Interstitial cystitis, also referred as painful bladder syndrome or bladder pain syndrome, is a chronic disorder of urinary bladder. Interstitial means 'in-between layers' and 'cystitis' means an inflammation of urinary bladder.

It is termed as chronic inflammatory condition of the mucosal and sub-mucosal layers of bladder causing chronic pain or discomfort, urine urgency and increased urine frequency. The signs and symptoms of interstitial cystitis are very similar to urinary tract infections, urethritis, prostatitis or any other bacterial infection of the urinary system. Interstitial cystitis is more common in females than in males and is found to occur in middle-aged people.

Mechanism and structure of urinary bladder:

Urine, which is formed in the kidneys, flows through the ureter and enters the hollow, balloon shaped organ called the urinary bladder. Bladder is a muscular structure with elastic walls, which expands during storage of urine and contracts while excretion of urine. Bladder is covered with epithelial lining, which is a barrier between urine and bladder muscles and prevents any bacterial infections. Urine is thrown out of the body through a tube like structure called urethra.

Causes Interstitial cystitis

The causes for interstitial cystitis are unknown. Yet, there are many theories, which demonstrate the underlying cause. Some of them are:

1. A defect in the epithelium which allows the toxic substances in urine to come in contact with bladder and irritate the bladder
2. Inflammatory cells called as mast cells release histamines and other harmful chemicals in the bladder
3. Changes in the nerve responses of the bladder
4. Auto-immune response of the body attacking the bladder
5. Production of toxic substance in the urine
6. Hereditary factors
7. Some allergies

Over and above this, physical and mental stress and prolonged anxiety are also responsible for triggering the condition. Certain food and drinks also worsen the condition in some people with interstitial cystitis.

Often people with interstitial cystitis are likely to suffer from other chronic conditions like irritable bowel syndrome, fibromyalgia, endometriosis, systemic lupus erythematous, chronic non-bacterial prostatitis, allergies, anxiety disorder, other pain syndromes etc.

Symptoms Interstitial cystitis

The signs and symptoms may vary from person to person. It is also observed that there may be a period of complete remission and the signs and symptoms relapse after a certain period remission. Some of the commonly experienced symptoms are:

1. Pain associated with filling up of bladder and relieved after emptying of bladder
2. Increased urine frequency in the day as well as night
3. Urine urgency
4. Pressure in the bladder or discomfort in the supra pubic area
5. Passing urine stream after waiting for sometime
6. Painful sexual intercourse
7. Pain or discomfort in the perineum
8. Tenderness over the pelvic area
9. Burning sensation while passing urine
10. Discomfort while performing daily activities
11. Women may experience increase in symptoms during menstruation and men may feel pain in scrotum or penis while ejaculation.

Patients may experience some or a combination of these symptoms with varying intensity.

Diagnosis

There is no definite test available to identify interstitial cystitis. However, interstitial cystitis can be ruled out by excluding other similar disease conditions.

Other similar conditions are:

• Urinary tract infection
• Chronic prostatitis in men
• Eosinophilic or tuberculous cystitis
• Bladder cancer
• Endometriosis
• Kidney stones
• Sexually transmitted diseases
• Neurological disorders
• The tests required to diagnose these conditions are urinalysis, urine culture, cystoscopy, potassium sensitivity test, biopsy and culture for prostate secretions.

These investigations also help in finding out changes of interstitial cystitis in the bladder wall. In interstitial cystitis, the inflammation of the bladder wall leads to scarring and stiffness of the bladder wall. There may be pin-point bleeding (petechial hemorrhages) on the wall of the bladder. Some may develop severe patches of inflammation and broken skin of the bladder called as Hunner's ulcers.

Treatment of Interstitial cystitis

There is no specific treatment for interstitial cystitis. Some treatments which are found to be helpful in relieving the symptoms and managing IC are:

• Oral medications include heparin like drug substances, antidepressants, antihistamines and NSAID's
• Bladder distension
• Instilling medications into the bladder for quick response
• Surgeries like fulguration for burning Hunner's ulcers, resection to remove the ulcers, bladder augmentation to remove damaged areas of the bladder and in some cases bladder removal
• Transcutaneous electrical nerve stimulation
• Physiotherapy
• Bladder training
• Dietary changes; avoiding bladder irritants like alcohol, carbonated beverages, citrus products, chocolates and all caffeine products
• Avoiding smoking
• Reducing stress
• Wearing loose clothes
• Interstitial cystitis is a chronic condition, which has periods of remission and relapse; there is no effective treatment, which helps in preventing the relapse or slowing the progression of the disease.

Homeopathic treatment for Interstitial cystitis

The Homeopathic treatment approach is to treat the cause as much as possible and whenever known. If it is difficult to perceive the exact cause, which often happens, the homeopathic treatment is designed to manage the symptoms. Significant relief in symptoms can be archived using homeopathy. Recurring infections affecting the urinary bladder can reduce drastically reducing the need for courses of antibiotics; which itself is a good contribution to the overall health of the patient.

Some of the commonly used homeopathic medicines for interstitial cystitis are Sepia, Staphysagria, Medorrhinum, Cantharis, Lycopodium clavatum, Calcaria sulphuricum, Hepar sulphuricum, Kali carbonicum and more; which are chosen on the basis of the patients state of health, extent of the disease and the nature of symptoms.