Interstitial cystitis – Diagnosis and treatment – Mayo Clinic


diagnosis of interstitial cystitis might include :

  • Medical history and bladder diary. Your health care provider may ask you to describe your symptoms and to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass.
  • Pelvic exam. During a pelvic exam, your provider examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. Your provider may also examine your anus and rectum.
  • Urine test. A sample of your urine is analyzed for signs of a urinary tract infection.
  • Cystoscopy. Your provider inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. Your provider may also inject liquid into your bladder to measure your bladder capacity. Your provider may perform this procedure, known as hydrodistention, after you’ve been numbed with an anesthetic medication to make you more comfortable.
  • Biopsy. During cystoscopy under anesthesia, your provider may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. This is to check for bladder cancer and other rare causes of bladder pain.
  • Urine cytology. Your provider collects a urine sample and examines the cells to help rule out cancer.
  • Potassium sensitivity test. Your provider places (instills) two solutions — water and potassium chloride — into your bladder, one at a time. You’re asked to rate on a scale of 0 to 5 the pain and urgency you feel after each solution is instilled. If you feel noticeably more pain or urgency with the potassium solution than with the water, your provider may diagnose interstitial cystitis. People with typical bladders can’t tell the difference between the two solutions.


No childlike treatment eliminates the signs and symptoms of interstitial cystitis, and no one treatment works for everyone. You may need to try respective treatments or combinations of treatments before you find an approach path that relieves your symptoms .

Physical therapy

Working with a physical therapist may relieve pelvic pain associated with muscle softheartedness, restrictive connective tissue or muscleman abnormalities in your pelvic shock.

Oral medications

Certain medicines that you take by sass ( oral medications ) may improve signs and symptoms of interstitial cystitis :

  • Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), to relieve pain.
  • Tricyclic antidepressants, such as amitriptyline or imipramine (Tofranil), to help relax your bladder and block pain.
  • Antihistamines, such as loratadine (Claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms.
  • Pentosan polysulfate sodium (Elmiron), which is approved by the Food and Drug Administration specifically for treating interstitial cystitis. How it works is nameless, but it may restore the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It may take two to four months before you begin to feel pain stand-in and up to six months to experience a decrease in urinary frequency .
    Macular eye disease has been associated with consumption of this medication in some people. Before starting this treatment, you may need a comprehensive eye examination. You may besides need extra eye exams to monitor for eye disease as you continue therapy .

Nerve stimulation

Sacral nerve stimulator

Implanted sacral nerve stimulation device

Sacral nerve stimulator

During sacral heart stimulation, a surgically plant device delivers electric impulses to the nerves that regulate bladder action ( sacral nerves ). The unit is placed beneath the skin of the buttocks, near the sacral nerves .
Nerve foreplay techniques include :

  • Transcutaneous electrical nerve stimulation (TENS). With TENS, balmy electric pulses relieve pelvic pain and, in some cases, reduce urinary frequency. TENS may increase blood flow to the bladder. This may strengthen the muscles that help control the bladder or gun trigger the release of substances that block pain .
    electric wires placed on your lower back or just above your pubic area deliver electric pulses — the distance of time and frequency of therapy depends on what works best for you .
  • Sacral nerve stimulation. Your sacral nerves are a primary yoke between the spinal cord and nerves in your bladder. Stimulating these nerves may reduce urinary importunity associated with interstitial cystitis .
    With sacral steel stimulation, a dilute electrify placed near the sacral nerves sends electrical impulses to your bladder, like to what a pacemaker does for your heart. If the operation decreases your symptoms, you may have a permanent wave device surgically implanted. This routine does n’t manage pain from interstitial cystitis, but may help to relieve some symptoms of urinary frequency and urgency .

Bladder distention

Some people notice a irregular improvement in symptoms after cystoscopy with bladder distention. Bladder distention is the unfold of the bladder with body of water. If you have long-run improvement, the routine may be repeated .
Botulinum toxin A ( Botox ) may be injected into the bladder wall during bladder distention. But, this treatment option could lead to not being able to empty your bladder wholly when you urinate. You may need to self-catheterize — be able to insert a tube into your own bladder to drain urine — after this treatment .

Medications instilled into the bladder

In bladder instillation, your provider places the prescription drug medication dimethyl sulfoxide ( Rimso-50 ) into your bladder through a thin, elastic tube ( catheter ) inserted through the urethra .
The solution sometimes is assorted with early medications, such as a local anaesthetic, and remains in your bladder for about 15 minutes. You urinate to expel the solution .
You might receive dimethyl sulfoxide — besides called DMSO — treatment weekly for six to eight weeks, and then have care treatments as needed — such as every couple of weeks, for up to one year .
Another access to bladder instillation uses a solution containing the medications lidocaine, sodium bicarbonate, and either pentosan or heparin .


Doctors rarely use surgery to treat interstitial cystitis because removing the bladder does n’t relieve annoyance and can lead to other complications.

