Interstitial cystitis/bladder pain syndrome

Last reviewed: September 2018

Last updated: January 2018

Summary

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 SLE.

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.

Definition

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] [2] 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] 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 monograph 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]

History and exam

Key diagnostic factors

food or stress triggers
urinary urgency
urinary frequency
urinary incontinence
nocturia
dysuria
pelvic-floor pain
dyspareunia
worsening of symptoms before menses
urethral pain
bladder neck pain
suprapubic pain
levator ani pain
pain after placement of Foley catheter

Full details

Other diagnostic factors

fibromyalgia
vulvar vestibulitis
vulvodynia
features of SLE
migraine
features of rheumatoid arthritis
features of chronic fatigue syndrome
allergies
sexual/domestic abuse
scrotal or anal pain

Full details

Risk factors

age 20 to 60 years
female gender
white ethnicity
positive FHx
sexual or domestic abuse

Full details

Diagnostic investigations

1st investigations to order

urinalysis with microscopy and culture
vaginal wet prep
voiding diary
urine cytology

Full details

Investigations to consider

cystoscopy with hydrodistention of bladder
bladder biopsy

Full details

Emerging tests

stress protein gene assay
urine antiproliferative factor
urine nerve growth factor (NGF)

Full details

Treatment algorithm

ONGOING

nonulcerative interstitial cystitis

ulcerative interstitial cystitis

Contributors

Authors VIEW ALL 

Kenneth M. Peters, MD

Professor and Chairman

Department of Urology

Oakland University William Beaumont School of Medicine

Chair

Department of Urology

Beaumont Health System

Royal Oak

Disclosures

KMP declares that he has worked as a consultant/Investigator for Medtronic, Inc, as a consultant/investigator for StimGuard, Inc., as a consultant for Allergan, and as a consultant for Taris, Inc.

Natalie Gaines, MD

Fellow

Female Pelvic Medicine and Reconstructive Surgery

Department of Urology

Beaumont Health System

Royal Oak

Disclosures

NG declares that she has no competing interests.

Acknowledgements

Dr Kenneth M. Peters and Dr Natalie Gaines would like to gratefully acknowledge Dr Serge P. Marinkovic, Dr Robert Moldwin, Dr Stuart L. Stanton, Dr Lisa M. Gillen, Dr Christina Marinkovic, and Dr Michael Ehlert, the previous contributors to this monograph. SPM, RM, SLS, LMG, CM, and ME declare that they have no competing interests.

Peer reviewers VIEW ALL 

Nissrine Nakib, MD

Assistant Professor

Director of Female Urology and Urodynamics

University of Minnesota

Minneapolis

Disclosures

NN declares that she has no competing interests.

Neil Baum, MD

Urologist

Touro Medical Office

New Orleans

Disclosures

NB declares that he has no competing interests.

James Malone-Lee, MD, FRCP

Professor of Medicine

Department of Clinical Physiology

Division of Medicine

Whittington Campus

University College London Medical School

London

Disclosures

JML declares that he has no competing interests.

Charles Butrick, MD

Director

The Urogynecology Center

Overland Park

Disclosures

CB declares that he has no competing interests.

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Interstitial cystitis/bladder pain syndrome

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic investigations

1st investigations to order

Investigations to consider

Emerging tests

Treatment algorithm

nonulcerative interstitial cystitis

ulcerative interstitial cystitis

Contributors

Authors VIEW ALL 

Kenneth M. Peters, MD

Disclosures

Natalie Gaines, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

Nissrine Nakib, MD

Disclosures

Neil Baum, MD

Disclosures

James Malone-Lee, MD, FRCP

Disclosures

Charles Butrick, MD

Disclosures

Differentials

Guidelines

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