Interstitial Cystitis: Symptoms and Diagnosis Insights

The diagnosis of interstitial cystitis?

Hello, Dr.
Hsu.
I have been experiencing symptoms of frequent urination for about two months.
On one hand, I often feel a strong urge to urinate after about 150cc, and I can only hold it in until about 300cc at most, after which I frequently start leaking urine.
On the other hand, it seems that my urine production is quite rapid; sometimes, even when I haven't consumed much water (and my food doesn't contain much liquid), I find myself unable to hold it in and urinate two to three times within an hour, with each time being about 200 to 280cc.
However, the kidneys seem to produce urine at a rate of about 60 to 100cc.
This urine production rate seems abnormal.
I have undergone various tests at the hospital, ruling out issues such as kidney stones (ultrasound), kidney dysfunction (urinalysis + ultrasound), diabetes (blood test), urinary tract infection (urinalysis), benign prostatic hyperplasia (not considered due to my age, so no tests were done), diabetes insipidus (urinalysis), and urinary retention (ultrasound + uroflowmetry).
Therefore, the hospital doctors diagnosed me with overactive bladder, but they are concerned that there might still be an undetected infection, so they prescribed me a two-week course of antibiotics and anti-inflammatory medication, along with a two-month supply of medication for overactive bladder (with a long-term prescription).
However, two months later, not only has there been no improvement, but I have also started experiencing nocturia, and during the day, I frequently have sudden urges to urinate.
If I am not quick enough to respond, I will leak a little urine, but if I manage to hold it in when my bladder isn't too full, I can temporarily suppress the urge.
I have also experienced a significant decrease in the flow rate towards the end of urination, where it dribbles out, and I have to exert abdominal pressure to fully empty my bladder.
There have been several instances where, after urinating, I still feel a sense of residual urine, and after about ten seconds, I can expel another 10 to 20cc of urine.
Additionally, when I hold my urine until it exceeds 250cc, I sometimes feel a burning sensation in the urethra during urination, along with a prickling feeling.
After urination, I experience a tight, sore sensation in the area around the penis and bladder.
This week, during a follow-up appointment, the doctor scheduled me for a cystoscopy to check for interstitial cystitis, mainly because I feel some pain when pressing about five centimeters below my navel.
The doctor mentioned that he currently cannot identify any other causes, so he is continuing to rule things out.
However, isn't that area related to the intestines? Occasionally, I also feel pain shortly after eating, even when I tighten my abdomen.
I have always thought it was an intestinal issue, which has been a long-standing problem for me.
I have been having regular bowel movements, typically once a day, and very rarely experience constipation or diarrhea.
Therefore, I only seek medical attention when the pain becomes unbearable (the doctor said it was inflammation).
According to information I found online, the typical symptom of interstitial cystitis is pain during bladder filling, but I have noticed that the pain in my area does not seem to worsen or improve with bladder filling or urination.
Moreover, when that area is not painful, my frequent urination does not improve either.
Most of the time, I only feel pain when I press on that area.
Does this still align with the symptoms of interstitial cystitis? Additionally, the worsening symptoms I mentioned do not seem to match the typical symptoms of interstitial cystitis but rather resemble benign prostatic hyperplasia or a urinary tract infection (which the hospital doctors ruled out early on).
Furthermore, if that area is indeed related to the intestines, could the pain possibly be connected to the frequent urination? I apologize for the lengthy questions, and I appreciate your time, Doctor.

Zhonglin, 30~39 year old female. Ask Date: 2022/02/16

Dr. Xu Wencang reply Urology

Unlike typical interstitial cystitis, it may also involve chronic pelvic pain.
Follow-up treatment can be done in an outpatient setting.

Reply Date: 2022/02/16

More Info

Understanding interstitial cystitis (IC) can be quite complex, especially when symptoms overlap with other urological or gastrointestinal conditions. Based on your detailed description, it seems you are experiencing a range of urinary symptoms that have not improved despite treatment. Let’s break down your situation and address your concerns.

Symptoms Overview
You mentioned experiencing frequent urination, urgency, and discomfort during urination. The fact that you feel a strong urge to urinate after only a small volume (150cc) and experience leakage indicates a significant bladder irritability. Additionally, the sensation of heat and tightness in the urethra, along with the feeling of incomplete bladder emptying, can be distressing and may suggest an underlying issue.

Interstitial Cystitis vs. Other Conditions
1. Interstitial Cystitis (IC): IC is characterized by chronic pelvic pain, pressure, or discomfort in the bladder and surrounding pelvic region, often accompanied by urinary frequency and urgency. While pain typically worsens with bladder filling and improves with urination, some patients report pain that does not correlate directly with bladder fullness. Your description of pain upon deep pressure in the lower abdomen could suggest IC, but the absence of pain correlating with bladder filling is atypical.

2. Prostatitis or Enlarged Prostate: Although you are young and your doctor has ruled out prostate issues, symptoms like urgency, frequency, and discomfort can sometimes be attributed to prostatitis. This condition can cause pelvic pain and urinary symptoms similar to IC.

3. Urinary Tract Infection (UTI): While you have been tested for UTIs, it’s worth noting that some infections can be difficult to detect. Symptoms of urgency, frequency, and burning can overlap with IC, so if your symptoms persist, a repeat urine culture may be warranted.

4. Gastrointestinal Issues: Given your history of abdominal pain, it’s important to consider that gastrointestinal issues, such as irritable bowel syndrome (IBS) or other functional gastrointestinal disorders, can sometimes present with pelvic pain and urinary symptoms. The bladder and bowel are closely related anatomically and functionally, and issues in one can affect the other.

Next Steps
1. Cystoscopy: The bladder scope (cystoscopy) your doctor has scheduled is a crucial step in diagnosing IC. This procedure allows direct visualization of the bladder lining and can help identify any abnormalities, such as Hunner’s lesions, which are indicative of IC.

2. Pain Assessment: Since you experience pain primarily upon pressure, it may be beneficial to keep a pain diary. Documenting when the pain occurs, its intensity, and any associated activities can provide valuable information to your healthcare provider.

3. Consider a Multidisciplinary Approach: Given the complexity of your symptoms, a multidisciplinary approach involving urologists, gastroenterologists, and possibly pain specialists may be beneficial. This can help ensure that all potential causes of your symptoms are thoroughly evaluated.

4. Lifestyle Modifications: While awaiting further evaluation, consider dietary changes that may reduce bladder irritation. Some patients find relief by avoiding caffeine, alcohol, spicy foods, and artificial sweeteners.

5. Symptom Management: If IC is confirmed, treatment options may include medications to relieve pain and inflammation, bladder instillations, and physical therapy focused on pelvic floor dysfunction.

Conclusion
Your symptoms are indeed concerning and warrant thorough investigation. While interstitial cystitis is a possibility, the overlap with other conditions means that a comprehensive evaluation is essential. The upcoming cystoscopy will be a key component in determining the underlying cause of your symptoms. In the meantime, maintaining open communication with your healthcare provider about any changes in your symptoms will be crucial for effective management.

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