People with dangerous pain or those whose bladders can hold merely very humble volumes of urine are possible candidates for operation, but normally only after early treatments fail and symptoms affect quality of life sentence. surgical options include :

  • Fulguration. This minimally invasive method involves insertion of instruments through the urethra to burn off ulcers that may be present with interstitial cystitis.
  • Resection. This is another minimally invasive method that involves insertion of instruments through the urethra to cut around any ulcers.
  • Bladder augmentation. In this procedure, a surgeon increases the capacity of your bladder by putting a patch of intestine on the bladder. However, this is performed only in very specific and rare instances. The procedure doesn’t eliminate pain and some people need to empty their bladders with a catheter many times a day.

More Information

  • Acupuncture

Lifestyle and home remedies

Some people with interstitial cystitis find symptom easing from these strategies :

  • Dietary changes. Eliminating or reducing foods in your diet that irritate your bladder may help to relieve the discomfort of interstitial cystitis .
    coarse bladder irritants — known as the “ four Cs ” — include : carbonated beverages, caffeine in all forms ( including cocoa ), citrus products and food containing senior high school concentrations of vitamin C. Consider avoiding alike foods, such as tomatoes, pickled foods, alcohol and spices. artificial sweeteners may aggravate symptoms in some people .
    If you think certain foods may irritate your bladder, try eliminating them from your diet. Reintroduce them one at a time and pay attention to which, if any, worsen symptoms .
  • Bladder training. Bladder prepare involves timed micturition — going to the gutter according to the clock quite than waiting for the need to go. You start by urinating at set intervals, such as every half-hour — whether you have to go or not. then you gradually wait longer between bathroom visits .
    During bladder training, you may learn to control urinary urges by using relaxation techniques, such as breathing lento and profoundly or distracting yourself with another activeness .

These self-care measures besides may help :

  • Wear loose clothing. Avoid belts or clothes that put pressure on your abdomen.
  • Reduce stress. Try methods such as visualization and biofeedback.
  • If you smoke, stop. Smoking may worsen any painful condition, and smoking contributes to bladder cancer.
  • Exercise. Easy stretching exercises may help reduce interstitial cystitis symptoms.

Alternative medicine

Two complementary color and option therapies show some promise in treating interstitial cystitis :

  • Guided imagery. This type of therapy employs visualization and direct suggestions using imagery to help you imagine healing, with the hope that the body will follow the mind’s suggestions.
  • Acupuncture. During an acupuncture session, a practitioner places numerous thin needles in your skin at specific points on your body. According to traditional Chinese medicine, precisely placed acupuncture needles relieve pain and other symptoms by rebalancing the flow of life energy. Western medical practitioners tend to believe that acupuncture boosts the activity of your body’s natural painkillers.

These treatments have not been well-studied for interstitial cystitis, so be sure to discuss the use of these therapies with your health concern supplier .

Coping and support

interstitial cystitis can worsen your quality of life. support from family and friends is significant, but because the condition is a urinary problem, you may find the subject unmanageable to discuss .
Find a supportive health worry supplier who is concerned about your quality of life a well as your condition. Seek person who will work with you to help relieve your urinary frequency, urgency and bladder pain .
You might besides benefit from joining a support group. A patronize group can provide charitable listening and utilitarian information. Ask your supplier for information on support groups or see the Interstitial Cystitis Association on the web .

Preparing for your appointment

You may be asked to keep a bladder diary for a few days to record information, such as how often you urinate and how much and what kinds of fluent you consume .
For more quiz, you may be referred to a specialist in urinary disorders ( urologist ) or urinary disorders in women ( urogynecologist ) .

What you can do

To get the most from your visit to your health caution provider, organize in advance :

  • Write down any symptoms you’re experiencing. Include all of your symptoms, even if you don’t think they’re related.
  • Make a list of any medications, vitamins or other supplements you take. Many over-the-counter supplements can irritate the urinary tract. Also note the doses and how often you take the medication or supplements.
  • Have a family member or close friend go with you. You may be given a lot of information at your visit, and it can be difficult to remember everything.
  • Take a notepad or an electronic device with you. Use it to note important information during your visit.
  • Prepare a list of questions to ask. List your most important questions first, in case time runs out.

For interstitial cystitis, some basic questions to ask admit :

  • Will my symptoms eventually go away?
  • What kind of tests might I need?
  • Will changing my diet help with my symptoms?
  • Could the medicines I take be aggravating my condition?
  • Are there any medications that would help ease my symptoms?
  • Will I need surgery?

Make sure that you understand what your provider tells you. Do n’t hesitate to ask your provider to repeat information or to ask follow-up questions for clarification .

What to expect from your provider

Be prepared to answer questions from your provider, such as :

  • How often do you feel the urge to urinate with little or no warning?
  • Do you feel the urge to urinate immediately after you’ve urinated?
  • Do you ever urinate less than two hours after you finished urinating?
  • Do you wake up at night to urinate?
  • Do you have pain or burning in your bladder?
  • Do you feel pain in your abdomen or pelvis?
  • Are you currently sexually active?
  • How much do your symptoms bother you?

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