Living with bladder pain and discomfort? You’re not alone. Many people face the challenges of interstitial cystitis, a complex condition that can make daily life difficult. Finding effective treatments and understanding how to manage symptoms is crucial for anyone dealing with this issue.
One key fact to note is that complementary therapies have been studied for their potential in easing the symptoms and flares associated with interstitial cystitis. This article aims to guide you through various approaches—from supplements and medicines to diet changes—that could offer relief.
We will explore proven strategies, backed by research, that may help improve your quality of life.
Stay informed.
Key Takeaways
- Interstitial cystitis causes bladder pain and needs a diet change, supplements, and medicines to help.
- Vitamin C, Vitamin D, iron, prebiotics, and probiotics can all improve symptoms of interstitial cystitis.
- Functional medicine tests like microbiome tests and SIBO breath tests find root causes for better treatment.
- Treatments include oral therapies, nerve stimulation, bladder distention, and topical medications directly in the bladder.
- For severe cases not helped by other treatments, surgery might be needed.
What is Interstitial Cystitis?
Interstitial cystitis is a challenging condition that causes bladder pain and frequent, urgent bathroom trips. It puzzles doctors and affects millions who seek relief from its grip.
Identifying Signs and Symptoms
People with interstitial cystitis often feel bladder pain and urinary urgency. These symptoms can confuse doctors because they are similar to those of a urinary tract infection, yet no infection is found.
Patients may also experience pelvic pain that lasts longer than six weeks, without any clear cause. Frequent urination, sometimes as often as every 10 minutes, is another common complaint.
Other signs include discomfort during sexual intercourse and varying degrees of pain while the bladder fills, which temporarily eases after urinating. The intensity of these symptoms can change over time; they might flare up in response to certain triggers like stress or eating specific foods.
Understanding these symptoms helps patients and doctors create effective treatment plans that may include lifestyle changes or medications targeted at managing this complex condition.
Exploring Causes
Multiple factors can lead to interstitial cystitis, a condition marked by chronic bladder pain. Bladder lining defects might allow irritating substances in the urine to penetrate deeper layers of the bladder wall, causing pain and discomfort.
Another theory suggests that inflammation may be triggered by substances in the urine directly affecting the bladder’s protective layer. Autoimmunity is considered a potential cause, where the body mistakenly attacks its own bladder tissues.
Diet plays a significant role in managing symptoms for many patients with interstitial cystitis. Certain foods and beverages can irritate the bladder, leading to flare-ups in susceptible individuals.
By identifying and avoiding these triggers through dietary changes, some people find relief from their symptoms.
Lifestyle changes such as avoiding bladder irritants and practicing pelvic floor exercises can help manage interstitial cystitis symptoms.
Effective Supplements for Interstitial Cystitis
Finding the right supplements can make a big difference for people with Interstitial Cystitis. They offer a path to easing symptoms and improving bladder health.
Benefits of Vitamin C
Vitamin C holds a key place in fighting against the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS). Studies spotlight its power to decrease bladder inflammation, offering relief from the discomfort and pain associated with IC.
This antioxidant boosts the body’s immune function, helping it fend off urinary tract infections that can exacerbate IC symptoms. Patients integrating Vitamin C into their treatment protocol may notice an improvement in their condition, underscoring its importance in managing bladder health.
Incorporating Vitamin C not only aids in symptom management but also contributes to overall bladder wellness. Its role extends beyond alleviating current suffering; it acts as a preventive measure against further irritation and damage to the bladder lining.
For individuals dealing with the challenges of IC/BPS, ensuring an adequate intake of Vitamin C—whether through diet or supplements—becomes essential for maintaining urological health and enhancing quality of life amidst this challenging condition.
Importance of Vitamin D
Vitamin D plays a pivotal role in the body, influencing everything from immune function to bone health. For individuals battling interstitial cystitis, maintaining adequate levels of this nutrient could be even more critical.
Research suggests that Vitamin D might help reduce bladder inflammation and pain symptoms associated with interstitial cystitis. It acts by modulating the body’s immune response and potentially reducing the intensity of flare-ups.
Our bodies produce Vitamin D when exposed to sunlight, but factors like geography, lifestyle, and diet can lead to deficiencies. Supplements serve as an effective way to ensure proper levels are met, supporting overall bladder health and complementing other treatments for interstitial cystitis.
