What is this condition
The inner surface of the bladder is covered with a protective layer that prevents aggressive components of urine from contacting the wall. With interstitial cystitis, this barrier is disrupted: urine irritates the submucosal layer, nerve endings are activated, chronic inflammation and increased sensitivity develop.
Over time, the wall of the bladder becomes less elastic, its functional capacity decreases, and the person is forced to urinate more and more often, and in small portions. Pain usually increases as you fill and decreases immediately after emptying - this is a characteristic sign.
The cause of the disease has not been fully established. Disruption of the protective layer, autoimmune mechanisms, increased mast cell activity, neurogenic inflammation, and impaired central processing of pain signals are discussed. The condition is often combined with fibromyalgia, irritable bowel syndrome and chronic pelvic pain.
Symptoms
- Pain, pressure or discomfort in the bladder and lower abdomen
- Increased pain when the bladder fills and relief after urination
- Very frequent urination in small portions, sometimes more than twenty times a day
- Night rises
- Pain in the perineum, vagina, urethra, and in men - in the scrotum and penis
- Pain during intercourse
- Increased symptoms before menstruation, during stress, after certain foods
- Undulating course: periods of exacerbation followed by relative calm
- Absence of bacteria in urine cultures
Diagnostics: what needs to be excluded
- Urinalysis and repeated cultures - confirmation of sterility
- PCR for sexually transmitted infections
- Diary of urination for 3 days with volumes - shows small portions with a normal daily amount
- Ultrasound of the kidneys and bladder with determination of residual urine
- Cystoscopy - exclusion of stone, tumor, leukoplakia; with hydrodistension, characteristic submucosal hemorrhages or ulcers may be detected
- Bladder biopsy for suspicious areas
- Urine cytology
- Gynecological examination in women
- Prostate examination in men
- Assessment of the pelvic floor muscles - their spasm often accompanies and increases pain
We would like to emphasize separately: the presence of blood in the urine is not typical for interstitial cystitis and requires a full oncological search, including cystoscopy and CT urography.
Treatment: lifestyle changes
Treatment is always comprehensive and begins with measures that the patient implements independently. For some people this is enough for significant improvement.
- Food diary and exclusion of trigger foods: coffee, strong tea, carbonated and energy drinks, alcohol, citrus fruits, tomatoes, hot spices, chocolate, artificial sweeteners
- Sufficient, but even drinking - sharp fluid restriction makes urine concentrated and increases pain
- Bladder training with gradually increasing intervals - when frequency prevails over pain
- Working with the pelvic floor muscles: relaxing techniques rather than strengthening exercises; If you have a spasm, Kegel exercises can make the pain worse.
- Stress management, sleep normalization
- Treatment of constipation
- Warmth on the lower abdomen during an exacerbation
Drug and intravesical treatment
- Drugs that restore the protective layer of the bladder mucosa
- Antihistamines with pronounced participation of mast cells
- Drugs that affect the neuropathic component of pain - as prescribed by a doctor
- Painkillers and antispasmodics during exacerbations
- Instillations into the bladder: solutions that restore the protective layer, local anesthetics, anti-inflammatory components
- Hydrodistension of the bladder - stretching under anesthesia; simultaneously diagnostic and therapeutic procedure
- Botulinum therapy of the bladder with pronounced frequency and urgency
- Neuromodulation in resistant forms
- Pelvic floor physical therapy and manual techniques
- Psychotherapeutic support for chronic pain - not because the pain is “in the head”, but because chronic pain changes the functioning of the nervous system
Living with a diagnosis
- The course is undulating: exacerbations alternate with remissions, and this is normal
- Keeping a diary helps identify personal triggers - they are different for everyone
- A complete rejection of all “forbidden” products is not immediately necessary: they are excluded and then returned one by one, monitoring the reaction
- Planning trips and work around toilet access reduces anxiety
- A realistic treatment goal is long-term symptom control and normal quality of life.
- Partner support and open conversation about pain during intimacy are important and alleviate the condition.
Where they are examined and treated in Tashkent
The diagnosis is made by exclusion, so a laboratory, ultrasound and, most importantly, the ability to perform cystoscopy with biopsy are needed.
In Tashkent, such examination and treatment, including intravesical instillations and botulinum therapy of the bladder, are carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have been diagnosed with “chronic cystitis” for years, and your urine cultures are sterile and antibiotics do not help, ask your doctor to consider this particular diagnosis. Bring a completed three-day voiding diary to your appointment. Clinic contacts are below.
