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  • Many sufferers do not seem to suffer with IC alone
  • Different symptoms of IC
  • Severe urethral burning
  • If they can transplant hearts, etc., why not bladders?
  • At times of anxiety my bladder fills much more rapidly than usual
  • Can the beneficial effects to an IC sufferer of taking Amitriptyline wear off over a sustained period
  • I have found Atarax helpful
  • I suffer from IC, and also have serious constipation

Q: Many sufferers do not seem to suffer with IC alone. They often seem to have irritable bowel syndrome, vulvodynia, fibromyalgia, allergies etc. Why is this? 

A: It is claimed that about 75% of IC patients have some kind of allergy and that 40% have IBS. Why this is I don’t really know. There may be a small contribution from an allergic reaction to the overall disease make-up. The pathogenesis of most of these disorders is still a mystery.
Their fancy names hide the fact that we really don’t know their cause. They could well all be part of the same disease process. However, one thing that many of these conditions have in common is the presence of mast cells in the tissues. These specialised inflammatory cells, when activated by the appropriate stimulus, release lots of granules containing many different chemicals which induce pain and inflammation.
Mr Paul Irwin MCh FRCS(Urol)

Q: Some people seem to suffer from different symptoms of IC. Are there different types? 

A: There are certainly many different types of Cystitis…and the symptoms that one patient experiences may be totally different to those of another, regardless of the exact cause. The same applies to the form of Cystitis that we refer to as IC; it affects different patients in different ways. IC patients are given this diagnosis once the other causes of cystitis have been excluded. There may well be different ‘types’ of IC, each with a different cause or trigger, but as yet we cannot differentiate one form of IC from another.
Mr Paul Irwin MCh FRCS(Urol) 
Q: Can anything be done to ease severe urethral burning after passing urine? 

A: There is no universal remedy for this problem as there are different causes for it in different people. Clearly it is important to treat any urinary infection if one is found. Bladder stones can also cause it, as can infective and inflammatory conditions of the vulval area. A common cause of such inflammation is infection with the herpes virus which may respond to anti-viral medication. In the event that no obvious cause is found, empirical use of substances which neutralise acid in the urine may provide temporary relief. Occasionally a minor operation to stretch the urethra is required and is often successful. 
Mr Paul Irwin MCh FRCS(Urol) 

Q: If they can transplant hearts, lungs, kidneys etc., why not bladders ? 

A: Good question! The function of the bladder is simply to store urine in reasonable volumes so that it can be emptied completely at an appropriate time. If the bladder cannot perform this task it presents an inconvenience rather than a life-threatening problem, unlike heart, lung and kidney failure where organ transplantation with its associated risks and complications may be essential. Major organ transplants from other humans are always at risk of rejection and necessitate life-long drug treatment to keep the recipient’s immune system under control. The bladder on the other hand is not an essential organ and surgeons can fashion good urine storage pouches and ‘bladders’ out of the patient’s own bowel thus avoiding the organ rejection problems associated with transplants from other humans. 
Mr Paul Irwin MCh FRCSI(Urol) 
Q: At times of anxiety (visits to the dentist, travelling) my bladder fills much more rapidly than usual, and as I normally need to void when it only holds 3oz. this causes problems. Can you suggest a remedy? Should I be asking my GP for an anti-anxiety drug? 

A: It is not unusual for people to feel the need to void frequently at times of stress; I remember too well the feeling at exam time! It is therefore not unique to patients with IC, but, because IC patients have such small capacity bladders with extra-sensitive linings, stress-induced urgency becomes even more problematic and noticeable. I do not think that anti-anxiety drugs are the answer. I would recommend a programme of bladder retraining in addition to the standard medical treatments for IC (Hydroxyzine, Amitriptyline, Elmiron® etc.). 
Mr Paul Irwin MCh FRCSI(Urol) 

Q: Can the beneficial effects to an IC sufferer of taking Amitriptyline wear off over a sustained period of taking the medication (over 2 years)? 

A: Amitriptyline is an antidepressant medication which, in low doses, is useful in relieving chronic pain conditions such as IC. About 35% of IC sufferers will obtain symptomatic relief from Amitriptyline. However, the body develops a tolerance to the drug over time in which case it may be necessary to increase the dose a little or to switch to another treatment. 
Mr Paul Irwin MCh FRCSI(Urol) 

Q: I have had IC for about 6 years and have found Atarax helpful in resolving symptoms. Does this mean that allergy is the cause of my IC? 

A: I am delighted that you have hit upon something which manages to keep your IC symptoms in check. I have found Atarax (Hydroxyzine) to be a very useful drug in the treatment of IC. It is a special antihistamine which has a chemical structure similar to some antidepressant agents like Amitriptyline, which is also used to treat IC. This means that it not only blocks the effects of histamine from bladder mast cells but it also has an effect on the passage of pain messages from the bladder. While it appears to work especially well in patients who have a history of allergies the fact that it works for you does not necessarily imply that your IC is due entirely to allergy. 
Mr Paul Irwin MCh FRCSI(Urol) 

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