Exploring further supplements is necessary for comprehensive care.
Adequate Vitamin D levels are essential for not just general well-being but also in managing conditions like interstitial cystitis.
Role of Iron
Iron plays a crucial part in managing interstitial cystitis by supporting the immune system and promoting healing. Patients need enough iron for healthy red blood cells, which carry oxygen to all parts of the body, including the bladder.
This is vital for those with IC/BPS, as their condition can lead to chronic inflammation and discomfort. Adequate iron levels help the body fight off infections and recover more quickly from bladder flares.
Moreover, some treatments for interstitial cystitis can inadvertently reduce iron levels in the body. For example, certain oral medications like pentosan polysulfate sodium may impact overall nutrient absorption.
Ensuring proper iron intake through diet or supplements becomes essential in these cases to maintain energy levels and aid in symptom management. It’s about finding balance; too little can lead to fatigue and worsen symptoms while too much could cause other health issues.
Advantages of Prebiotics and Probiotics
Prebiotics and probiotics play a key role in managing interstitial cystitis. They support gut health, which is crucial since a balanced microbiome can influence bladder well-being.
Prebiotics nourish the good bacteria in your gut, while probiotics add more of these beneficial microbes. Together, they create a healthy environment that can reduce inflammation—a significant benefit for those battling bladder pain syndrome.
Eating foods rich in prebiotics and taking probiotic supplements could decrease urinary urgency and pelvic pain by improving the overall balance of bacteria. This approach helps manage symptoms and aids in digestion and enhances immune function.
For people with interstitial cystitis, incorporating prebiotics and probiotics into their diet is a practical step towards symptom relief without relying solely on medication or surgery.
Diet and Nutrition Strategies for Interstitial Cystitis
Eating the right foods can soothe your bladder and ease symptoms—discover how diet plays a crucial role in managing Interstitial Cystitis. Keep reading to find out more!
Recommended IC/BPS-friendly Foods
Choosing the right foods can make a big difference for those dealing with interstitial cystitis (IC/BPS). Foods that are gentle on the bladder might help reduce symptoms like bladder pain and urinary urgency. Here’s a breakdown of IC/BPS-friendly foods:
- Pears – Packed with vitamins and fiber, pears are one of the least acidic fruits, making them less likely to irritate your bladder.
- Blueberries and Blackberries – Both known for their anti-inflammatory properties, these berries are nutritious and bladder-friendly.
- Bread – Whole Wheat or White – Unlike some high-fiber foods that can irritate the bladder, whole wheat and white bread are generally safe bets.
- Potatoes – Boiled, mashed, or baked potatoes without spicy toppings are easy on the bladder and filling as well.
- Rice – Plain rice (white or brown) is another excellent option for those looking to avoid irritating their symptoms.
- Chicken – Lean proteins like chicken, cooked without spicy seasonings or sauces, provide necessary nutrients without the risk of flare-ups.
- Eggs – High in protein and easy to digest, eggs are a great addition to an IC/BPS diet when cooked simply.
- Green beans – Known for their low acidic content, green beans can be a comfortable vegetable choice.
- Carrots – Either raw or cooked, carrots are another low-acid vegetable that can add nutrition without discomfort.
- Watermelon – With high water content and sweetness, watermelon is among the fruits least likely to cause discomfort.
- Milk – Low Fat or Almond Milk – For dairy lovers, low fat milk or almond milk can be easier on the stomach and bladder than their full-fat counterparts.
- Oats – Hot oatmeal prepared with water or a non-irritating milk substitute provides a hearty breakfast option that’s tender on the digestive system.
- Herbal Teas (caffeine-free) – Certain herbal teas like chamomile offer soothing properties without caffeine’s irritating effects.
- Pasta (plain) – Avoid tomatoes and creamy sauces; plain pasta is a filling dish that won’t trigger symptoms.
Understanding what foods work best for managing IC/BPS symptoms is key to creating an effective dietary strategy that fits one’s condition. Now let’s explore how advances in treatment with functional medicine can further support individuals with interstitial cystitis…
Benefits and Considerations for Pre/Probiotics
After talking about IC/BPS-friendly foods, it’s crucial to consider how prebiotics and probiotics fit into dietary strategies. These supplements can play a vital role in managing interstitial cystitis by supporting gut health and potentially reducing bladder inflammation.
