Interstitial cystitis is called inflammation of the bladder, not associated with 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 bladder mucosa and muscles. Many nerve endings are concentrated in this space, their irritation leads to pain. Another name for this condition is painful bladder syndrome (BPS).
Causes of 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;
- diseases of the gastrointestinal tract;
- genitourinary surgery;
- weakened immune system;
- change in the biochemical composition of urine due to kidney pathologies;
- hormonal disruptions;
- metabolic disorders;
- chronic stress;
- violations of innervation and tone of the bladder.
Most likely, one of the main causes of pathology is a decrease in immunity. With the 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 Hunner ulcers.
The presence of such ulcers is one of the main signs of the disease. In detail, the main symptoms and treatment of interstitial cystitis will be discussed below.
Clinical picture
The main symptom 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. Pain in interstitial cystitis in women increases during menstruation and during intercourse, after drinking alcohol and eating spicy foods.
Another manifestation of the disease is a violation of the excretion function. Patients are concerned about frequent, sometimes false urge to urinate. Their frequency canreach up to 100 times a day, including at night. The analysis determines changes in the composition of urine and blood impurities.
After urination, there is a feeling of incomplete emptying of the bladder. The pain syndrome can be of different intensity: from a slight burning sensation to severe discomfort.
Against the background of symptoms of interstitial cystitis, depression, insomnia, and irritability develop. This pathology has an extremely negative impact on the quality of life of patients: working capacity is disturbed, general well-being worsens, sometimes sexual life becomes impossible due to pain.
The disease can be periodic, when the exacerbation phase is replaced by remission. But more often this ailment worries the patient constantly and progresses over time.
Diagnosis
It is important to make 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 identified during the examination. These are 3 important criteria for diagnosing interstitial cystitis. These include:
- Reducing the capacity of the bladder. This sign indicates the amount of urine that can be retained in the organ. If the capacity is more than 350 ml, then we can conclude that the patient does not suffer from this pathology. However, this feature is not the most informative, so other survey indicators are also paid attention to.
- Presence of glomerulations. These are small hemorrhages under the mucous membrane of the bladder.
- Hunner's ulcers. They look like orange or pink sores. Not all patients have such injuries, they are more often observed in the later stages of the pathology.
If a patient has hemorrhages or ulcers in the bladder during the examination, the urologist diagnoses "interstitial cystitis".
In the photo below you can see pathological changes (glomerulation) on the mucosa.
The following examination methods are used to detect the disease:
- Hydrodistension. The procedure involves filling the bladder with fluid. This is necessary to determine the elasticity of the body. This method of examination can also be a therapeutic measure at the same time. Many patients report a long-term improvement in well-being after hydrodistension.
- Cystoscopy. It is this study that makes it possible to identify the most important signs of pathology: glomerulations and Hunner's ulcers. Under local anesthesia, a thin long tube is inserted into the cavity of the bladder. An optical device is fixed at the end of the device; with its help, the mucous membrane of the organ is examined.
- Potassium test. A solution of potassium chloride is injected into the bladder. This analysis reveals the barrier properties of the mucous membrane of the organ. In he althy people, the injected solution does not penetrate into the interstitial tissue. Therefore, their test is not accompanied by any unpleasantsensations. If a person is sick, then the mucous membrane passes potassium chloride into the interstitial space. There are pains in the lower abdomen and the urge to urinate.
Also, to clarify the diagnosis, urine tests are prescribed: for general indicators and for bakposev. It is necessary to separate interstitial cystitis from inflammation of an infectious origin.
In some cases, cystoscopy is combined with tissue biopsy. But such a procedure is not required. It is carried out only when the doctor suspects a patient has an oncological pathology.
Medicated treatment
How to treat interstitial cystitis without resorting to invasive methods? There are many drug treatments for this disease. If the pathology is not running, 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 drug treatment may vary from doctor to doctor. The most commonly prescribed medications are:
- "Elmiron". This drug is often 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 drug helps to restore the barrier function of the mucous membrane. They also use the drug "Heparin", which is one of the analogues of "Elmiron".
