Urinary urgency and pain during intercourse could signal interstitial cystitis

A woman in her 40s, known only by her family name of Park, was diagnosed with cystitis several times and took antibiotics. However, her symptoms did not improve significantly; they improved briefly but recurred later.

Ms. Park, who had frequently experienced cystitis in the past, believed that she had a “sensitive bladder constitution” and often skipped visiting the hospital, taking previously prescribed medication without consulting a doctor when her symptoms were not severe.

Recently, however, she began experiencing severe pain even with minimal urine accumulation in her bladder, significantly disrupting her daily life. Ms. Park eventually visited a urology department at a hospital, where she underwent detailed examinations and was diagnosed with interstitial cystitis (IC), rather than the previously suspected acute bacterial cystitis.

When people think of “cystitis,” they first think of acute bacterial cystitis caused by bacterial infections, such as E. coli. This occurs when bacteria enter the bladder through the urethra, causing inflammation and symptoms, including pain during urination, frequent urination, hematuria, and lower abdominal discomfort. Bacterial cystitis is diagnosed through urine tests and urine culture tests, and is typically treated with antibiotics.

In comparison, interstitial cystitis is a condition that causes chronic pain and urinary dysfunction due to a combination of factors, including bladder mucosal dysfunction, neurogenic hypersensitivity, and immunological factors, rather than bacterial infection.

The bladder surface is protected by a GAG (glycosaminoglycan) layer that prevents microorganisms and irritants in urine from penetrating the bladder wall. In patients with interstitial cystitis, this protective layer is weakened or damaged, allowing irritants to penetrate the bladder tissue and cause inflammation and pain.

Interstitial cystitis is characterized by increased pain as the bladder fills and temporary relief after urination. Pain may also be felt in the upper pubic area, lower abdomen, perineum, and vagina. Frequent urination, urgent urination, and painful intercourse may also occur during the day and night.

Interstitial cystitis is often difficult to diagnose solely based on symptoms. A diagnostic process is necessary to rule out other conditions, including bacterial cystitis, urinary tract stones, and an overactive bladder. This includes urine tests, urine culture, blood tests, pelvic CT scans, bladder ultrasound, and prostate exams for men.

Cystoscopy may reveal ulcer-like lesions called “Hunner's ulcers” on the bladder mucosa or “glomerulation,” which appears as a net-like pattern of pinpoint hemorrhages within the bladder. These findings are important diagnostic clues for interstitial cystitis.

Treatment for interstitial cystitis focuses on alleviating symptoms and enhancing quality of life. Bladder training can help increase bladder capacity and extend the interval between urination. It is advisable to avoid foods that may irritate the bladder, such as caffeine, alcohol, and chocolate. Depending on the patient's condition, medication may be prescribed to protect the bladder mucosa and alleviate pain.

Pelvic floor muscle strengthening exercises (also known as Kegel exercises), light yoga, and stretching can help improve bladder function and reduce stress. Activities that put strain on the pelvis, such as running, should be avoided.

“Urinary dysfunction may seem like a simple inconvenience, but it can be a sign of an underlying condition. Chronic conditions, such as interstitial cystitis, progress slowly and manifest in various forms,” said Seo Young-eun, director of the Department of Urology at Daedong Hospital. “Therefore, it is essential to seek an accurate diagnosis from a urologist and establish a systematic treatment plan rather than self-diagnosis or self-medication.”