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JAMA Patient Page
May 23/30, 2012

Interstitial Cystitis

JAMA. 2012;307(20):2211. doi:10.1001/jama.2012.3943

In interstitial cystitis or bladder pain syndrome (IC/BPS), the lining of the bladder is constantly irritated, causing pain during urination and urinary frequency. It is not certain why individuals have IC/BPS, but it is thought to be due to chronic inflammation of the bladder, possibly from defects in the inside wall of the bladder. It may also be partly an autoimmune disorder, in which the body makes substances that attack the lining of the bladder. Sometimes IC/BPS runs in families. IC/BPS occurs in men and women, but is 5 times more common in women. It may be more common than previously thought because individuals with other painful conditions of the pelvis may also have IC/BPS that has not been diagnosed. Your primary care doctor may refer you to a urologist, a doctor with specialized education in the management of problems with the urinary system, including the kidneys, the ureters, the bladder, and the urethra.

SIGNS AND SYMPTOMS

  • Urinary frequency, urinating more than 8 times per day or at night

  • Urgency to urinate, sometimes immediately after urinating

  • Pain or discomfort that worsens as the bladder fills or is improved after emptying the bladder

  • Pelvic pain or pelvic pressure

  • Pain with sexual intercourse

DIAGNOSIS AND TESTING

Most cases of IC/BPS can be diagnosed through a medical history and a physical examination. Urinalysis is usually done to exclude a urinary tract infection (UTI) because UTI can cause the same symptoms but is treatable with antibiotics. Cystoscopy, inserting a small flexible lighted tube into the bladder through the urethra, is often done in the urologist's office, with the patient under local anesthesia. More complicated cystoscopy, biopsy, or other procedures using the cystoscope are done in the operating room, using sedation or anesthesia.

TREATMENT

  • Some foods (citrus, tomatoes, and other acid-containing foods), beverages, and alcoholic drinks may make interstitial cystitis worse for some individuals. Changing your diet and no longer drinking alcohol may help to reduce symptoms of interstitial cystitis.

  • Quitting smoking is an important step for anyone with bladder problems.

  • Relaxation techniques and stress management can help to improve symptoms. Stress does not cause IC/BPS but can make its symptoms worse. Support groups can be useful sources of information about coping with IC/BPS.

  • If lifestyle changes do not improve symptoms, physicians may recommend medications or therapies such as hydrodistention. This is a procedure that fills the bladder with fluid through a cystoscope.

FOR MORE INFORMATION

INFORM YOURSELF

To find this and previous JAMA Patient Pages, go to the Patient Page Index on JAMA's website at www.jama.com. Many are available in English and Spanish. A Patient Page on urinary tract infection was published in the May 2, 2012, issue, one on urinary incontinence in older women was published in the June 2, 2010, issue; and one on bladder cancer was published in the February 16, 2005, issue.

Sources: National Institute of Diabetes and Digestive and Kidney Diseases; Interstitial Cystitis Association; American Urogynecologic Society

Topic: URINARY TRACT DISORDERS

The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.

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