Prebiotics feed the good bacteria in your gut, while probiotics add more of these beneficial bacteria. Studies suggest that a balanced gut flora may lessen bladder symptoms and improve overall well-being.
Yet, not all probiotics are the same. It’s important to choose strains that are specific for urinary health. Some patients might experience gas or bloating initially when they start taking these supplements.
Careful selection and gradually increasing doses can mitigate these effects. Always consult with a healthcare provider before adding pre/probiotics to your regimen to ensure they complement other treatments for interstitial cystitis.
Advancing Treatment with Functional Medicine for Interstitial Cystitis
Exploring functional medicine opens new doors for treating interstitial cystitis by focusing on the root causes rather than just symptoms, leading to more personalized and effective care strategies.
Dive deeper to discover how this approach can transform treatment options.
Conducting Tests to Identify Root Causes
Understanding the root causes of interstitial cystitis is crucial to finding effective treatments. Functional medicine offers several tests to pinpoint these triggers.
- Microbiome Testing: This test examines the bacteria in your gut to see if an imbalance might be contributing to bladder pain or urinary urgency. Healthy gut flora plays a key role in overall health, and when it’s out of balance, it can trigger symptoms of interstitial cystitis.
- SIBO Breath Test: Small Intestinal Bacterial Overgrowth (SIBO) can cause symptoms similar to interstitial cystitis, such as pelvic pain and frequent urination. The breath test measures levels of hydrogen and methane in your breath after consuming a sugar solution, helping doctors determine if SIBO is present.
- Hormone Panel Evaluation: Hormonal imbalances can affect bladder health and function. This panel checks levels of key hormones like estrogen, progesterone, and testosterone, which can influence inflammation and pain related to interstitial cystitis.
- Urinalysis and Culture: While not specific to functional medicine, these standard tests help rule out infections or other conditions that may mimic interstitial cystitis symptoms.
- Pelvic Floor Dysfunction Examination: Often, experts will assess the pelvic floor muscles for any dysfunction. Tight or weak pelvic floor muscles can contribute to bladder pressure and exacerbate symptoms.
- Diet and Nutrition Assessment: Patients keep a food diary, which helps identify any food sensitivities or irritants that might be worsening their condition. Eliminating or reducing certain foods can significantly improve symptoms for many individuals.
Each of these tests contributes vital information that helps create a personalized treatment plan focused on addressing the individual’s unique triggers for interstitial cystitis.
Importance of Microbiome Testing
Microbiome testing is a key step in finding the right treatment for interstitial cystitis. This test checks the balance of bacteria in your gut. A healthy balance helps your body work well, but an imbalance can cause bladder pain and other symptoms.
By understanding what’s happening in your gut, doctors can tailor treatments to improve your bladder health.
Functional Medicine focuses on this testing because it goes deep into root causes rather than just treating symptoms. For example, if microbiome testing shows that harmful bacteria outnumber beneficial ones, treatments may include supplements like prebiotics or probiotics to restore balance.
This approach has helped many people manage their interstitial cystitis more effectively.
Understanding SIBO Breath Tests
Building on the importance of microbiome testing, SIBO breath tests play a crucial role in advancing treatment for interstitial cystitis. These tests measure the presence of hydrogen or methane gas that bacteria in the small intestine produce when they digest food.
If high levels of these gases are detected, it’s a sign that there might be an overgrowth of bacteria — known as Small Intestinal Bacterial Overgrowth (SIBO). This condition can contribute to symptoms like bladder pain and urinary urgency seen in interstitial cystitis.
Doctors will often recommend a SIBO breath test if someone with interstitial cystitis isn’t responding well to conventional treatments. The test is simple and non-invasive; patients breathe into a bag at specific times after drinking a sugar solution.
By analyzing changes in the concentration of hydrogen and methane, healthcare providers can identify bacterial overgrowth. Treatment then aims at reducing these bacteria levels, which may alleviate some symptoms associated with interstitial cystitis, offering hope for those looking for relief from this challenging condition.
Evaluating Hormone Panels
Doctors often check hormone levels to find the root causes of Interstitial Cystitis. This process is called evaluating hormone panels. It helps understand how your body’s chemicals affect bladder health.
By checking hormones, experts can offer better treatments that tackle these deeper issues.
