Interstitial cystitis is called inflammation of the bladder, not associated with the penetration of infection or trauma to the organ. Pathology occurs mainly in women of childbearing age. In men, the elderly and children, this form of cystitis is extremely rare. In this disease, the inflammatory process affects the intermediate (interstitial) tissue located between the mucosa of the bladder and muscles. A lot of nerve endings are concentrated in this space, their irritation leads to the appearance of pain. Another name for this ailment is painful bladder syndrome (SBP).
Causes of the disease
Currently, the exact causes of interstitial cystitis are unknown. It is assumed that the following factors can provoke an inflammatory process:
- infectious diseases of the genitourinary system;
- chronic endometriosis;
- gastrointestinal diseases;
- genitourinary surgery;
- weakening of the immune system;
- a change in the biochemical composition of urine due to renal pathologies;
- hormonal disruptions;
- metabolic disorders;
- chronic stress;
- disorders of the innervation and tone of the bladder.
It is most likely that one of the main causes of pathology is a decrease in immunity. With weakening of the body's defenses, the barrier function of the mucous membrane of the bladder worsens. Substances from the urine enter the interstitial space, causing irritation and inflammation of the tissue. In the future, cicatricial changes are formed. The bladder loses elasticity, when it stretches, tears appear, which are filled with blood clots and protein (fibrin). These lesions are called Gunner's ulcers.
The presence of such ulcers is one of the main signs of the disease. The main symptoms and treatment of interstitial cystitis will be discussed in more detail below.
Clinical picture
The main sign of pathology is pain in the lower abdomen. It radiates to the genital area and groin, as well as to the lower back and thighs. The pain syndrome with interstitial cystitis in women intensifies during menstruation and during intercourse, after taking alcohol and eating spicy foods.
Another manifestation of the disease is a violation of the function of excretion. Patients are concerned about the frequent, sometimes false urge to urinate. Their frequency can reach up to 100 times a day, including at night. The analysis determines changes in the composition of urine and blood impurity.
After urination, there is a feeling of incomplete emptying of the bladder. The pain syndrome can be of different intensities: from a slight burning sensation to severely expressed unpleasant sensations.
Against the background of symptoms of interstitial cystitis, depression, insomnia, irritability develop. This pathology has an extremely negative effect on the quality of life of patients: performance is impaired, general well-being worsens, and sexual life sometimes becomes impossible due to pain.
The disease can be periodic in nature, when the acute phase is replaced by remission. But more often this ailment bothers the patient constantly and progresses over time.
Diagnostics
It is important to conduct an accurate differential diagnosis of interstitial cystitis. This disease must be separated from inflammation of the bladder and urethra of infectious etiology, as well as from tumors of the excretory organs.
There are some manifestations by which it is possible to determine the disease with high accuracy. They are detected during the examination. These are 3 important criteria for the diagnosis of interstitial cystitis. These include:
- Reduced bladder capacity. This symptom indicates the amount of urine that can be retained in the body. If the capacity is more than 350 ml, then we can conclude that the patient does not suffer from this pathology. However, this symptom is not the most informative, therefore, pay attention to other indicators of the survey.
- The presence of glomerulation. These are small hemorrhages under the mucous membrane of the bladder.
- The presence of Gunner's ulcers. They look like wounds of orange or pink. Not all patients have such injuries; more often they are observed in the late stages of pathology.
If the patient during the examination revealed hemorrhages or ulcers in the bladder, then the urologist makes a diagnosis of "interstitial cystitis."
In the photo below, you can see pathological changes (glomerulation) on the mucosa.
To identify the disease, the following examination methods are used:
- Hydrodistension. The procedure is filling the bladder with fluid. This is necessary to determine the elasticity of the organ. This method of examination at the same time can be a therapeutic measure. Many patients after conducting hydrodistension note a long-term improvement in health.
- Cystoscopy It is this study that allows us to identify the most important signs of pathology: glomerulation and Gunner's ulcers. Under local anesthesia, a thin long tube is inserted into the bladder cavity. An optical device is fixed at the end of the device, with its help they examine the mucous membrane of the organ.
- Test with potassium. A solution of potassium chloride is injected into the bladder. This analysis reveals the barrier properties of the organ mucosa. In healthy people, the injected solution does not penetrate into the interstitial tissue. Therefore, their test is not accompanied by any unpleasant sensations. If a person is sick, then the mucous membrane passes potassium chloride into the interstitial space. There are pains in the lower abdomen and urges to urinate.
Also, to clarify the diagnosis, urine tests are prescribed: for general indicators and for bacterial inoculation. It is necessary to separate interstitial cystitis from inflammation of an infectious origin.
In some cases, cystoscopy is combined with a tissue biopsy. But such a procedure is optional. It is carried out only when the doctor suspects cancer of the patient.
Drug treatment
How to treat interstitial cystitis without resorting to invasive methods? There are many drug treatments for this disease. If the pathology is not started, then most often you can do without surgical intervention.
However, today there is no consensus on the causes of this pathology. There are only theories about its etiology. Therefore, the approach to medical treatment may differ from one doctor to another. The most commonly prescribed medications are:
- "Elmiron." Often, this drug is used to treat interstitial cystitis. It belongs to the class of anticoagulants and thins the blood. This helps reduce pain and inflammation. In addition, the medicine helps to restore the barrier function of the mucous membrane. Use the drug "Heparin", which is one of the analogues of "Elmiron".
