There is a specific type of cystitis called interstitial cystitis. If you have recently experienced frequent urination, painful urination, increased nighttime urination, especially heavy pain when you are about to urinate, and a feeling of relief after urination, then you should be careful if you have interstitial cystitis. Interstitial cystitis often occurs in middle-aged women and is characterized mainly by fibrosis of the bladder wall with a reduction in bladder volume, which can sometimes be less than 100 ml. Pathological changes The deep fibrosis of the bladder wall found in the pathology reduces its volume, sometimes quite significantly. The bladder mucosa thins, which is most evident at the site of maximum bladder stretch, and sometimes small ulcers or fissures can be seen. In some severe cases, damage to the vesicoureteral junction can produce vesicoureteral reflux and even ureteral hydronephrosis and pyelonephritis. Microscopically, the bladder mucosa becomes thin and even exfoliates, capillaries in the lamina propria are often congested with an inflammatory response, fibrous tissue proliferation is evident in the muscularis, and lymphatic vessels are dilated. There is also lymphocytic infiltration and mast cell infiltration. Clinical manifestations of interstitial cystitis (1) Symptoms: Patients often have chronic progressive urinary frequency, urgency and increased nocturia, pain in the suprapubic region is evident during bladder filling, sometimes pain in the urethra and perineum can also occur, which is relieved after urination, hematuria can occasionally occur. (2) Signs: Clinical examination is generally normal, some patients may have tenderness in the suprapubic area, and in female patients there may be tenderness in the bladder area during palpation of the anterior vaginal wall. (3) Laboratory tests: Most of the patients have normal urine routine, hematuria may be present, and renal function tests may change except in cases of bladder fibrosis leading to vesicoureteral reflux or obstruction. (4) Radiological examination: excretory urography is generally abnormal, but in case of combined reflux, hydronephrosis and reduced bladder capacity are seen on the film. (5) Instrumentation: Cystoscopy is an important method for the diagnosis of interstitial cystitis. Due to the reduced bladder volume, patients are in great pain and small patches of petechiae, bleeding, some scars, fissures or oozing blood can be seen at the top of the bladder after liquid cyst expansion is performed. When interstitial cystitis is clinically suspected, cystoscopy is recommended to be performed under anesthesia.