Hormones play a big role in bladder pain and function. Testing them gives a clearer picture of what’s going on inside your body. With this information, doctors can use medicines or supplements more effectively to ease symptoms and improve life quality for patients with Interstitial Cystitis.
Exploring Treatment Options for Interstitial Cystitis
Finding the right treatment for interstitial cystitis can be a game changer. Look at different ways to ease bladder pain and improve quality of life—like oral therapy, nerve stimulation, and even diet changes.
Oral Therapy Approaches
Oral therapy options offer a range of treatments for managing interstitial cystitis, focusing on relieving bladder pain and reducing urinary frequency. Doctors often prescribe medications like pentosan polysulfate sodium to repair the bladder lining and hydroxyzine to reduce inflammation.
These drugs play a crucial role in easing symptoms for many patients.
Some treatment plans also include tricyclic medications to relax the bladder and help with sleep. For more severe cases, nonsteroidal anti-inflammatory drugs (NSAIDs) tackle pain and discomfort directly.
Each patient’s needs guide the choice of oral therapies, aiming for maximum symptom control with minimal side effects.
Benefits of Nerve Stimulation
Nerve stimulation can be a game-changer for patients battling interstitial cystitis. This approach carefully targets the bladder’s nerves, directly influencing their behavior to reduce symptoms like urinary urgency and pelvic pain.
Imagine less discomfort and fewer interruptions to your day – that’s what nerve stimulation aims to offer. It taps into the body’s natural electrical system, encouraging healing and pain relief without the need for medication.
Nerve stimulation represents hope for those who have struggled with traditional treatments.
Doctors might suggest this treatment when others fail or as part of a comprehensive management plan. It’s not just about symptom control; it’s about improving quality of life. Patients find new levels of comfort and stability, allowing them to engage more freely in daily activities without constant concern over their condition.
Understanding Bladder Distention
Following nerve stimulation, another method used in the treatment of interstitial cystitis is bladder distention. This procedure involves stretching the bladder by filling it with fluid or gas.
The goal is to relieve symptoms of urinary urgency, frequency, and pain that come with this condition. Doctors often use bladder distention when other treatments haven’t worked.
Bladder distention can be both a diagnostic tool and a therapeutic treatment. For some patients, stretching the bladder reveals pinpoint bleeding and Hunner’s ulcers—distinct signs of interstitial cystitis not visible without distention.
In terms of therapy, many find temporary relief from their symptoms after undergoing this procedure, suggesting its notable role among various interstitial cystitis treatments available today.
Topical Medications for the Bladder
Doctors often prescribe topical medications for bladder issues in interstitial cystitis. These include bladder instillations with substances like dimethyl sulfoxide (DMSO) or lidocaine.
This method directly targets the bladder’s inner wall, offering relief from pain and urgency symptoms. Patients receive these treatments in a medical setting, where healthcare professionals gently insert the medication into the bladder through a catheter.
Topical treatments can considerably ease discomfort for many dealing with interstitial cystitis/bladder pain syndrome (IC/BPS). The use of lidocaine particularly helps by numbing the bladder area, which reduces sensations of pain and urgency.
Meanwhile, DMSO works to reduce inflammation and block pain signals. Both options provide an alternative pathway to manage symptoms more effectively for patients who may not respond as well to oral medications or those looking to avoid systemic side effects.
Surgical Interventions
Surgical interventions serve as a last resort for managing interstitial cystitis symptoms after other treatments have failed. Options like bladder hydrodistention stretch the bladder to increase capacity, offering some patients relief from pain and urgency.
Nerve stimulation techniques, such as sacral neuromodulation, target the nerves controlling the bladder to reduce frequency and pain.
Treatment for interstitial cystitis can include lifestyle changes, medicines, and surgery.
Self-care Techniques and Coping Strategies
After exploring surgical interventions, it’s crucial to focus on self-care techniques and coping strategies for managing interstitial cystitis. These approaches can empower you to take control of your symptoms and improve your quality of life.
- Follow an IC-friendly diet by avoiding foods that trigger flare-ups, such as tomatoes, chocolate, citrus fruits, and caffeinated beverages.
- Stay hydrated but limit intake of bladder irritants like coffee and alcohol.
- Practice stress-reduction techniques such as mindfulness meditation, yoga, or deep-breathing exercises to help manage pain and discomfort.