- Nonsteroidal analgesics and anti-inflammatory drugs. With severe pain, Ibuprofen and Indomethacin are prescribed; paracetamol medications are used to reduce inflammation.
- Antidepressants. Amitriptyline is usually prescribed. It has not only a sedative, but also a slight analgesic and antidiuretic effect. This helps to reduce pain and reduce the urge to urinate. And also the medicine helps eliminate the depression, which is often accompanied by the disease.
- The drug "Urolife" in capsules with hyaluronic acid. This substance strengthens the mucous membrane of the bladder.
- Antihistamines There is an assumption that inflammation and pain provokes an excess of histamine. Therefore, some doctors prescribe medications for allergies: Suprastin, Tavegil, Diphenhydramine. However, the histamine theory of cystitis has not been confirmed.
- Cholinolytics and Cyclosporin A. This medication reduces the urge to urinate.
Drug therapy is supplemented by physiotherapy, the introduction of drugs directly into the bladder (instillations), and physiotherapy. Also, patients are recommended to follow a diet.
Exercise therapy, psychotherapy and diet
With interstitial cystitis, moderate exercise is indicated. There is special gymnastics (Kegel exercises), which is aimed at strengthening the muscles of the pelvis. This is a good way to prevent urinary incontinence. Patients need to perform exercises for at least 6 months, this will help increase muscle tone of the bladder. As a result, the frequency of urges will decrease.
Psychotherapeutic treatments include bladder training. By willpower, the patient increases the time intervals between urination. This prevents a decrease in organ capacity.
In the treatment of interstitial cystitis in women, gynecological massage is used. This procedure is carried out by a doctor. The patient lies on a chair or on a special table. The vaginal area is massaged with one hand, and the abdominal wall with the other. Such a therapeutic measure improves blood circulation and reduces the inflammatory process.
An important role is played by diet. Spicy foods, chocolate, coffee, cocoa, tomatoes and citrus fruits should be excluded from the diet. It is forbidden to drink alcohol and carbonated sugary drinks. At least 1 liter of water should be drunk per day.
Instillations
Together with taking medications inside, local treatment is used. The drugs are injected directly into the cavity of the bladder. This procedure is called instillation.
The following drugs are used for administration:
- "Dimexide". The solution of this drug has analgesic, anti-inflammatory and antihistamine properties.
- "Lidocaine". This substance is a local anesthetic, used for severe pain.
- "Heparin" and "Actovegin" (in the form of solutions). These medicines are used simultaneously. "Heparin" has an anti-inflammatory effect and helps to restore the mucosa, and "Actovegin" improves blood circulation in the body.
- Urolife in the form of a solution. A medicine with hyaluronic acid acts directly on the mucous membrane, contributing to its recovery. Often instillations are combined with taking Urolife capsules inside.
Physiotherapy
Physiotherapy is used simultaneously with the instillation, for better absorption of drugs. Appoint sessions of magnetotherapy, UHF, laser irradiation of the lower abdomen. In addition to external physiotherapy, intracavitary magnetophoresis is also used. Medicinal substances are fed into the mucous membrane of the bladder using a magnetic field. In some cases, bladder electrical stimulation sessions are performed. This helps to improve muscle tone of the organ and reduces the frequency of urges.
Surgery
Surgical intervention is extremely rare, only in cases where the disease is not amenable to conservative treatment.
The most gentle method is laser cauterization of the bladder. This allows you to remove lesions on the mucosa. The operation is performed under general anesthesia. A hospital stay is not required, after 1 - 1.5 hours the patient can go home.
In severe cases, abdominal surgery is performed. The affected area is excised and replaced with part of the intestine. Sometimes the bladder has to be removed completely. A new organ is also formed from the gut. But such radical operations have to be resorted to very rarely. In most cases, the disease is amenable to medical and physiotherapeutic treatment.
Prevention
Since the causes of the pathology are still unknown, specific prevention has not been developed. The following measures will help reduce the risk of the disease:
- timely treatment of diseases of the excretory and reproductive system;
- avoid contact with allergens;
- strengthening the immune system;
- minimizing stressful situations;
- restriction in the diet of spicy and salty foods;
- regular medical examinations.
Reviews about therapy and diagnosis
You can find positive reviews of patients with interstitial cystitis about the treatment with the antidepressant Amitriptyline. Patients decreased urination, decreased pain and improved sleep.
Patients also note the effectiveness of the drug Elmiron. It acts on the main symptom of the disease - the deterioration of the protective function of the mucous membrane. However, in some patients, this medicine causes a side effect - hair loss. People also write that this drug helps only with strict adherence to the diet. After all, all the substances that enter the body along with salty and spicy foods irritate the bladder.
Patients leave positive feedback on the treatment of interstitial cystitis by instillation and physiotherapy. Good results are given by the introduction into the bladder of "Dimexidum" and "Lidocaine" in combination with magnetotherapy. However, patients note that this should not be supercooling, as this can lead to the return of all unpleasant symptoms.
There are different opinions about the diagnosis of this disease. Patients write that it is sometimes very difficult to detect interstitial cystitis. The reviews noted that patients had to undergo many different doctors and examinations before they were correctly diagnosed. This ailment can disguise itself as other pathology. With systematic pain in the lower abdomen and impaired urination, cystoscopy should be done. Many patients are afraid of this procedure, but their fears are in vain. In modern medicine, cystoscopy is performed under anesthesia and is quite tolerant. Only this examination can accurately identify pathological changes and make the correct diagnosis.