This book describes Interstitial Cystitis, Diagnosis and Treatment and Related Diseases Interstitial cystitis (IC) is often called the painful bladder syndrome. It is difficult to diagnose and there is no cure though treatments can make life better with it. If the patient has urinary pain that persists for more than 6 weeks and is not caused by other disorders like infection or kidney stones, the patient may have IC. The disease can affect the social life, exercise, sleep and even the ability to work. IC is a chronic bladder disorder. The bladder retains urine after the kidneys have filtered it but before the patient passes it out. This disorder induces pain and pressure below the abdominal navel. Symptoms can come and go. Or they may be constant. The patient may have to urinate as many as 40-60 times a day in severe cases. It can even cause the patient to stay awake at night. 1.Bladder pressure and pain that becomes worse as the bladder fills up. 2.Pain in the lower abdomen, lower back, pelvis, or urethra (the tube that carries urine from the bladder out of the body) 3.For women, pain in the vulva, vagina, or the region behind the vagina 4.For men, pain in the scrotum, testicles, penis, or the region behind the scrotum 5.The necessity to urinate often (more than the normal 7-8 times daily) All people with it have an inflamed bladder. About 5% to 10% of people have ulcers in their bladder Men and women have pain during sex. About 90% of people with IC are women. There is an estimate that about 3% to 6% of adult women have some type of IC. That is about 3 million to 8 million American women. About 1.3% of American men also have it On average, people first begin having urinary problems in their 40s. The risk of having IC goes up as the patient becomes older Causes: 1.A disorder with bladder tissue allows things in the urine to irritate the bladder. 2.Inflammation induces the body to release chemicals that produce symptoms. 3.Something in the urine injures the bladder. 4.A nerve disorder makes the bladder feel pain from things that normally do not hurt. 5.The immune system cells attacks the bladder cells (autoimmune reaction). 6.Another disorder that causes inflammation somewhere else is also targeting the bladder. Diagnosis: There is no specific test for interstitial cystitis These tests can exclude other disorders: Urinalysis and urine culture Post-void residual urine volume Cystoscopy Bladder and urethra biopsy Treatment: The main treatments for IC are outlined in the AUA IC guideline: 1.First-Line Treatment a.Self-help 2.Second-Line Treatment a.Physical Therapy is very important b.Complementary and Alternative Therapy c.Oral Medications (e.g. Elmiron) d.Bladder Instillation 3.Third-Line Treatment a.Cystoscopy with hydrodistention 4.Fourth-Line Treatment a.Neurostimulation 5.Fifth-Line Treatment a.Immunosuppressants (e.g. Cyclosporine) b.Botox 6.Sixth-Line Treatment a.Surgery Updated treatment Doctors think of the first line of treatment as the typical one. 1. Pentosan polysulfate 2. Hydroxyzine A defective layer coating the bladder lining (glycosaminoglycan) in IC caused testing of the Elmiron to replace the layer. The mast cell proliferation and swelling in the bladder wall observed in IC also appeared like an allergic reaction, so doctors began to try antihistamines, such as hydroxyzine (Atarax). Some autoimmune diseases are more frequent in IC patients The idea triggered medical uses of immunosuppressive drugs One useful IC treatment is amitriptyline, a tricyclic antidepressant which can also relieve pain A new treatment is based on liposomes, microscopic particles that can dissolve fat for bladder instillation TABLE OF CONTENT Introduction Chapter 1 Interstitial Cystitis Chapter 2 Causes Chapter 3 Symptoms Chapter 4 Diagnosis Chapter 5 Treatment Chapter 6 Prognosis Chapter 7 Cystitis Chapter 8 Urethritis Epilogue

General adult

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