A condition causing extreme bladder pain, urinary frequency and urgency was identified in 1937. Additional symptoms included severe and unique blood vessel inflammation and scarring in the bladder wall. Drs. Philip Physick and Joseph Parrish worked throughout the 1800s and into the 1900s, respectively, to collect data and describe details in support of a single, new bladder disease, now called interstitial cystitis (IC). In the 21st century, IC research has evolved, but the cause or causes of IC remain elusive.
Autoimmune Disorder
IC has been linked to myriad autoimmune disorders, including food allergies and asthma, rheumatoid arthritis and irritable bowel syndrome. In autoimmune disorders, a substance that isn't dangerous triggers an overreaction of the immune system, the body's means of protection. In allergies and asthma, milk or pollen may be triggers for excessive wheezing and hives; in IC, an acidic substance or a bladder infection may trigger release of immune cell chemicals, particularly mast cell histamines. In autoimmune disorders the body does not turn off its reaction by itself or grow accustomed to the triggering substance, so it keeps attacking the harmless substance, causing severe reactions.
Infectious Cause
IC may also be caused by low-grade and continual bacterial infections that are not related to autoimmune disorders. Although a particular infectious cause has not been identified as of spring 2010, there are many possibilities. Uncommon bacteria or bacteria that are highly resistant to treatment may be present; a slow-growing viral infection is also considered possible, note J. Dasgupta and D.G. Tincello in the December 2009 issue of "Maturitas." Regardless of the source, many patients are given repeated antibiotic treatments for confirmed urinary tract infections (UTI) before they are diagnosed with IC, so an underlying infectious cause cannot be ruled out.
If infections continue during UTI antibiotic treatments, patients are sent to specialists who identify IC primarily on the appearance of blood vessel breakage and ulcers in the bladder; these symptoms are specific to IC.
Bladder Wall Damage
The symptoms and disease progression in IC appear linked to damage on the inner bladder wall. This wall lining contains mast cells that release histamines, and the lining is made up of glycosaminoglycans (GAG), which protect the entire organ wall. A decrease in GAGs, whether from a direct toxin attack, an immune response or a lack of production, can leave the bladder wall vulnerable to damage. IC bleeding and scarring can result from immune response, histamine response or acidic substances in the urine. This mechanism of bladder wall damage appears integral to IC symptoms and development.
Joint Causes
It is likely that the true beginnings of IC involve a combination of methods, including bladder wall damage and a trigger by nerves, infection, immune response or an unknown source.
References
- National Library of Medicine: The Historical Origins of Interstitial Cystitis
- Urology Health: Adult Conditions: Interstitial Cystitis
- University of Miami Department of Urology: Interstitial Cystitis
- J. Dasgupta, D.G. Tincello. Interstitial Cystitis/Bladder Pain Syndrome: An Update. Maturitas, December 2009, pp 212-217