- Non-steroidal analgesics and anti-inflammatory drugs. With severe pain syndrome, drugs are prescribed"Ibuprofen", "Indomethacin", medicines with paracetamol are used to reduce inflammation.
- Antidepressants. Usually prescribe the drug "Amitriptyline". It has not only a sedative, but also a slight analgesic and antidiuretic effect. This helps relieve pain and reduce the urge to urinate. And also the medicine helps to eliminate depression, which often accompanies the disease.
- Preparation "Urolife" in capsules with hyaluronic acid. This substance strengthens the lining of the bladder.
- Antihistamines. There is an assumption that inflammation and pain provokes an excess of histamine. Therefore, some doctors prescribe anti-allergy drugs: Suprastin, Tavegil, Dimedrol. However, the histamine theory of cystitis has not been confirmed.
- Cholinolytics and "Cyclosporin A". These medicines reduce the frequency of the urge to urinate.
Drug therapy is supplemented with physiotherapy, the introduction of drugs directly into the bladder (instillations), physiotherapy. Patients are also advised to follow a diet.
exercise therapy, psychotherapy and diet
With interstitial cystitis, moderate physical activity is indicated. There is a special gymnastics (Kegel exercises), which is aimed at strengthening the muscles of the pelvis. This is a good remedy for preventing urinary incontinence. Patients need to exercise for at least 6 months, this will helpincrease the tone of the muscles of the bladder. As a result, the frequency of calls will decrease.
Psychotherapeutic treatments include bladder training. By volitional efforts, 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. One hand massages the vaginal area, and the other - the abdominal wall. This treatment improves circulation and reduces inflammation.
Diet plays an important role. It is necessary to exclude spicy foods, chocolate, coffee, cocoa, tomatoes and citrus fruits from the diet. Alcoholic and carbonated sweet drinks are prohibited. Drink at least 1 liter of water per day.
Instillations
Topical treatment is used along with oral medication. 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 at the same time. "Heparin" hasanti-inflammatory effect and helps to restore the mucosa, and Actovegin improves blood circulation in the organ.
- "Urolife" in the form of a solution. The drug with hyaluronic acid acts directly on the mucous membrane, contributing to its recovery. Often instillations are combined with oral administration of "Urolife" capsules.
Physiotherapy
Physiotherapy is used simultaneously with instillations for better absorption of drugs. Assign 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, conduct sessions of electrical stimulation of the bladder. This improves the tone of the muscles of the organ and reduces the frequency of urges.
Surgical treatment
Surgical interventions are used extremely rarely, only in cases where the disease is not amenable to conservative treatment.
The most gentle method is cauterization of the bladder with a laser. This allows you to remove lesions on the mucosa. The operation is performed under general anesthesia. No hospital stay is required, after 1 - 1.5 hours the patient can go home.
In severe cases, abdominal operations are performed. The affected area is excised and replaced with part of the intestine. Sometimesthe bladder must be removed completely. A new organ is also formed from the intestine. 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 disease:
- timely treatment of diseases of the excretory and reproductive system;
- avoiding contact with allergens;
- strengthening the immune system;
- minimizing stressful situations;
- restriction in the diet of spicy and s alty foods;
- Regular medical check-ups.
Reviews on therapy and diagnostics
You can find positive feedback from patients with interstitial cystitis about the treatment with the antidepressant "Amitriptyline". Patients had less urge to urinate, less pain and better sleep.
Patients also note the effectiveness of the drug "Elmiron". It affects 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 substances that enter the body along with s alty and spicy foods irritate the bladder.
Patients leave positive feedback abouttreatment of interstitial cystitis with instillations and physiotherapy. Good results are obtained by the introduction of "Dimexide" and "Lidocaine" into the bladder in combination with magnetotherapy. However, patients note that it is impossible to supercool, 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 identify interstitial cystitis. The reviews note that patients had to go through many different doctors and examinations before a correct diagnosis was made. This disease can masquerade as other pathologies. 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 unfounded. In modern medicine, cystoscopy is performed under anesthesia and is quite tolerable. Only this examination can accurately identify pathological changes and make the correct diagnosis.
