What is a Interstitial Cystitis (IC): Bladder Pain Syndrome?

IC is a chronic condition resulting in bladder discomfort or pain.

It affects 5 in 1000 of the population, of which 80% are women.

It usually starts around the age of 40 years.

Causes are unknown, but the symptoms include:

   

1. •Frequency (urinating more than 12 times a day (often 20 or more times).
   

1. •Urgency (having to urinate immediately)
   

1. •Pain (lower abdominal, urethral, vaginal)
   

Diagnosis

Unfortunately IC has no specific test. It is diagnosed by the symptoms displayed, the look during cystoscopy (small camera in bladder) and by excluding other abormalities, such as infection, tumours etc.

The blood-urine barrier

There is a protective (glycosaminoglycan GAG) layer in the inside of the bladder which helps to protect the bladder from eg bacteria. In IC this layer is deficient, potentially causing irritation.

Treatment

High concentration cranberry juice is not recommended as (similar to other acidic fruit juices) it can irritate the bladder more.

Cystistat, Uracyst and more recently iAluril can be used. These are instilled into the bladder through a small catheter.

Instillation of iAluRil solution into the bladder.

What are the alternatives to this procedure?

We can wait. We can used low dose antibiotics. Surgical treatment involves urinary diversion, removal of the bladder with urinary diversion or bladder reconstruction.

What should I expect before the procedure?

The treatment is performed without the need for any anaesthetic and is carried out on an outpatient basis.

You may be asked to complete a questionnaire before your treatment If you have not done this already.

Six treatment sessions are usually performed at weekly intervals to ensure the best response.

Please be sure to inform your Urogynaecologist or nurse if you have any of the following:

an artificial heart valve a coronary artery stent a heart pacemaker or defibrillator

an artificial joint

an artificial blood vessel graft

a prescription for Warfarin, Aspirin or Clopidogrel

What happens during the procedure?

Treatment involves inserting a fine tube (called a catheter) into your bladder using some local anaesthetic jelly. The drug is then instilled into the bladder for at least 30 minutes, but less than two hours. Whilst the drug is in your bladder, you will idealy remain active and mobile : turning every few minutes in order to coat the whole of the bladder wall with the solution.

At the end of the treatment, you will be able to go to the toilet and pass out the drug solution in the normal manner after removal of the catheter.

During the treatment, you may experience stinging or burning and you may not be able to tolerate it for the full amount of time. However, after the first couple of treatments, this usually improves and, by the end of the course, you should notice a lessening of your symptoms.

What happens immediately after the procedure?

Once the treatment has been completed, you will be able to go home.

You should drink plenty of fluids (2-3 litres) for the few days after the treatment. We also advise you to continue any medications which you have been prescribed for your symptoms during this period.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common (greater than 1 in 10)

Pain/discomfort during treatment resulting with inability to tolerate the treatment for the full period

Discolouration of the urine

Blood in the urine

Occasional (between 1 in 10 and 1 in 50)

Urine infection

Failure to relieve symptoms completely requiring further treatment Rare (less than 1 in 50)

Inability to pass urine (retention of urine)

What should I expect when I get home?

If you experience flu-like symptoms, shivering/shaking, any pain/burning when passing urine or a high temperature, you should contact your GP since you may require treatment with antibiotics.

If you are unable to pass urine after the test, you should contact your GP or the Specialist Nurses immediately

When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge.

Are there any other important points?

Once your treatment is complete, a follow-up outpatient appointment will be arranged for you to re-assess your symptoms. If there has been a good response to the treatment, we often recommend maintenance treatment, on a monthly basis for up to 6 - 24 months, to prevent a recurrence.

Is there any research being carried out in this field?

There is no specific research in this area at the moment but all operative procedures performed in the department are subject to rigorous audit at a monthly Audit & Clinical Governance meeting.

Who can I contact for more help or information?

Urology Nurses in the Unit

LINKS:

Cystitis and Overactive Bladder Foundation