches/migraines, panic disorder, and mitral valve prolapse. SymptomsIt may well be that the symptoms of interstitial cystitis have multiple causes, and IC is actually several syndromes which will eventually be discerned. For example, patients with Hunner's Ulcers are believed to be the most advanced cases. They have larger "wounds" in the bladder that are much more difficult to treat. It is estimated that only 5 to 10% of patients have these ulcers. Far more patients may experience a very mild form of IC, inwhich they have no visible wounds in their bladder, yet struggle with symptoms of frequency, urgency and/or pain. Still other patients may have discomfort only in their urethra, while others struggle with pain in the entire pelvis. Some patients may experience pelvic floor tightness and dysfunction, while others have normal muscle tone. Often the symptoms of IC are misdiagnosed as a "common" bladder infection (cystitis), however unlike cystitis, IC has not been conclusively proven to be a bacterial infectionand the mis-prescribed treatment of antibioticsis ineffective. The symptoms of IC may also initially be attributed to prostatitisand epididymitis(in men) and endometriosisand uterine fibroids(in women). DiagnosisDiagnosis has been greatly simplied in recent years with the development of two new methodologies. The Pelvic Pain Urgency/Frequency (PUF) Patient Survey, created by C. Lowell Parsons, is a short questionnaire that will help doctors identify if pelvic pain could be coming from the bladder. The KCL Test, aka the Potassium Sensitivity Test, uses a mild potassiumsolution to test the integrity of the bladder wall. Though the latter is not specific for IC, it has been determined to be helpful in predicting the use of compounds, such as pentosan, which are designed to help repair the GAG layer. The previous "gold standard" test for IC was the use of hydrodistention with cystoscopy. Researchers, however, determined that this visual examination of the bladder wall after stretching the bladder was also not specific for IC and that the test, itself, can contribute to the development of small glomerulations(aka petechialhemorrhages) often found in IC. Thus, a diagnosis of IC is one of exclusion, as well as a review of clinical symptoms. TreatmentThe foundation of therapy is a modification of diet to help patients avoid those foods which can will further irritate the damaged bladder wall. Common offenders include coffees, teas, herbal teas, green teas, all sodas(particularly diet), concentrated fruit juices, multivitaminsand chocolate. Patients who continue to consume daily coffee are those which appear to struggle the most with symptoms, particularly pain. Most IC support groups and many urology clinics have diet lists available. As recently as a decade ago, treatments available were limited to the use of astringentinstillations, such as clorpactinor silver nitrate, designed to kill infection and/or strip off the bladder lining. In 2005, our understanding of IC has improved dramatically and these therapies are now no longer done. Rather, IC therapy is typically multi-modal, including the use of a bladder coating, an antihistamineto help control mast cellactivity and a low dose antidepressantto fight neuroinflammation. The two US FDA approved therapies for IC have had recent setbacks in various research studies. Oral Elmiron(aka pentosan polysulfate) is believed to provide a protective coating in the bladder, however data released in late 2005 by Alza Pharmaceuticalssuggests that 84% of Elmiron is eliminated, intact, in feces. Another 6% is excreted via urine. Reference: Metabolism of [3H]pentosan polysulfate sodium (PPS) in healthy human volunteers. Xenobiotica. 2005 Aug;35(8):775-84. In addition, the NIH funded ICCTG study of pentosan revealed results only slightly better than placebo. DMSO, a wood pulp extract, is the only approved bladder instillation for IC yet it is much less frequently used in urology clinics. Research studies presented at recent conferences of the American Urological Association by C. Subah Packer have demonstrated that the FDA approved dosage of a 50% solution of DMSO had the potential of creating irreversible muscle contraction. However, a lesser solution of 25% was found to be reversible. Long term use is questionable, at best, particularly given the fact that the method of action of DMSO is not fully understood. More recently, the use of a "rescue instillation" composed of elmironor heparin, lidocaineand sodium bicarbonate, has generated considerable excitement in the IC community because it is the first therapeutic intervention that can be used to reduce a flare of symptoms. Published studies report a 90% effectiveness in reducing symptoms. Pelvic floordysfunction may also be a contributing factor thus most major IC clinics now evaluate the pelvic floor and/or refer patients directly to a physical therapist for a prompt treatment of pelvic floor muscle tension or weakness. Pain control is usually necessary in the IC treatment plan. The pain of IC has been rated equivalent to cancer pain and should not ignored to avoid central sensitization. The use of a variety of traditional pain medications, including opiates are often necessary to treat the varying degrees of pain. Complementary therapiessuch as acupuncture, massage, and biofeedbackare also beneficial to some patients. It should be noted that even children with IC should be appropriately addressed regarding pelvic pain and receive necessary treatment to manage it. Surgicalinterventions are rarely used for IC. Neurostimulationtechniques are not FDA approved for IC. It is important to note that some people with IC also develop other medical conditions such as Anxiety disorder(usually because of the nature of the symptoms), and other conditions that may have the same etiology as IC. These include: IBS(Irritable Bowel Syndrome), Fibromyalgia, Endometriosisand chemical sensitivities. References
External links
Categories: Ailments of unknown etiology| Urology
| ||||||||||||||||||
