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Interstitial Cystitis

Interstitial cystitis, commonly abbreviated as IC, is a chronic condition primarily affecting the bladder and urinary system. It is characterised by a combination of uncomfortable bladder pressure, bladder pain and sometimes pelvic pain, varying in severity.

While the exact cause of IC is not fully understood, it is believed to be a result of multiple factors including a defect in the bladder lining, autoimmune response, infection, or allergies. Despite no cure currently being available, various treatments can help manage symptoms and improve patients’ quality of life.

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Symptoms

The symptoms of IC can vary widely among individuals, both in type and severity:

  • Chronic Pelvic Pain: A hallmark symptom, the pain ranges from mild discomfort to severe pressure or aching, often centred around the bladder area.
  • Increased Urinary Frequency: Patients frequently experience the need to urinate more often than usual, sometimes as often as every 10-20 minutes.
  • Urinary Urgency: This involves a persistent, urgent need to urinate, which can be distressing and disruptive to daily life.
  • Pain During Urination: Many individuals report pain or discomfort while urinating, a symptom that intensifies as the bladder fills and often eases after voiding.
  • Pain During Sexual Activity: Sexual intercourse can exacerbate pain and discomfort, particularly in women.
  • Nocturia: Frequent urination during the night is common, often disrupting sleep patterns.
  • Variable Symptom Intensity: Symptoms can fluctuate, with periods of flare-ups and remission. Stress, menstrual cycles, and certain foods or drinks may trigger or worsen symptoms.

Causes

The exact causes of IC are not well understood, but several theories suggest a combination of factors:

  • Defective Bladder Lining: A compromised bladder lining may allow irritating substances in urine to penetrate the bladder wall, causing pain and inflammation.
  • Autoimmune Response: Some studies suggest that an autoimmune response, where the body’s immune system mistakenly attacks bladder tissues, might be involved.
  • Pelvic Floor Dysfunction: Abnormalities in the muscles of the pelvic floor may contribute to IC symptoms.
  • Neurogenic Inflammation: Overactivity of nerves in the bladder can lead to increased pain and urinary symptoms.
  • Genetic Factors: A familial predisposition to IC has been suggested in some studies, indicating a possible genetic component.
  • Infections and Allergies: Past urinary or bladder infections, as well as allergies, may play a role in the development of IC.

Diagnosis

Diagnosing interstitial cystitis involves a combination of methods, as there is no single test that can definitively diagnose IC:

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    Medical History and Symptom Review

    A detailed discussion of symptoms, their duration, and intensity is the first step.

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    Urine Tests

    To rule out infections or other conditions that cause similar symptoms.

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    Bladder Diary

    Keeping a record of urinary habits, pain levels, and dietary intake can provide insights into symptom patterns.

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    Potassium Sensitivity Test

    This involves instilling solutions into the bladder to identify abnormal bladder lining.

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    Cystoscopy with Hydrodistension

    Inspecting the inside of the bladder with a camera, often while stretching the bladder, can reveal characteristic signs of IC.

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    Biopsy

    In some cases, a biopsy of the bladder wall may be performed to rule out other conditions.

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Treatment Options

Treatment for IC aims to relieve symptoms and improve quality of life, with options including:

  • Oral Medications: Pentosan polysulfate sodium is commonly prescribed, along with tricyclic antidepressants for pain management.
  • Bladder Instillations: Medications instilled directly into the bladder can help reduce pain and inflammation.
  • Physical Therapy: Pelvic floor therapy can alleviate pelvic pain and urinary frequency.
  • Pain Management: Over-the-counter pain relievers and prescription pain medications can be used to manage discomfort.
  • Dietary Modifications: Avoiding foods that irritate the bladder can help reduce symptoms.
  • Stress Management: Techniques like biofeedback, meditation, and counselling can help manage the emotional impact of IC.
  • Surgical Options: In severe cases, procedures to increase bladder capacity or urinary diversion may be considered.

Care and Recovery

Care and recovery in the context of IC primarily pertains to the period following diagnostic or minor surgical procedures. This phase is necessary to ensure comfort and prevent complications.

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    Monitoring for Complications

    Patients should be vigilant for signs of infection or severe pain post-procedure and report these to their healthcare provider immediately.

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    Pain Management

    Over-the-counter pain relief medications may be used to help manage discomfort following procedures.

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    Increased Fluid Intake

    Drinking increased amounts of water can help flush out the bladder and reduce the risk of urinary tract infections.

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    Rest and Recuperation

    Adequate rest aids recovery, particularly after any surgical interventions.

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    Follow-up Appointments

    Regular check-ups are necessary to monitor the patient’s recovery and to adjust treatment plans if needed.

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    Continuation of IC Management

    Ongoing treatments for IC, such as medications or bladder instillations, typically continue during the recovery phase.

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    Lifestyle Modifications

    Continuing with lifestyle changes such as dietary adjustments and stress management techniques can aid in overall recovery and symptom management.

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    Emotional Support

    Given the chronic nature of IC, continued emotional and psychological support may be beneficial during the recovery period.

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Dr Lee Fang Jann image

Dr Lee is a urologist and kidney transplant surgeon with a broad-based expertise of all urological disorders

He has subspecialty focus on men’s health and male infertility, and special interest in minimally invasive prostate enlargement therapy and kidney stone treatment. Dr Lee has received numerous awards for service excellence such as the Service With A Heart Award (2006-2008, 2011) and the Singapore Health Quality Service Award (2016).

  • Bachelor of Medicine and Bachelor of Surgery (Singapore)
  • Membership of The Royal College of Surgeons (Edin)
  • Master of Medicine (Surgery) (Singapore)
  • Fellowship of the Academy of Medicine (Urology)
  • Clinical fellowship at Oxford Transplant Centre in the UK
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Prior to entering private practice, Dr Lee served in the public sector for 16 years at SGH, where he initiated dedicated clinics evaluating and treating patients with complex men’s health and fertility issues. He also led the Renal Transplant Program and laparoscopic donor nephrectomy service as Surgical Director.

Apart from clinical work, Dr Lee is active in academia and believes in the importance of grooming the next generation of doctor. He was Senior Clinical Lecturer at NUS’ Yong Loo Lin School of Medicine and currently, Adjunct Assistant Professor at the Duke-NUS Medical School. Dr Lee is also regularly invited to share his experiences locally and regionally through lectures, workshops and surgical demonstrations.

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    Frequently Asked Questions

    What is Interstitial Cystitis?
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    A chronic condition characterised by bladder pressure, bladder pain, and sometimes pelvic pain, with varying severity.

    What Causes Interstitial Cystitis?
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    The exact cause is unknown, but it may involve a defect in the bladder lining, an autoimmune response, or other factors.

    Who is at Risk of Developing IC?
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    IC can affect individuals of any age, gender, or ethnicity, but is more commonly observed in women.

    How is IC Diagnosed?
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    Diagnosis involves ruling out other urinary conditions and assessing symptoms; procedures like cystoscopy may be used.

    What Treatments are Available for IC?
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    Treatments include medications, bladder instillations, physical therapy, dietary modifications, and, in severe cases, surgery.

    Can IC be Cured?
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    There is currently no cure for IC, but various treatments can help manage symptoms and improve quality of life.

    How Does IC Affect Daily Life?
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    Symptoms can impact daily activities, but with effective management, most individuals can maintain an active lifestyle.

    Is IC Related to Diet?
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    Certain foods and beverages might exacerbate symptoms, so dietary modifications can be part of the management strategy.

    Can IC Affect Sexual Health?
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    IC can cause pain during sexual activity, but treatment can improve these symptoms.