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INTERSTITIAL CYSTITIS

Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as unpleasant sensation (such as pain, pressure, or discomfort) believed to be linked to the urinary bladder, characterized by chronic inflammation and lower urinary tract symptoms persisting for more than six weeks, without any presence of infection or other identifiable reasons.

IC/BPS is considered a chronic pelvic pain condition rather than an incurable bladder disease. This is because factors beyond the bladder might also contribute to these symptoms. There are two subtypes- IC with "Hunner's Lesions," which affects 5-10% of patients, where bleeding and damage to the bladder wall are evident. The other is "BPS: Non-Ulcer," which affects the remaining 90% and involves bladder and pelvic pain symptoms.

Symptoms

  1. Pain and Discomfort: People with IC often experience pelvic pain, pressure, or discomfort, typically located in the lower abdomen, pelvic region, or bladder area. This pain can vary in intensity and may be described as aching, burning, or stabbing.

  2. Frequent Urination: Frequent urination is a hallmark symptom of IC. People may feel the urge to urinate more often than usual, even if only small amounts of urine are passed each time.

  3. Urgency: IC can lead to a strong and sudden urge to urinate, often difficult to control. This urgency can contribute to increased stress and anxiety.

  4. Painful Urination: Urinating with interstitial cystitis can be painful or uncomfortable, often described as a burning sensation. Some people may also experience pain after urination.

  5. Nocturia: Nocturia refers to waking up multiple times during the night to urinate. IC can lead to increased nighttime urination, disrupting sleep patterns.

  6. Pain during Sexual Intercourse: Many individuals with IC experience pain or discomfort during sexual intercourse, a condition known as dyspareunia.

  7. Flare-ups: IC symptoms tend to come and go in flare-ups. Symptoms can worsen significantly during a flare-up, causing more intense pain, urgency, and discomfort.

  8. Sensitive Bladder: People with IC often have a sensitive bladder that reacts strongly to certain foods, beverages, and other triggers. Common triggers include caffeine, alcohol, acidic foods, artificial sweeteners, and spicy foods.

  9. Mental Health: The chronic nature of IC and its impact on daily life can lead to emotional stress, anxiety, and depression.

IC can be quite complex because its causes can differ significantly from person to person. It's important to recognize that some individuals might even have a combination of factors contributing to their condition. Getting an accurate diagnosis for IC can be a real challenge, mainly because its symptoms can manifest in various ways, and there aren't specific diagnostic tests available.

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Root Causes 

  1. Bladder Lining Defects: It's believed that a defect or disruption in the bladder's protective lining (GAG Layer) could lead to irritation and inflammation. This may allow substances in urine to penetrate the bladder wall and trigger symptoms.

  2. Autoimmune Response: Some researchers believe IC might involve an autoimmune response in individuals with coexisting conditions like irritable bowel syndrome (IBS) and chronic fatigue. Multiple conditions with suspected autoimmune components suggest that there may be chronic or excessive immune activation. 

  3. Neurogenic Inflammation: Neurogenic inflammation refers to the involvement of nerve endings in inflammation. In IC, nerve endings in the bladder lining might become hypersensitive, amplifying pain and discomfort signals.

  4. Genetics: There might be a genetic predisposition to developing IC. If a family member has IC, you might be at a slightly higher risk of developing it as well.

  5. Infection: Embedded or hidden infections that are missed on standard urine cultures could also be considered potential contributors to interstitial cystitis (IC). Some researchers have explored the possibility of chronic, low-grade infections that routine urine culture methods might not detect.

  6. Allergy: Allergies to certain foods or substances might exacerbate symptoms in some, causing an immune system response and potentially causing inflammation and discomfort in the bladder. Identifying and avoiding these triggers could provide relief for individuals with IC.

  7. Chronic Inflammation: Chronic inflammation anywhere in the body might contribute to the development or exacerbation of IC. Inflammation can cause tissue damage and increased sensitivity.

