LOUISVILLE The Hubbard Clinic has treated over 1500 cases of Interstitial Cystitis (IC) since 2000. Many patients tell us they have had an extensive work-up and been told everything is normal, yet they continue to have symptoms.
Our most common complaint is symptoms of a UTI, yet antibiotics don’t really help; and when we get records, their urine cultures (when obtained) were negative. A typical UTI is a bacterial infection involving the mucosal lining of the bladder. A urinalysis is very helpful but never totally accurate, so a urine culture is imperative. If the culture is negative, antibiotics are not indicated. On the other hand, IC is a nonbacterial irritation/inflammation of the inner wall of the bladder because of microscopic leaks in the bladder mucosa. Therefore, urine (which is high in potassium) leaks into the inner bladder wall, causing muscles and nerves to become irritated. This leads to typical IC symptoms of frequency (tight muscles lead to decreased bladder capacity), nighttime voiding, discomfort with a full bladder, urethral pain, feeling of incomplete emptying, pelvic pain/pressure, and pain with intercourse.
Recent large studies reveal three-to-six percent of females have some symptoms of IC, and it tends to run in families. The female-male ratio is 5:1. The cause of IC is unknown. It is not infrequently associated with migraine headaches, irritable bowel syndrome, fibromyalgia, and endometriosis – yes, other conditions that are difficult to diagnose but nevertheless very symptomatic and painful to the patient.
Treatment depends on the severity of the symptoms. The most important step is telling the patient that I believe I know what is causing their symptoms; it is not in their head; it will not take one day off their life; and it is treatable but chronic so they must follow all of our advice to get better. In mild cases this explanation plus diet changes is all that is needed.
In more symptomatic cases a cysto/hydrodistension/biopsy is done under conscious sedation in the office. At different levels of sedation the patient reacts to pain, so a determination is made of the degree of urethral pain, posterior bladder pain, bladder pain as the bladder is distended, and bladder volume. Biopses are then obtained to count mast cells to gauge if environmental pollutants are playing a role. At the end of the procedure a pain cocktail is instilled into the bladder to alleviate post-op discomfort.
These findings tell us how aggressive we need to be in our treatment. Rarely is only one treatment needed. There is a lot of trial and error when coming up with the right ingredients for a particular patient, especially when it comes to diet, meds, and allergies. Treatments presently being used in our clinic include: oral medications, dietary advice, bladder instillations, behavioral therapy, physical therapy, Botox bladder instillations, and Allergist consultation.
John Hubbard, MD, urologist, is a solo practitioner and medical director of the Hubbard Clinic.