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Diagnosis of Interstitial Cystitis
Interstitial cystitis [IC]
is not difficult to diagnose. The most important aspect of the diagnosis is to be aware and suspect it [called a high index of suspicion]. The certain way to make the diagnosis is to examine the bladder under general anaesthesia or spinal anaesthesia with a camera [cystoscope].
The bladder is first examined while stretching it with fluid. This fluid is retained for two minutes and drained. Finally the bladder is re-filled.
If IC is present, the small blood vessels on the bladder surface ‘crack’ and show as pin-point bleeding areas called glomerulations [see diagnosis of IC]. A bladder biopsy can be taken from an area of glomerulation, but this is not essential. The alternative to a bladder biopsy is an examination of the cells in the urine [cytology], to detect abnormal cells.
What do we know for certain?
Although we do not know the precise cause of IC, we are certain that it is a chronic inflammation of the bladder wall. It might also contain mast cells [cells that contain histamine], although not essential for diagnosis.
How should IC be treated?
Unlike the cystitis from infection which responds to one week of treatment, interstitial cystitis requires longer duration of treatment [up to three months] to allow the bladder wall enough time to heal from the chronic inflammation.
Options for treatment of IC [visit www.ichelp.com]
Investigation of pelvic pain
During the investigation of pelvic pain, a common operation is a laparoscopy. We previously showed that no cause is found for this problem in 40% of women. This raises the possibility that pelvic pain could be from the bladder or bowels, which like the ovaries, fallopian tubes and uterus, are the other organs in the pelvis.
If the symptoms fit, then the bladder should also be examined.
Symptoms:
Urinary – frequency during the day and at night; and urgency; blood in the urine
Pain – pubic area, at penetration and during intercourse, bladder spasms.
Unusual bladder sensation – like ‘blades in the bladder’ or broken glass in the bladder’ or a red-hot poker in the bladder.
Blood in the urine
Signs:
Pubic tenderness, rawness in the vestibular area
Urine test
Cystoscopy - click to view video
Bladder biopsy
Mild chronic inflammation
Mast cells
Absence of other abnormality
Interstitial Cystitis Slide Presentation
Interstitial Cystitis in Women - Click to view presentation
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At Cystoscopy
At Histology
Inflammation within bladder muscle
At Histology
Mast cells within Bladder muscle
At Histology
Special stains for mast cells within muscle
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