Tubulointerstitial Cystitis
Also known as: Interstitial
Nephritis
What is it?
Tubulointerstitial cystitis is a chronic
inflammation of the bladder that causes frequent,
painful urination.
Who gets it?
Tubulointerstitial cystitis affects more than
700,000 Americans each year, and as many as 90
percent are women over the age of 40. People who
have allergies, inflammatory bowel syndrome,
fibrom yalgia (a condition causing muscle pain),
and vulvitis (pain in the soft folds of tissue
outside the vagina) are at an increased risk for
developing tubulointerstitial cystitis.
What causes it?
No one knows the exact cause of
tubulointerstitial cystitis. An undetected virus
or an autoimmune disorder set in motion by a
bladder infection may be the cause. Some
researchers theorize that cells normally involved
in allergic responses release histamine into the
bladder, resulting in tubulointerstitial cystitis.
Recent research suggests that leaky bladder
syndrome may be a cause of tubulointerstitial
cystitis due to harmful substance that are allowed
to leak through the layer of protective mucus that
lines the bladder. Because tubulointerstitial
cystitis affects mostly females, researchers think
that hormones possibly contribute.
What are the symptoms?
Symptoms of tubulointerstitial cystitis can be
excruciating and may vary from patient to patient.
They include bladder pain, fever, and discomfort
while urinating and during sexual intercourse.
Symptoms may change from day to day or week to
week, or they may remain constant for months or
years and then resolve spontaneously, with or
without therapy.
In premenopausal women, symptoms often worsen
with menstruation. Some pregnant patients may
experience complete relief during the second and
third trimesters.
How is it diagnosed?
Tubulointerstitial cystitis is usually
diagnosed by means of exclusion. The doctor,
usually an urologist or gynecologist, may take a
through medical history of the patient and perform
tests to rule out other causes such as infection
and bladder stones.
The doctor may perform a procedure called
cystoscopy with hydrodistension under general
anesthesia. The doctor inserts a fiber-optic tube
through the urethra and into the bladder and fills
it beyond its usual capacity with liquid or gas to
stretch it and allow a closer view of the bladder
lining. In most cases of tubulointerstitial
cystitis, tiny hemorrhages on the inside wall of
the bladder are visible during the procedure.
During cystoscopy, the doctor may take a biopsy
(tissue sample) of the bladder to rule out bladder
cancer and look for evidence of an allergic
response among the cells.
What is the treatment?
While there is no cure for tubulointerstitial
cystitis, many treatments can offer patients
relief from the symptoms. The doctor may prescribe
oral medications and bladder instillations - drugs
that are introduced into the bladder by catheter
and held for 15 minutes. Common treatments for
tubulointerstitial cystitis include tricyclic
antidepressants taken at low doses to relax the
bladder and reduce pain an inflammation.
Amitriptyline is the medication most commonly
prescribed to treat the condition. The doctor may
also prescribe Pentosan polysulfate sodium (Elmiron),
which is the only oral drug approved by the FDA
specifically for tubulointerstitial cystitis. It
improves the bladder lining, making it less leaky
and therefore less inflamed and painful.
Antihistamines such as hydroxyzine (Atarax,
Vistaril) interfere with the cells' release of
histamine, helping to relieve bladder inflammation
and pain, urinary frequency, and nighttime
urination. The doctor may recommend nonsteroidal
anti-inflammatory drugs (aspirin, naproxen sodium,
ibuprofen) and acetaminophen to help with pain
relief.
Self-care tips
In about 50 percent of all cases of
tubulointerstitial cystitis, the disease
disappears on its own. No single treatment will
alleviate all symptoms, so it is important that
the patient discovers what works through trial and
error.
Tubulointerstitial cystitis can be both
physically and psychologically disabling; patients
often need help coping with its many effects.
Sometimes psychotherapy is recommended, especially
if depression or anxiety is a problem. Support
groups, which give people a chance to talk with
others who are in a similar situation, can also
help.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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