Men and Interstitial Cystitis
Interstitial cystitis is diagnosed far less often in men than it is in women.
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 actually have IC are inappropriately
diagnosed as having chronic prostatitis, and 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.
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.
Even when IC is diagnosed, it is sometimes difficult for a man to accept
that he has this condition and that almost everyone who has the disease is a
woman. In a survey one urologist made of 50 male IC patients, he found that
men had seen an average of 3.3 physicians before their diagnosis was made.
This was disturbing because, while women will usually see a general
practitioner or gynecologist before going to a urologist, men ordinarily see
a urologist first.
How Do I Know if I Have IC?
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 such as antibiotics, analgesics,
anti-inflammatory drugs, or alpha blockers, he may actually have interstitial
cystitis.
It is very important for male patients to have a thorough diagnostic workup,
including hydrodistention and cystoscopy under general or regional
anesthesia. This workup will rule out other medical conditions that can exist
in males, and will confirm the presence or absence of IC. An additional
benefit is that in more than half of patients who undergo the procedure,
hydrodistention can provide relief of symptoms for as long as 4 to 6 months.
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).
IC and Erectile Function
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.
IC and Prostatitis
Recent studies at the University of Washington and Tufts New England Medical
Center suggest that many men who are diagnosed with non-bacterial prostatitis
or prostatodynia might actually have IC, and if they are treated specifically
for IC, tend to do better than if they are treated as if they have
prostatitis.
Treatments
Standard IC treatments for males are similar to those used for women. There
is also an array of self-help strategies that can provide relief for both
male and female IC sufferers. 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.
Oral Medications
ELMIRON® (pentosan polysulfate sodium): Elmiron received FDA approval in
1996. It 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: Tricyclic antidepressants such as Elavil® (amitriptyline)
have been shown to help with both the pain and frequency of IC. In IC, these
medications are used for their anti-pain properties, and not as a treatment
for depression.
OTHER ORAL MEDICATIONS: These include anti-inflammatory agents,
antispasmodics, antihistamines and muscle relaxants.
Bladder Instillations
BLADDER 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 is therapeutic as well.
DMSO® (dimethyl sulfoxide)1: This medication is instilled directly into the
bladder. It is believed to work as an anti-inflammatory agent and therefore
reduces pain. DMSO can be mixed with steroids, heparin, and/or local
anesthetics to form a bladder “cocktail.”
BCG (bacillus Calmette-Guerin): This promising experimental treatment is
currently in the clinical trial phase and is not yet approved by the FDA. It
appears to work by boosting the immune system.
CYSTISTAT® (hyaluronic acid): This medication is also in clinical trials and
is not yet approved for use in IC by the FDA. It is thought to work by
replacing the defective lining of the bladder. Efficacy is not known at this
time.
OTHER BLADDER INSTILLATIONS: Heparin, Silver Nitrate, Clorpactin®
(oxychlorosene sodium).
Other Treatments
DIET: Eliminating certain foods (acidic, spicy) may decrease the severity of
IC symptoms. Also, smoking, drinking coffee or tea, and alcoholic beverages
may aggravate IC.
SELF-HELP: Self-help techniques can improve the 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.
ELECTRONIC NERVE STIMULATORS:
Transcutaneous Electrical Nerve Stimulation (TENS):
This device, which is worn externally, relieves bladder pain in some people.
Sacral Nerve Stimulation Implants: These surgically implanted devices are
approved for use in treating urinary incontinence, urgency, and frequency,
and are undergoing testing for use in treating IC pain.
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.
