Interstitial cystitis (painful bladder syndrome) is a chronic condition characterized by pain perceived to be from the urinary bladder, urinary urgency and frequency, and nocturia.
In the United States, 3-6% of women and 2-4% of men have interstitial cystitis. Among women, the average age at onset is the early forties, but the range is from childhood through the early sixties.
The etiology remains unknown.
- Theoretical possibilities include chronic bladder infection, inflammatory factors such as mast cells, autoimmunity, increased permeability of the bladder mucosa, and unusual pain sensitivity.
- However, few data support any of these factors as an inciting cause.
The cardinal symptoms of pain (often at ≥2 sites), urinary urgency and frequency, and nocturia occur in no consistent order. Symptoms can begin acutely or gradually.
- Unlike pelvic pain arising from other sources, pain caused by interstitial cystitis is exacerbated by bladder filling and relieved by bladder emptying.
- 85% of pts void >10 times per day; some do so as often as 60 times per day.
- Many pts with interstitial cystitis have comorbid functional somatic syndromes (e.g., fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, vulvodynia, migraine).
The diagnosis is based on the presence of appropriate symptoms and the exclusion of diseases with a similar presentation (e.g., diseases that manifest with pelvic pain and/or urinary symptoms; functional somatic syndromes with urinary symptoms); physical exam and laboratory findings are insensitive and/or nonspecific. Cystoscopy may reveal an ulcer (10% of pts) or petechial hemorrhages after bladder distension, but neither of these findings is specific.
Treatment: Interstitial Cystitis The goal of therapy is the relief of symptoms, which often requires a multifaceted approach (e.g., education, stress reduction, dietary changes, medications such as nonsteroidal anti-inflammatory drugs or amitriptyline, pelvic-floor physical therapy, and treatment of associated functional somatic syndromes). |
For a more detailed discussion, see Warren JW: Dysuria, Bladder Pain, and the Interstitial Cystitis/Bladder Pain Syndrome, Chap. 60e; and Gupta K, Trautner BW: Urinary Tract Infections, Pyelonephritis, and Prostatitis, Chap. 162, p. 861, in HPIM-19. |
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