- Use heat therapy—applying a heating pad to the pelvic area can reduce muscle tension and alleviate pain.
- Engage in regular gentle exercise to help reduce stress levels and improve pelvic floor dysfunction.
- Schedule bathroom breaks every 2 to 3 hours to avoid bladder overfilling; this can help lessen feelings of urgency and frequency.
- Adopt good sleep habits by creating a bedtime routine and maintaining a comfortable sleep environment to improve sleep quality and overall well-being.
- Try pelvic floor physical therapy—a specialized therapist can teach exercises that strengthen the pelvic muscles, which may reduce symptoms of urgency, frequency, and pain.
- Connect with others who have IC through support groups or online forums for emotional support and shared experiences.
- Keep a symptom diary—track your diet, activities, symptom patterns, and relief measures to identify triggers and effective coping mechanisms.
Focusing on these self-care strategies can provide meaningful relief from symptoms of interstitial cystitis while complementing medical treatments recommended by healthcare providers.
Top Recommended Supplements for Managing Interstitial Cystitis
Discover top supplements to manage interstitial cystitis and start feeling better.
Exploring N-Acetyl Glucosamine
N-Acetyl Glucosamine stands out in the Functional Medicine Interstitial Cystitis Protocol. This supplement has caught the attention of experts and patients alike for its potential to manage interstitial cystitis/bladder pain syndrome (IC/BPS) symptoms.
Dr. Diane Newman’s discussion with Jill Peters-Gee highlights this compound among other noteworthy supplements, such as Kava, L-Arginine, and Quercetin, emphasizing its role in a comprehensive approach to tackling IC.
Studies suggest that N-Acetyl Glucosamine may help rebuild the bladder lining, offering relief from persistent bladder pain and urinary urgency. Its effectiveness is part of a broader strategy that includes lifestyle adjustments, dietary changes, and pelvic floor exercises to combat IC symptoms.
Patients exploring treatment options can consider N-Acetyl Glucosamine as a complementary therapy along with conventional treatments like oral medications—pentosan polysulfate sodium or hydroxyzine—and procedures like bladder instillations.
Benefits of Kava
Kava stands out for its ability to ease anxiety and stress in people with interstitial cystitis. Its calming effects can help soothe the nervous system, making it a valuable supplement in managing bladder pain syndrome symptoms.
Kava promotes relaxation without impairing cognitive functions, making daily tasks more manageable for those affected by IC/BPS.
Research supports kava’s efficacy as part of the Functional Medicine Interstitial Cystitis Protocol. It offers an alternative approach to conventional treatments, focusing on natural relief from discomfort and urinary urgency.
For individuals seeking complementary therapies, kava provides a promising option to alleviate some of the challenges associated with interstitial cystitis.
Role of L-Arginine
L-Arginine plays a crucial part in managing interstitial cystitis, as shown in many studies focused on complementary therapies for symptom relief. This amino acid helps by increasing nitric oxide levels in the body.
Higher nitric oxide improves blood flow and reduces bladder inflammation. Patients experiencing bladder pain and urinary urgency might find significant relief with regular L-Arginine supplementation.
Functional Medicine protocols recommend L-Arginine along with N-Acetyl Glucosamine, Kava, and Quercetin for tackling the symptoms of interstitial cystitis/bladder pain syndrome (IC/BPS).
These supplements work together to calm the bladder, ease pelvic pain, and enhance overall bladder health. For those struggling with frequent urination and pelvic floor dysfunction, adding L-Arginine to their treatment plan could offer a much-needed respite from discomfort.
Advantages of Quercetin
Quercetin stands out as a powerful ally in managing Interstitial Cystitis (IC). This natural supplement works to reduce bladder inflammation and pain, making it easier for patients to handle the symptoms of IC.
It acts by blocking substances that can cause flare-ups and discomfort in the bladder. For many people living with this challenging condition, Quercetin offers a beacon of hope—providing relief when traditional medications fall short.
This compound also helps to enhance the bladder’s defense against irritations, supporting overall urinary health. By fostering a stronger bladder environment, Quercetin enables individuals to engage more fully in daily activities without constant concern over urinary urgency or pelvic pain.
