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It's your umpteenth trip to the bathroom to empty your bladder, and the pressure still feels intense. Another annoying urinary-tract infection? Maybe not. If you've had this experience, and antibiotics haven't helped, you may have a different and more aggravating condition called interstitial cystitis. This chronic, poorly understood bladder inflammation affects more than 700,000 people in this country--and 90 percent of them are women.
No one knows exactly what causes interstitial cystitis. It doesn't involve the bacteria that trigger typical urinary infections. Most experts believe it results from small breaches in the mucus barrier that normally prevents noxious substances in the urine from seeping through and irritating the bladder wall. There is no scientific evidence linking interstitial cystitis to diet, but many people believe that caffeine, alcohol and certain foods (including tomatoes, citrus fruits and chocolate) may aggravate it.
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Half of all cases go away on their own, but some worsen over time, progressing from occasional urinary urgency to constant pelvic pain. Women with severe cases may lose the ability to enjoy sex or even sit comfortably in a chair. Fortunately, doctors are getting better at recognizing the condition.
Unlike a urinary-tract infection, interstitial cystitis can't be diagnosed with a urine test. The first step is to rule out other conditions, such as bladder stones, bladder cancer, kidney disease, multiple sclerosis, endometriosis and sexually transmitted diseases. After excluding those possibilities, the clinician (usually a urologist) may use an endoscope to check the bladder wall for telltale spots of blood.
Interstitial cystitis isn't yet preventable, but treatment can make it less debilitating. Pain-killers, antihistamines and low-dose antidepressants help ease the pain and inflammation, and other drugs may help repair the bladder lining. The key to relief is proper diagnosis, so if you think interstitial cystitis may be your problem, see your primary-care doctor for a referral to a urologist.
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