  8. Nerve Dysfunction: Dysfunction in the nerves that communicate between the bladder and the brain might play a role in the development of IC symptoms, such as increased urgency and frequency.

  9. Pelvic Floor Dysfunction: Problems with the muscles and tissues in the pelvic floor region might contribute to IC symptoms. Pelvic floor dysfunction can lead to pain and pressure in the pelvic area.

  10. Hormones: Fluctuations in hormone levels, particularly estrogen, might influence bladder

  11. Trauma: whether physical (to the bladder or other organs), emotional, or psychological, has been proposed as a potential root cause or contributing factor in some cases of interstitial cystitis (IC). Trauma-related factors, such as injuries to the pelvic region, urinary tract infections, surgical procedures, or emotional stress, might trigger or exacerbate IC symptoms.

  12. Anti-Proliferative Factor (APF): is a substance found in the urine of some individuals with interstitial cystitis (IC). It is a potential factor contributing to the development of IC. It is believed to inhibit the growth and repair of the bladder's protective lining (urothelium), leading to increased vulnerability to irritation, inflammation, and other symptoms associated with IC.

  13. Mast Cell Dysfunction or Hyper-activation: Mast cells are immune cells involved in allergic responses and inflammation. Dysfunction or hyper-activation of mast cells in the bladder could contribute to inflammation and pain.

  14. Increase in Grey Matter Volume: An increase in grey matter volume in some regions of the brain might be associated with heightened pain sensitivity, potentially contributing to the perception of pain in IC.

  15. Fibrosis: Fibrosis refers to excess fibrous connective tissue formation. In IC, fibrosis within the bladder wall might contribute to pain and reduced bladder capacity.

  16. Vascular Malformations/Glomerulations: small areas of pinpoint bleeding seen on cystoscopy. They might indicate vascular malformations or damage to blood vessels in the bladder lining.

Diagnosing interstitial cystitis/bladder pain syndrome(IC/BPS) can be challenging because it shares symptoms with other urinary and pelvic conditions. To get an accurate diagnosis, you should follow these steps:

 

Consult a Healthcare Provider: If you suspect you have IC due to recurring urinary symptoms, pelvic pain, or discomfort, start by scheduling an appointment with a healthcare provider. A urologist or urogynecologist specializing in urinary and pelvic disorders can be a good choice.

 

Provide Medical History: Be prepared to discuss your medical history, including any urinary symptoms, pain or discomfort, and any triggers that worsen your symptoms. Inform your healthcare provider of any other medical conditions or medications you are taking.

 

Physical Examination: Your healthcare provider will likely perform a physical examination, including a pelvic exam, to assess your symptoms.

 

Diagnostic Tests: Several tests may be ordered to rule out other conditions and provide evidence of IC:

  • Urinalysis: A urine sample is analyzed for signs of infection or other abnormalities.

  • Cystoscopy: This procedure involves using a thin tube with a camera (cystoscope) to examine the bladder's interior. During cystoscopy, your doctor may perform a hydrodistention to assess the bladder's capacity and appearance.

  • Biopsy: A small tissue sample may be taken from the bladder during cystoscopy to rule out other conditions and sometimes to look for signs of IC.

  • Urodynamic Testing: These tests assess how well your bladder stores and releases urine.

 

Symptom Diary: Keeping a diary of your symptoms, including when and what might trigger

them (such as specific foods or activities), can help your healthcare provider diagnose.

 

Exclusion of Other Conditions: To diagnose IC, your healthcare provider will typically exclude other potential causes of your symptoms, such as urinary tract infections, bladder stones, or other bladder conditions.

 

Discussion of Results: Once the tests are complete, your healthcare provider will discuss the findings. If the diagnosis of IC is confirmed, they will work with you to develop a treatment plan tailored to your specific needs.

 

Remember that IC can vary greatly among individuals, and some cases may be more challenging to diagnose. Be patient, communicate openly with your healthcare provider, and consider seeking a second opinion if necessary to ensure an accurate diagnosis and appropriate treatment.

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