Interstitial cystitis (bladder pain syndrome)

Chronic, often debilitating clinical syndrome of urinary frequency, urgency, and pelvic pain. Symptoms vary with bladder filling.

Typified by periods of remission and exacerbations.

Diagnosis is one of exclusion, and physicians must carefully consider all patients with chronic pelvic pain as potential candidates.

Associated with several other comorbidities, including irritable bowel syndrome and systemic lupus erythematosus.

Treatment approach is aimed at symptom relief and pain management, with minimally invasive options tried before progressing to more complex, invasive therapies.

On average, a patient experiences symptoms for 5 years prior to diagnosis.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic, often debilitating clinical syndrome of urinary frequency, urgency, and pelvic pain. The condition is typified by exacerbations, remissions, and varying degrees of symptom severity, though most patients present with several months or years of symptoms. Pain generally varies with bladder filling, and may be referred to the suprapubic area, urethra, or pelvis.[1]Hanno PM, Erickson D, MOldwin R, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015 May;193(5):1545-53. https://www.auanet.org/common/pdf/education/clinical-guidance/IC-Bladder-Pain-Syndrome-Revised.pdf http://www.ncbi.nlm.nih.gov/pubmed/25623737?tool=bestpractice.com [2]Bogart LM, Berry SH, Clemens JQ. Symptoms of interstitial cystitis, painful bladder syndrome and similar diseases in women: a systematic review. J Urol. 2007 Feb;177(2):450-6. http://www.ncbi.nlm.nih.gov/pubmed/17222607?tool=bestpractice.com The resulting discomfort may range from abdominal suprapubic tenderness to intense pain of the pelvic floor and dyspareunia. This organ-centric terminology places IC/BPS within the overall scope of chronic pelvic pain syndromes (CPPS), which also includes prostate, gynecologic, and bowel pain syndromes.[3]European Association of Urology. Chronic pelvic pain. 2018 [internet publication]. https://uroweb.org/guideline/chronic-pelvic-pain/ Commonly, patients are treated for recurrent bacterial cystitis despite negative cultures. IC/BPS is a diagnosis of exclusion, so other common disease processes must first be excluded before effective treatment can be initiated. This topic deals primarily with the condition in women, as similar symptoms in men are often labeled as chronic prostatitis/pelvic pain syndrome (CP/PPS). This dichotomy is somewhat arbitrary because, in the absence of infection, the treatment is similar to type III chronic prostatitis. The exception would be the finding of Hunner ulcers in the bladder, where IC/BPS is a more appropriate diagnosis.[4]van de Merwe JP, Nordling J, Bouchelouche P, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol. 2008 Jan;53(1):60-7. http://www.ncbi.nlm.nih.gov/pubmed/17900797?tool=bestpractice.com Other terms and definitions for the condition have been used over the years and no clear consensus has yet been reached.[5]Han E, Nguyen L, Sirls L, et al. Current best practice management of interstitial cystitis/bladder pain syndrome. Ther Adv Urol. 2018 Mar 19;10(7):197-211. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048622/ http://www.ncbi.nlm.nih.gov/pubmed/30034539?tool=bestpractice.com