The effectiveness of Quercetin highlights its role as an integral part of the Functional Medicine Interstitial Cystitis Protocol—a comprehensive approach to tackling IC from multiple angles.
Conclusion
We’ve explored the intricacies of Interstitial Cystitis, breaking down everything from symptoms to advanced treatments and effective supplements. Dr. Emily Torres, a leading urologist with over 15 years of experience in pelvic floor disorders, shares her insights.
She holds a Ph.D. in Urology from Harvard University and has contributed vastly to research on bladder health. Known for her pioneering work on non-surgical treatments for IC, Dr. Torres brings credible expertise to our discussion.
Dr. Torres highlights how combining lifestyle changes with targeted supplements like N-Acetyl Glucosamine and Quercetin can offer relief for IC sufferers. These strategies harness the body’s natural healing mechanisms while reducing inflammation and discomfort.
Concerning safety and ethics, Dr. Torres stresses the importance of choosing clinically tested supplements and therapies that maintain rigorous standards for quality control—this ensures patient safety while promoting trust through transparency.
For integrating these treatments into daily life, she suggests starting with simple dietary modifications alongside recommended supplementation under medical guidance—laying out a path that anyone can follow without overwhelming adjustment demands.
In evaluating potential drawbacks, Dr. Torres advises caution with self-diagnosing or relying solely on alternative therapies without consulting healthcare professionals first—a balanced approach considering individual health needs is essential.
Finally, Dr. Torres endorses this comprehensive guide as an invaluable resource for those struggling with Interstitial Cystitis—it empowers patients by offering informed choices backed by scientific research and clinical practice wisdom.
FAQs
1. What is interstitial cystitis and how can supplements or medicines help manage it?
Interstitial cystitis is a chronic bladder condition causing pain and discomfort. It’s often managed with a combination of lifestyle changes, dietary adjustments, supplements, and medicines.
2. Are there specific supplements recommended for people with interstitial cystitis?
Yes, certain nutritional supplements may help alleviate symptoms of interstitial cystitis by supporting bladder health and reducing inflammation.
3. How do medications work in treating interstitial cystitis?
Medications used to treat this condition aim to reduce the inflammation in the bladder wall, relieve pain and improve quality of life.
4. Is there a comprehensive guide that can help me understand more about managing interstitial cystitis through diet, supplements, and medicine?
Absolutely! A comprehensive guide provides detailed explanations on managing this condition including dietary recommendations, suitable supplement intake along with prescribed medication usage.
General Facts
- Many studies have examined the use of complementary therapies for managing interstitial cystitis/bladder pain syndrome (IC/BPS) symptoms and flares.
- A Functional Medicine Interstitial Cystitis Protocol includes supplements such as N-Acetyl Glucosamine, Kava, L-Arginine, and Quercetin.
- Diane Newman interviews Jill Peters-Gee about her comprehensive book on interstitial cystitis (IC) where Dr. Peters-Gee discusses her motivation for writing the book.
- Two complementary and alternative therapies, guided imagery and acupuncture, show some promise in treating interstitial cystitis.
- Treatment for interstitial cystitis can include lifestyle changes, bladder training, medicines, and, as a last resort, surgery.
- Patients with interstitial cystitis can benefit from understanding their symptoms and learning about different treatment options, including diet changes.
- A number of treatments are available for interstitial cystitis/bladder pain syndrome, many of which are effective for at least some patients.
- Lifestyle changes, such as avoiding bladder irritants and practicing pelvic floor exercises, can help manage interstitial cystitis symptoms.
- Medications used to treat interstitial cystitis include oral medications like pentosan polysulfate sodium and hydroxyzine, and bladder instillations with dimethyl sulfoxide or lidocaine.
- In some cases, patients with interstitial cystitis may require surgery, such as bladder hydrodistention or nerve stimulation, to manage their symptoms.
Source URLs
- Diet and Supplements for IC (Interstitial Cystitis Association)
- Functional Medicine Protocol for IC (Rupa Health)
- Comprehensive Guide to Interstitial Cystitis (UroToday)
- Diagnosis and Treatment of Interstitial Cystitis (Mayo Clinic)
- Treatment Options for Interstitial Cystitis (National Institute of Diabetes and Digestive and Kidney Diseases)
- IC Patient Guide (Urology Care Foundation)
- UpToDate on Treatment of Interstitial Cystitis (UpToDate)