Interstitial cystitis (bladder pain syndrome)

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, although 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]Clemens JQ, Erickson DR, Varela NP et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2022 July;208(1):34-42. https://www.auajournals.org/doi/10.1097/JU.0000000000002756 ​​[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. 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.[1]Clemens JQ, Erickson DR, Varela NP et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2022 July;208(1):34-42. https://www.auajournals.org/doi/10.1097/JU.0000000000002756 [3]Engeler D, Baranowski AP, Berghmans B, et al. European Association of Urology. Guidelines on chronic pelvic pain. 2022 [internet publication]. https://uroweb.org/guidelines/chronic-pelvic-pain ​ Organ-centric terminology places the condition within the overall scope of chronic pelvic pain syndromes (CPPS), which also includes prostate, scrotal, gynaecological, gastrointestinal, musculoskeletal, and neurological pain syndromes.[3]Engeler D, Baranowski AP, Berghmans B, et al. European Association of Urology. Guidelines on chronic pelvic pain. 2022 [internet publication]. https://uroweb.org/guidelines/chronic-pelvic-pain ​ This topic deals primarily with the condition in women, as similar symptoms in men are often labelled 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's 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