Could you be confused and worried due to pain in your pelvis; do you urinate very many times a day, or probably feel a lot of pain when the bladder is full? Is there much pressure in the genital area or bleeding in the bladder?

Do you experience urinary pain that lasts for over six weeks and the cause is not due to conditions like kidney stones, infection like ulcers? There is a possibility that you are suffering from interstitial cystitis (IC), and it is advisable you visit an urologist as soon as you see some of these symptoms.

According to Dr Iba Mayele from Clinic Galien in Kimironko, Kigali, interstitial cystitis is an inflammatory disease of the bladder that causes ulceration and bleeding of the bladder’s lining and can lead to scathing pain.

Mayele says that interstitial cystitis predominantly affects women with an average age at onset of 40 years but it also affects men and in rare cases children.

Dr Robert Moldwin, the author of ‘The Interstitial Cystitis Survival Guide’, considered by many one of the best books written on the topic, who doubles as the director of both the Urological Pelvic Pain Centre and the Interstitial Cystitis Centre at the Smith Institute for Urology at Long Island Jewish Medical Centre, says that the best approach is not just to treat the pain but define the root of the problem, in this case the bladder, and target that specifically.

Although the exact cause of interstitial cystitis is still unknown, Moldwin asserts that they have found certain pathologies indicating the condition is real, which offers further validation for patients who are suffering with the problem and continue to get test results indicating nothing is wrong.

Mayele says some of the symptoms of interstitial cystitis include pelvis pain, frequent urination and urinary urgency.

"Interstitial cystitis is a poorly understood disease with unknown causes. Although no bacteria or viruses have not been found in urine of interstitial cystitis patients, it is believed that it occurs with ischemia (death tissue), and may be an autoimmune disease in which the immune system attacks healthy cells,” Mayele explains.

He adds that other conditions associated with interstitial cystitis include asthma, endometriosis, food allergies, irritable bowel syndrome, sinusitis, migraines and lupus.

However, Mayele says because of frequently delayed diagnosis, and the lack of cure, interstitial cystitis causes psychological and social problems that can affect family, work, and lifestyle. For example is can lead to anxiety, depression, fatigue, inability to enjoy usual activities, insomnia, panic disorder, weight fluctuation, and eating disorders.

Treatment

Mayele also says that one has to try out various treatments or combination of treatments like physical therapy exercising and working with a physical therapist to relieve pelvic pain associated with muscle tenderness, restrictive connective tissue or muscle abnormalities in the pelvic.

He adds that oral medication is also important where nonsteroidal anti inflammatory drugs such as ibuprofen, tricyclic antidepressants like amitriptyline tofranil antihistamines such as loratadine (claritin) used to reduce urinary urgency and frequency and also relieve other symptoms.

"People with bladder distention (stretching of the bladder with weather), have severe pain and those who can hold low volumes of urine are possible candidates for surgery,” Mayele says.

Moldwin says there are many theories of causation with regard to interstitial cystitis and probably the most popularised theory is that there is a defect in the surface mucin of the bladder.

"The surface mucin of the bladder is a slimy substance which seems to protect the bladder against bacterial invasion and also protects the underlying cells and nerves against some of the caustic agents in urine,” he says.

Moldwin, however says there are lots of other theories of causation. For example, some investigators have found that many interstitial cystitis patients have a lack of blood supply to the bladder wall and others have found problems suggestive of an autoimmune process (the body seems to actually be attacking itself.

Moldwin notes that another theory of causation is that some micro-organisms are missing but that does not mean that the germs cannot be found, but there are medications to reduce the pain which include DMSO (medication which is injected in the bladder) decreases the levels of substance P in the bladder wall.

He explains that substance P is a chemical that is found in high quantities in the urine and the bladder walls of interstitial cystitis patients. Substance P is responsible for inflammation and is also a chemical that is used to transfer pain information within nerves.

"When the DMSO contacts the bladder wall, the substance P is released and hopefully the patient’s pain might slowly subside. Unfortunately, as the medication works, the release of substance P can cause more irritation and patients often experience a significant worsening of symptoms during the first few instillations,” says Moldwin.

He says medicines used in the field include elmiron, tricyclic antidepressants, and hydroxyzine, and treatment where anesthetic is put directly into the bladder, and although it is not yet approved for use with interstitial cystitis, early clinical evidence has shown it can calm a lot of the symptoms.