Interstitial cystitis (bladder pain syndrome) is a 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. The resulting discomfort may range from abdominal suprapubic tenderness to intense pain of the pelvic floor and dyspareunia. 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.
The nomenclature of this condition is controversial; some guidelines continue to use IC/BPS, while others recommend the term primary bladder pain syndrome. Organ-centric terminology places the condition within the overall scope of chronic pelvic pain syndromes (CPPS), which also includes prostate, scrotal, gynecologic, gastrointestinal, musculoskeletal, and neurological pain syndromes. 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. Other terms and definitions for the condition have been used over the years and no clear consensus has yet been reached.
History and exam
Key diagnostic factors
- food or stress triggers
- urinary urgency
- urinary frequency
- urinary incontinence
- pelvic-floor pain
- worsening of symptoms before menses
- urethral pain
- bladder neck pain
- suprapubic pain
- levator ani pain
- pain after placement of Foley catheter
Other diagnostic factors
- vulvar vestibulitis
- features of systemic lupus erythematosus
- features of rheumatoid arthritis
- features of chronic fatigue syndrome
- sexual/domestic abuse
- scrotal or anal pain
- age 20 to 60 years
- female sex
- positive family history
- sexual or domestic abuse
- white ethnicity
1st investigations to order
- urinalysis with microscopy and culture
- vaginal wet prep
- voiding diary
- urine cytology
Investigations to consider
- cystoscopy with hydrodistention of bladder
- bladder biopsy
- stress protein gene assay
- urine antiproliferative factor
- urine nerve growth factor (NGF)
nonulcerative interstitial cystitis
ulcerative interstitial cystitis
- Irritable bowel syndrome (IBS)
- Urinary tract infection
- Diagnosis and treatment of interstitial cystitis/bladder pain syndrome
- Chronic pelvic pain
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