Persistent Bladder Trouble
Could be Interstitial Cystitis

SYMPTOMS OF INTERSTITIAL CYSTITIS The average age of onset of IC is 40, with 25 percent of patients under age 30. About half of patients experience spontaneous remissions and flare-ups. Symptoms include: A persistent, urgent need to urinate A burning sensation when urinating Pelvic or bladder pain Diminished bladder capacity Pain during sexual intercourse

That all changed in July 2004 when the pelvic pain and bladder pressure became so intense that Quintero landed in the emergency room three times in one week. As usual, tests for a UTI were negative.

"I was beside myself because no one could figure out what was wrong with me," says Quintero, who is now 40. She described her symptoms as "a bladder infection multiplied by 100."

After seeking out several specialists, she finally found an answer. She was diagnosed with interstitial cystitis (IC), a chronic and often severe inflammation of the bladder wall. It is estimated that between 750,000 and 1 million Americans – most of them women – have IC, also known as painful bladder syndrome. Its cause is unknown.

Painful bladder syndrome
Quintero's experience is not uncommon: on average, people with IC have painful flare-ups of symptoms for four years before receiving a diagnosis. IC is elusive because there is no definitive diagnostic test for the ailment, so doctors must first rule out other bladder disorders. Its symptoms mimic those of a UTI, but urine cultures are free of infection-causing bacteria, making antibiotics useless.

Mark Lenters, MD, a gynecologist and obstetrician with OB/GYN Associates of Holland, says that his office treats four to six women a month for IC. The diagnostic test that he uses begins with a questionnaire that asks patients to rate the severity of their symptoms.

"If they score high enough, we perform a potassium-chloride instillation test," Dr. Lenters says. For this test, a doctor uses a catheter to fill the patient's bladder with a potassium chloride solution. If the patient has IC, the solution will irritate the inflamed bladder wall and cause pain, leading to a diagnosis. Medication is then administered to relieve the pain.

Another test is cystoscopy, which allows doctors to view the bladder through a thin tube with a tiny camera. For this procedure, performed under anesthesia, a urologist examines the bladder wall for hemorrhages or ulcers that indicate IC. These are the wounds that scar the bladder wall and make it stiff, decreasing bladder capacity and sometimes causing bleeding.

Relief for IC sufferers
Although there is no cure for IC, there are several treatments that can help alleviate symptoms:

• Avoid foods that trigger symptoms, such as alcohol, caffeine, chocolate and acidic foods and drinks.
• The medicine Elmiron, taken orally, helps protect the bladder lining from the toxic parts of urine. Doctors may also prescribe an antihistamine or the pain-blocker Elavil.
• Other treatments include bladder distention – overfilling the bladder (under anesthesia) to stretch it – and bladder instillation – filling the bladder with liquid medicine.

"If I stay on my medication routine, I can make it through each day and be comfortable," says Quintero, who still has mild pain. Her goal now is to spread the word about IC to help others avoid needless suffering.

Dr. Lenters agrees that more people should be made aware of IC, but cautions that there are many other conditions that can cause pelvic and bladder pain. People with recurring symptoms should consult their health care providers.

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