Pathogenesis (development of disease)
Interstitial cystitis is due to chronic progressive (progressive) inflammation of all layers of the urinary bladder wall. It is considered an entity (object of consideration, which in itself is a separate entity or whole) of the hypersensitive bladder (HSB).
The following idiopathic genetic factors are possible or discussed:
- Dysfunction of the urothelium (malfunction of the multilayered covering tissue (epithelium) of the urinary tract): An important role in the pathogenesis is played by the inherently protective (protective) glycosaminoglycan layer (GAG layer/bladder protective layer) on the urothelium (multilayered covering tissue of the draining urinary tract, in this case the urinary bladder), which is presumably defective and thus becomes more permeable to noxae (toxins). The damaged GAG layer makes it easier for bacteria, proteins and carcinogenic substances to adhere to the bladder wall. Potassium ions in particular are suspected of penetrating through the disrupted mucosal barrier into deeper layers of the bladder wall where they irritate tissue, activate detrusor cells (detrusor vesicae muscle/smooth muscle cells in the bladder wall), and thus promote neural hyperactivity. Other aggressive components of urine also irritate the unprotected bladder wall, resulting in ongoing inflammatory processes.
- Neuronal overactivity: nerve fiber proliferation of the bladder wall (increased nerve sensors), mast cell infiltration of the detrusor muscles, and mast cell products in the urine suggest increased pain perception. Mast cells belong to the leukocytes (white blood cells). They play an important role in the immune system, wound healing as well as in allergic immediate reactions. Permanently activated mast cells release uncontrolled inflammatory mediators such as histamine and cytokines, which contributes to the maintenance of inflammatory (inflammatory) processes.
- Dysfunction (dysfunction) of the pelvic floor.
- Impaired microcirculation / reduced blood flow.
- Histamine intolerance
- Infections
- Psychosomatic stress disorders
- Influences of the microbiome (totality of all microorganisms of the respective individual).
- Genetic factors
In some sufferers, interstitial cystitis occurs in association with allergies, endometriosis (occurrence of endometrium (uterine lining) extrauterine (outside the uterine cavity)) understand that, irritable bowel syndrome, chronic inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis, migraine or rheumatic diseases (eg, fibromyalgia). Therefore, it is thought that autoimmune processes may underlie the disease.
Etiology (causes)
The exact etiology is unknown to date.
Discussed as possible trigger factors are:
- Autoimmune genetic predisposition
- History of severe and recurrent (recurrent) bacterial cystitis
- Chemotherapy
- Radiatio (radiotherapy) of tumors in the small pelvis.
Behavioral causes
