• • • A chronic bladder condition with lower urinary tract symptoms lasting over 6 wks with no diagnosis of infection or other clear cause
    • Two types
      
      • Hunner’s Ulcers
        
        • Distinctive areas of inflammation on the bladder wall that characterize the classic form of IC
        • 5-10% of IC patients
      • Non-Ulcerative
        
        • Pinpoint hemorrhages, also known as glomerulations, in the bladder wall
        • Also referred to as Bladder Pain Syndrome
        • 90% of IC patients
    • Difficult to estimate the number of people affected as a result of there being no standard diagnostic protocol
    • Typically 2-3x more common in women than in men
    • Risk increases with age

• • What causes IC/BPS is not exactly known, but there are many theories including:
    
    • A defect in the bladder tissue, which may allow irritating substances in the urine to penetrate the bladder
    • A specific type of inflammatory cell, called a mast cell. This cell releases histamine and other chemicals that lead to IC symptoms
    • An agent in the urine that causes damage to the bladder
    • Changes in the nerves that carry bladder sensations so pain is caused by events that are not normally painful (ie: bladder filling)
    • The immune system attacks the bladder

• • Vary for each patient and range from mild to severe
  • Suprapubic/pelvic pain that may worsen as the bladder fills, be constant or may come and go
    
    • Can be felt in other areas including the urethra, lower abdomen, lower back,
      pelvic/perineal area, vulva/vagina (in women) and scrotum/testicles/penis (in men)
  • • Pressure/discomfort when the bladder is filling
    • Urinary frequency often of small amounts, upwards of 60x a day
      
      • Average number of times a person urinates per day: 7
    • Persistent urinary urgency that can be triggered by
      
      • Certain foods/beverages
      • Physical/mental stress
      • Menstrual cycle
      • Sexual intercourse

• • Medical history to
    • Address symptoms
    • Past and current health problems
    • Over-the-counter and prescription drugs being taken
    • Diet and liquid consumption
  • Tests
    • Baseline Pain Evaluation: Series of questionnaires to determine your baseline pain value with the goal of finding pain location(s), intensity and characteristics and identifying factors that make pain/discomfort better or worse
    • Voiding Diary: To evaluate your voiding patterns 
    • Urodynamic Evaluation: The bladder is filled with water through a catheter to measure bladder pressures as it fills and empties *IC patients have a low capacity and potential pain with filling
    • Cystoscopy: Bladder is looked at through a cystoscope and often the bladder will be filled with water to see how much it can hold
      • If Hunner’s ulcers are seen (distinctive areas of inflammation on the bladder wall), the diagnosis is fairly certain

*All IC patients respond differently so trial and error needs to be carried out in order to determine what will work best for you

• • Diet: Certain foods can worsen symptoms
    • Bladder irritants for most: Alcohol, caffeine, artificial sweeteners, carbonated beverages, chocolate, citrus fruits, tomatoes and spicy food (See Diet section for a more extensive list)
    • Determining which foods irritate your bladder can be discovered through an elimination diet
  • Physical Activity: Walking and gentle stretching
  • Stress Reduction: Learning stress reduction methods including mindfulness meditation and restorative yoga can be helpful, as stress is a major flare trigger. (See the Lifestyle section)
  • Pelvic Physiotherapy: To reduce tenderness/pain/spasms in the pelvic floor area through exercise and massage
    • The Canadian Urological Association (CUA) recommends that everyone diagnosed with IC has a pelvic floor exam, looking for trigger points
    • Studies show that 79% of people with IC/BPS have trigger points in the pelvic floor
    • Up to 83% of patients who see a pelvic floor physiotherapist have their symptoms improved/resolved
  • Bladder Retraining: Helping you begin to hold more urine for longer periods of time by gradually increasing the time between each visit to the bathroom
    • Track the number of times and how often you have the urge to urinate 
    • Use the diary to gradually increase the length of time between bathroom breaks
  • Medications (Oral & Intravesical)
    • Pentosan polysulfate sodium (Elmiron): Used for treating pain
      • It could take up to 6 months before any improvement is noticed
      • Ophthalmic screening is advised for any patient who has taken Elmiron with any vision complaints for evidence of retinal maculopathy
      • ELMIRON ADVISORY
    • Heartburn medications: To reduce the amount of acid made by the body
    • Muscle relaxants: Can help relieve the symptoms by keeping the bladder from squeezing at the wrong time
    • Antihistamines: Decrease the amount of histamine in the bladder that leads to pain and other symptoms
    • Tricyclic antidepressants: Amitriptyline/nortriptyline have been shown to decrease bladder spasms and slow the nerves that carry pain messaging
    • Bladder Instillations: The bladder is filled with liquid medication including Dimethyl Sulfoxide (DMSO) and Heparin, through a catheter
      • DMSO may block swelling, decrease pain sensation and remove free radical toxins that can cause tissue damage
      • Combined with Heparin/steroids to decrease inflammation
    • Bladder Stretching/Hydrodistension: The bladder is filled with sterile water in order to distend it and increase the amount of urine it can hold
    • Neuromodulation Therapy
      • Delivers harmless electrical impulses to nerves to change how they work
      • More effective for urgency/frequency reduction, but can sometimes help with the bladder/suprapubic pain
    • Sacral Neuromodulation (SNS)
      • Changes how the sacral nerve works (the nerve that carries signals between the spinal cord and the bladder)
      • Electrical wire is implanted under the skin in the lower back
      • It’s first connected to a handheld pacemaker to send pulses to the sacral nerve
      • If it helps, a permanent pacemaker that can regulate the nerve rhythm is implanted
    • Cauterization/Steroid Injections: May provide long-term relief for those with Hunner’s ulcers for up to a year or more
    • Injections: To relieve pain, botulism is injected through a catheter to paralyze the bladder muscle
      • These often need to be repeated every 6-9 months
    • Cyclosporine: Immunosuppressant therapy reserved for severe cases only
    • Surgery: Bladder/parts of the bladder are removed
      • Reserved for patients with severely limited bladder capacity or severe symptoms that have not responded to other treatments