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Men and IC

Men often experience difficulties in obtaining an accurate diagnosis of IC. The symptoms of IC in men closely resemble those of non-bacterial prostatitis or prostatodynia (recently renamed chronic prostatitis Type IIIA and IIIB chronic prostatitis/chronic pelvic pain syndrome). Although in recent years awareness of IC has increased markedly in the urologic community, IC is often thought to be a "women's disease," and urologists do not always consider performing diagnostic tests that would help confirm IC in a male patient.

Interstitial cystitis symptoms in men are similar to those experienced by women -- urinary frequency and urgency, often accompanied by suprapubic pain. Men may also experience scrotal and/or anal pain. Many males who ultimately receive a diagnosis of IC have been previously diagnosed with another distressing condition -- chronic prostatitis. Therefore, the actual number of men with IC may not be as low as previously thought.

Chronic Prostatitis (CP)/Chronic Pelvic Pain Syndrome (CPPS)
CP/CPPS is a new term that is used to describe what used to be called prostatodynia or chronic nonbacterial prostatitis. The two subtypes differentiate between cases with evidence of inflammation (white blood cells from prostate secretions in urine) or no evidence of inflammation.

Some researchers believe that a significant percentage men diagnosed with CP/CPPS may actually have IC. A study of the IC urine marker antiproliferative factor (APF) in men diagnosed with IC and CP/CPPS showed that men with definite IC had APF, men with CP/CPPS did not, but also that a number of men diagnosed with CP/CPPS who had voiding symptoms typical of IC (frequency, nocturia, and pain with bladder filling) had APF and should have been classified as having IC.

IC and CP/CPPS
If a man with apparent CP/CPPS also has chronic lower urinary tract symptoms, such as urgency, frequency, nocturia, pain with bladder filling, suprapubic pressure, or painful urination and does not respond to standard therapies for prostatitis, he may have IC. Clinical experience suggests that if these patients are treated specifically for IC, they tend to do better than if they are treated only with typical CP/CPPS therapies.

It is very important for male patients to have a thorough diagnostic workup, which may include hydrodistention and cystoscopy under general or regional anesthesia. This workup will help rule out other medical conditions and will help to rule in IC as a diagnosis.

Other conditions that may have symptoms similar to IC include: urinary tract infections, bacterial prostatitis, bladder cancer, kidney problems, tuberculosis, sexually transmitted diseases, radiation cystitis, neurogenic diseases, and benign prostatic hyperplasia (BPH), also known as enlargement of the prostate gland.

Treatments
Standard IC treatments for males are similar to those used for women. At this time there is no cure for IC nor is there an effective treatment which works for everyone, but a vast majority of IC patients are helped by one or more of the following treatments.

Oral Medicines: Pentosan polysulfate sodium (Elmiron) is the only oral medicine approved specifically for use in IC. It is believed to work by repairing a thin or damaged bladder lining. Low-dose tricyclic antidepressants such as amitriptyline have been shown to help with both the pain and frequency of IC. In IC, these medicines are used for their side effects, including their anti-pain properties, not as a treatment for depression. Other medicines include anti-inflammatory agents, antispasmodics, antihistamines, muscle relaxants, anticonvulsants, and bladder analgesics.

Bladder Distention: The bladder is stretched by filling it with water under general or regional anesthesia. This helps rule out other conditions, may help rule in IC, and may sometimes be therapeutic as well.

Bladder Instillations: These medicines are put into the bladder to relieve IC symptoms.

Anesthetics (numbing agents, such as lidocaine) can be placed into the bladder via catheter to help to provide temporary relief from pain. Lidocaine is often given with bicarbonate, which increases its absorption.
Heparin is also a commonly used component of bladder cocktails.
DMSO (dimethyl sulfoxide/Rimso-50) is instilled directly into the bladder.
Sodium hyaluronate (Cystistat) is approved for use in Canada and Europe, but is not approved for use in the US.

Electrical Nerve Stimulation: Electrical nerve stimulators, also known as neuromodulators, send mild electrical pulses to nerves in the lower back and help manage urinary function or offer relief of chronic pain.

Surgery: Laser surgery is reserved for patients with Hunner's ulcers. For a small minority of patients whose symptoms are severe and who do not respond to other IC treatments, bladder surgery may be considered.

Sexuality and IC
For most IC patients, the difficulty they experience engaging in and enjoying sexual activity is one of IC's more debilitating aspects. However, IC does not have to bring an end to your sex life. By taking a creative approach and remaining open to alternatives, many IC patients have found ways to be intimate and loving.

Pain or the anticipation of pain can affect normal sexual response. In addition men with CP/CPPS and possibly also IC may have pain with ejaculation or erectile dysfunction. Anecdotal evidence suggests that men treated successfully for IC usually experience normal erections and ejaculations.

Having a painful, chronic illness like IC often results in a loss of sexual interest or ability to become aroused. The need for frequent trips to the bathroom may make people feel undesirable or sexually inadequate. Pain, stress, depression, and certain medicines, including antihistamines, pain-killers, and antidepressants, may also interfere with sexual interest and activity. If you think you are feeling depressed, it would probably be helpful to see a psychotherapist. If you are not sure of the type of therapy you need, there are various guides sold in bookstores that may be helpful. A sex therapist may also be of help in suggesting ways to increase sexual interest and activity.

Revised December 3, 2008