Interstitial Cystitis

by Makayla Boyle, MBS 2019

Geisinger Commonwealth School of Medicine, Scranton, PA

 

Mentor: Dr. Sonia Lobo, PhD

Do you have pelvic pain that never seems to go away? Do you feel like you need to use the restroom constantly? Well then you could have Interstitial Cystitis (IC) and should go see a doctor. Fair warning, though, your doctor may not know you have IC, because it is very difficult to diagnosis. Because of this, you may go years before you actually begin to receive any sort of helpful treatment. What’s even worse is that the current treatments for IC do not work very well and will only treat your pain. So, while you may finally have some alleviation of your pain, you will still be running to the restroom constantly. Also, the only “cure” available is surgery to remove your bladder (Yikes!). If that seems a little drastic to you, that’s because it is. But no fear, your doctor will not resort to this unless it becomes absolutely necessary.



There is some good news on the horizon. Ongoing research is focused on addressing the gaps in diagnosis and treatment. Because no doctor in their right mind wants to be just as confused as their patient, there has been a movement towards figuring out a better way(s) to diagnosis IC. Also, a doctor’s job is to help a patient feel better. Therefore, there is a movement towards finding a treatment for IC that has long-term effects and will do more than just manage a patient’s pain. While this research is still in testing phases, the hope is that it can be proven effective in clinical trials. The end goal, as may seem obvious, is to have earlier diagnosis and more effective, long-term treatment options available for patients with IC.



IC is difficult to diagnosis, because current diagnosis is most often based on ruling out other possible bladder related diseases. Testing for other illness, waiting for results, and repeating this process until all other options have been accounted for takes quite a bit of time. The only other option currently used to help diagnose IC is the use of scope put into the bladder. The scope can be used to see Hunner’s lesions, which are red patches in the bladder, or multiple, small spots of bleeding. In many cases, neither of these are visible, and the procedure itself is especially painful for IC patients. As such, doctors must resort to the first method for diagnosis.



There are some possible methods in the developmental stages. These methods focus on either collecting urine or taking a sample of bladder tissue from patients. Doctors may be able to use urine samples to look for specific IC biomarkers, such as nerve growth factor and MAPK genes, that would show an increase in expression above what is considered normal if a patient has IC. A urine sample may also be used to look for the presence of antiproliferative factor. The other method consists of sampling bladder tissue in the form of a biopsy to look at other markers including WNT11, uroplakin III, TSG-6, and nerve fiber growth. For this, there would be increased expression of TSG-6 and nerve fiber growth and/or decreased expression of WNT11 and uroplakin III. The specific increase or decrease in expression of any of these markers may be used in the future to help diagnose IC at an earlier stage.



The second area lacking is in the treatment of IC. I have already stated that these treatment options mainly focus on alleviating pain and do not usually work long-term. Doctors follow an AUA guideline that lays out the order in which treatments should be used. The order of this guideline progresses from common treatments for more mild cases of IC to surgery for chronic cases. As can be seen in these guidelines, though, they mainly focus on pain and not the other symptoms of IC.



There is ongoing research looking into better treatments options that look at targeting either bladder function or IC associated inflammation. Researchers have looked at using either methanol or an injection of hyaluronic acid directly into the bladder to help reduce bladder inflammation. This may also help some of the pain associated with IC. Other treatment options look into restoring bladder capacity to normal levels. Such treatments include the use of TSG-6, transplantation of stem cells, injection of pioglitazone, or oral medication with AQX-1125. Studies on these treatments have shown that they increase the capacity of the bladder and/or decrease the amount of times a person feels that they need to urinate. The hope is that once proven effective for long-term use, these treatments can be used to treat more than just IC related pain.

Support for living with IC, as well as further information new on treatments, can be found at this link.