IC and Men
What is Interstitial Cystitis/Painful Bladder Syndrome? Interstitial cystitis (IC) is a chronic inflammatory condition of the bladder wall. Its cause is unknown. "Common" cystitis, also known as a urinary tract infection, is caused by bacteria and is usually successfully treated with antibiotics. Unlike common cystitis, IC is not caused by bacteria and does not respond to conventional antibiotic therapy. It is important to note that IC is not a psychosomatic disorder nor is it caused by stress. Men and Interstitial Cystitis/Painful Bladder Syndrome Interstitial cystitis is diagnosed far less often in men than it is in women. Current estimates indicate that about ten percent of all diagnosed IC patients are men. Symptoms 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. The Male IC Experience Like women, men have often experienced difficulties in obtaining an accurate diagnosis of IC, but for somewhat different reasons. The symptoms of IC in men closely resemble those of non-bacterial prostatitis or prostatodynia (recently renamed Type IIIA and IIIB chronic prostatitis/chronic pelvic pain syndrome, respectively). 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 confirm IC in a male patient. Chronic Prostatitis (CP)/Chronic Pelvic Pain Syndrome (CPPS) Chronic Prostatitis (CP) / Chronic Pelvic Pain Syndrome (CPPS) CP/CPPS is a new term that is used to describe men with prostate symptoms. The classification of CP/CPPS has been established to help with the diagnosis and treatment of this condition.
Type I: Acute Bacterial Prostatitis: Caused by bacteria and treated with antibiotics. The patient always has a severe urinary tract infection that may be accompanied by high fever, chills, and even the inability to urinate. Type I patients may need hospitalization.
Type II: Chronic Bacterial Prostatitis: Typified by recurrent urinary tract infections (see above). Symptoms are caused by an infection within the prostate gland. Treated with long-term antibiotics; relapses are common.
Type III A and III B typically represent patients with interstitial cystitis:
Type IIIA - Chronic Non-Bacterial Prostatitis (CP/CPPS): Signs of prostate inflammation are present, but no obvious infection is found.
Type IIIB - Chronic Non-Bacterial Prostatitis (CP/CPPS): Symptoms of bacterial prostatitis are present, with no evidence of inflammation.
Type IV: Asymptomatic inflammatory prostatitis: Signs of inflammation within the prostate, however the patient experiences no symptoms.
Many researchers believe that CP/CPPS types IIIA and IIIB may in fact be interstitial cystitis because the symptoms are similar to IC, and many patients respond best to IC therapies. IC and Non-Bacterial Prostatitis Types IIIA and IIIB If a man has chronic lower urinary tract symptoms including urgency, frequency, painful urination, decreased urine flow, or a sense of incomplete emptying, as well as suprapubic pressure and chronic bladder pain, and does not respond to standard therapies for prostatitis, such as long-term antibiotics, he may actually have interstitial cystitis. Clinical experience suggests that if these patients are treated specifically for IC, they tend to do better than if they are treated for CP/CPPS Types IIIA & IIIB.
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 rule out other medical conditions that can exist in males, and will help to confirm the presence or absence of IC.
Other conditions that may have symptoms similar to IC must be ruled out. These include: urinary tract infections, bacterial prostatitis, bladder cancer, kidney problems, tuberculosis, sexually transmitted diseases, radiation cystitis, neurogenic diseases and benign prostatic hypertrophy (BPH)—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, yet a vast majority of IC patients are helped by one or more of the following treatments.
Diet: Eliminating certain foods (acidic, spicy) may decrease the severity of IC symptoms. Also, smoking, drinking coffee or tea, and alcoholic beverages may exacerbate IC.
Self-Help: Self-help techniques can improve quality of life and reduce the incidence and severity of flare-ups. These include changes in diet, stress reduction, visualization, biofeedback, bladder retraining, and exercise, among others.
Physical Therapy: The goal of physical therapy for IC patient is to relax the pelvic floor muscles and avoid overly tightening them. Many people with IC have problems with this group of muscles and develop a condition called pelvic floor dysfunction (PFD). Treatment usually combines physical therapy, home exercise, medication, and self-care.
Oral Medications: Elmiron (pentosan polysulfate sodium): FDA- approved in 1996, Elmiron is the only oral medication approved specifically for use in IC. It is believed to work by repairing a thin or damaged bladder lining.
Antidepressants: Low-dose tricyclic antidepressants such as amitriptyline have been shown to help with both the pain and frequency of IC. In IC, these medications are used for their side effects, including their anti-pain properties, not as a treatment for depression.
Other Oral Medications: These include anti-inflammatory agents, antispasmodics, antihistamines, muscle relaxants, anticonvulsants, and bladder analgesics.
Bladder InstillationsBladder Distention: The bladder is stretched by filling it with water under general or regional anesthesia. This is part of the diagnostic procedure for IC, and may sometimes be therapeutic as well.
DMSO (dimethyl sulfoxide/Rimso®-50): Approved for use in IC in 1978, DMSO is instilled directly into the bladder. Believed to work as an anti-inflammatory agent. DMSO can be combined with steroids, heparin, and/or local anesthetics to form a bladder "cocktail."
Heparin: Has both anti-inflammatory and surface protective actions. Heparin may mimic the activity of the bladder's mucous lining, temporarily "repairing" the glycosaminoglycans (GAG) layer. Heparin is also a commonly used component of bladder "cocktails."
Anesthetics: Anesthetics (numbing agents, such as Lidocaine®) can be placed into the bladder via catheter to help to provide temporary relief from pain.
Cystistat: This medication, distributed by Bioniche Life Sciences, Inc., a Canadian biopharmaceutical company, is approved for use in Canada and Europe. It is not FDA-approved for use in IC in the US, however it can be obtained through Canada. It is thought to work by replacing the defective lining of the bladder. (See the ICA Fact Sheet, Cystistat and IC.)
Other Bladder Instillations Include:Clorpactin WCS-90 (oxychlorosene sodium) and silver nitrate: Clorpactin can be very painful and usually requires general anesthesia. It has been used in a diluted form in an office setting. Silver nitrate, which also requires general anesthesia, is used infrequently and is considered an outdated therapy.Other Treatments
Sacral Nerve Stimulation Implants: The neuromodulation device by Medtronic, Inc., called InterStim® Therapy for Urinary Control, is approved for urinary urge incontinence, nonobstructive urinary retention, and significant symptoms of urgency-frequency. Clinical trials are under way for use in IC. InterStim is a small, surgically implanted device that sends mild electrical pulses to nerves located in the lower back (just above the tailbone). These nerves influence the bladder and surrounding muscles that manage urinary function. InterStim is considered as a potential IC treatment when other more conservative therapies have failed. (See the ICA Fact Sheet, InterStim and IC.)
Surgery: For a small minority of patients whose symptoms are severe and who do not respond to other IC treatments, bladder surgery may be considered. Several types of surgery have been used to treat IC, including bladder augmentation and, in severe cases, urinary diversion. However, in some cases, IC symptoms may not improve with surgery. Laser surgery is reserved for patients with Hunner's ulcers. (See the ICA Fact Sheet, Surgery and IC.) 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.
IC has not been shown to cause erectile problems. However, IC can contribute to painful ejaculations, and normal sexual response can certainly be adversely affected by pain or the anticipation of pain. 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 medications, 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. Resources & ReferencesResourcesand References