In April 2020, the Food and Drug Administration (FDA) requested that all forms of prescription and over-the-counter (OTC) ranitidine (Zantac) be removed from the U.S. market. They made this recommendation because unacceptable levels of NDMA, a probable carcinogen (or cancer-causing chemical), were present in some ranitidine products. People taking prescription ranitidine should talk with their doctor about safe alternative options before stopping the drug. People taking OTC ranitidine should stop taking the drug and talk with their healthcare provider about alternative options. Instead of taking unused ranitidine products to a drug take-back site, a person should dispose of them according to the product’s instructions or by following the FDA’s guidance.
Interstitial cystitis (IC) is a chronic bladder syndrome in which there is the presence of pelvic pain, bladder pain or pressure, and urinary frequency or urgency. The pain can range in severity from mild to severe.
It affects approximately 4 to 12 million people in the United States alone. It is mostly women who have the condition, but IC can affect any individual, regardless of age, race, gender, or ethnicity.
IC is also commonly referred to as painful bladder syndrome (PBS), bladder pain syndrome (BPS) and chronic pelvic pain (CPP).
Some cases of IC continue for over 2 years. People with ongoing IC progress to having hard bladders with pain and a low capacity for storing urine.
People with IC may be sensitive to certain foods and beverages.
IC may also be accompanied by other conditions, such as constipation or irritable bowel syndrome (IBS), that flare up in the presence of certain foods.
There is a range of items a person should exclude from the diet after receiving an IC diagnosis, such as:
- tea and coffee
- citrus and cranberry
- artificial sweeteners
- spicy food
Some people may need to exclude other food items, and it is important to eliminate specific foods for several weeks to see if symptoms improve.
Acidic foods have often been said to cause a flare-up of symptoms, but there is little evidence to support this. Many fruits and vegetables do not have an irritating effect on the bladder and contain vital nutrients to help fight disease.
The treatment of interstitial cystitis is complex and can involve many approaches.
Potential treatments include:
- physical therapy or alternative therapies, such as guided imagery, massage, energy therapy, or acupuncture
- bladder distention
- bladder instillations with mixtures including DMSO, sodium hyaluronate, Heparin and others
- surgery to repair Hunner’s lesions, such as laser surgery
- neuromodulation, such as the use of electrical nerve stimulators
- injections, such as Botox
There are also several oral medications that can be taken to treat the pain, such as:
- narcotic and non-narcotic medications
- topical medications, such as lidocaine patches, vaginal or rectal diazepam, and topical amitriptyline
- tricyclic antidepressants, such as oral amitriptyline or imipramine (Tofranil)
- antihistamines, such as loratadine (Claritin)
- pentosan (Elmiron)
- immunosuppressants, such as cyclosporine, mycophenolate (CellCept), and mycophenolate mofetil
- alpha-blockers (Flomax)
- antiseizure medications (Neurontin)
- histamine blockers (Tagamet, Pepcid)
- leukotriene inhibitors
- prostaglandins, such as NSAIDS, ibuprofen
- urinary antacids, potassium or sodium citrate, and tricitrates
- urinary tract antispasmodics, including Detrol, Toviaz, VESIcare or certain herbal therapies
If you think you may have interstitial cystitis, speak with your healthcare provider for further examination and to discuss treatment.
Symptoms of interstitial cystitis may vary, although they typically include the following:
- chronic pelvic pain
- pain in the perineum, urethra, lower abdomen, and lower back
- pain in the vulva or vagina in females and the testicles or penis in males
- frequent and urgent urination, up to 60 times per day
- pain while the bladder is full and relief after emptying the bladder
- painful sex, or dyspareunia
Complications from IC can vary between individuals, but they include:
- reduced bladder volume
- a diminished quality of life
- decreased or altered sexual intimacy
- emotional distress
While the cause of IC is unknown, there are several theories as to what triggers the condition.
Some possible causes include:
- defects in the lining of the urinary bladder that cause irritation
- bladder trauma or overstretching
- pelvic floor muscle dysfunction
- autoimmune disorders
- primary neurogenic inflammation
- spinal cord trauma
Another possible cause of IC is sexual, physical, or childhood abuse. However, more research is needed in this area.
There are steps an individual can take to manage IC outside of dietary changes.
Self-care modifications can be made, such as:
- bladder retraining
- stress management
- smoking cessation
- wearing loose clothing
- enforcing healthy sleep habits
While these are not recommended as stand-alone measures, they can help to reduce symptoms and increase comfort for people with IC.
Another option is neutraceuticals, which trigger changes in the body despite being natural products. These include:
- Calcium glycerophosphate: This reduces the effects of substances that could irritate the bladder.
- L-arginine: This increases nitric oxide production, produces antibacterial, hormone-stimulating effects, and relaxes blood vessels. However, this treatment does not have an effect on people who make enough of their own nitric oxide and might not be effective for all people with IC.
- Mucopolysaccharides: These can help replenish the outer layer of the bladder.
- Bioflavonoids, such as quercitin: These have antioxidant and antibacterial qualities.
- Chinese herbs, such as Cornus, gardenia, rhubarb, and Rehmannia: These are sometimes offered as an alternative to conventional treatment.
Physical therapy of the pelvis can also help soothe pain and discomfort, and exercises to strengthen the pelvic floor muscle, such as Kegels, can help support and relieve the passing of urine.
Acupuncture can also be used to calm symptoms.
Sex therapy can help to increase libido and reduce orgasmic disorders. This can be as simple as being sure to urinate before and after intercourse or reducing the length of sexual encounters, or it may involve visiting a sex therapist.
An IC diagnosis is not “one size fits all” and currently has two recognizable subtypes:
- Ulcerative IC: This is a subtype of IC characterized by red, bleeding patches on the walls of the bladder known as Hunner’s ulcers. It affects approximately 5 to 10 percent of people diagnosed with IC.
- Non-ulcerative IC: This subtype involves tiny hemorrhages on the bladder wall known as glomerulations. It affects many people with IC, although the symptoms of non-ulcerative IC can also occur in any bladder inflammation.
During the evaluation of potential IC, several tests may be completed to make a diagnosis.
These tests may include:
- taking a medical history
- completing a bladder diary
- pelvic examination, including a neurological exam
- urinalysis to rule out or diagnose an infection
Other diagnostic tests that can be carried out include:
- Potassium sensitivity test: This is a test in which potassium and water are instilled into the bladder. In healthy bladders, pain is not felt with either solution. In cases of IC, however, pain is typically experienced when the potassium is instilled.
- Urodynamics: The bladder is filled to test its capacity by measuring the pressure during filling and draining. These tests evaluate the function of the bladder, urethra, and sphincter muscles.
- Cystoscopy: This is a diagnostic test in which a tube with a camera attached is inserted into the bladder to evaluate its lining. A healthcare provider may also evaluate the bladder capacity with a cystoscopy.
- Biopsy: During a cystoscopy, a biopsy may or may not be taken to examine an individual for cancer or other bladder conditions that can cause pain similar to IC.
While the results may offer a vague insight into the cause of the bladder pain, the only way to definitively diagnose IC is to identify Hunner’s lesions. If these lesions are absent, however, it does not mean that IC is not present.
IC is a chronic condition. It cannot be fully cured, only managed. However, by finding a course of treatment that suits your lifestyle, a good quality of life is still possible.