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Screening, Treatment, and Management of IC/PBS

(Published May 2008)

Symptoms of Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS)

The symptom presentation of interstitial cystitis/painful bladder syndrome (IC/PBS) is variable. Some patients have severe symptoms, like those described above. Others have less severe symptoms, which may feel like a persistent urinary tract infection. Indeed, patients with IC/PBS experience a wide range of symptoms of varying severity and frequency; symptoms can be mild to severe and intermittent or constant. In addition, IC/PBS symptoms can wax and wane over time in an individual patient.

"A hot poker being placed up into your bladder”
"Having to urinate so frequently you can’t go anywhere”
"A deep aching pain in the
pelvic region”
The characteristic symptoms of IC/PBS are reflected in the definition of IC/PBS crafted by the expert committee convened by ARHP and the ICA in February 2007:

  • Pelvic pain, pressure, or discomfort related to the bladder
  • Typically associated with persistent urge to void or urinary frequency
  • Absence of infection or other pathology

Bladder pain, which is sometimes described as pressure or discomfort, is a defining symptom of IC/PBS. A key characteristic of this bladder pain or discomfort is that it increases with bladder filling and may diminish during voiding.2 For some patients, the pain is constant and severe; for others, pain is minimal if they void at the first sense of filling or urge sensation. The bladder pain or discomfort is associated with a persistent urge to void, urinary frequency, or both. The persistence of the urgency associated with IC/PBS often distinguishes it from the urgency associated with an acute urinary tract infection or overactive bladder.

Urinary frequency is common among patients with IC/PBS and may be severe. Patients may void 10 to 15 times or more within 24 hours; some patients void more than once an hour.3 Some patients are rendered homebound due to voiding every 15 to 20 minutes.1 Nocturia is common among patients with IC/PBS, but incontinence is uncommon. Dyspareunia is frequently seen in women with the condition, as are symptom flares during the premenstrual week.4

Urinary urgency is common to both IC/PBS and overactive bladder (OAB), sometimes leading to misdiagnosis. However, the temporal course and underlying cause of the urgency of the conditions are different. Patients with IC/PBS tend to experience a progressive course of urgency that may be relieved by voiding. Urgency is caused by increasing pain. In contrast, patients with OAB tend to experience a waxing and waning course of urgency. Urgency in these patients is due to concern about impending incontinence2 (see Figure 3).

References:

  1. The Many Faces of IC: People Living with Interstitial Cystitis: Their Stories. Rockville, MD: Interstitial Cystitis Association; 2006.
  2. Hanno PM. Painful bladder syndrome (interstitial cystitis). In: Hanno PM, Wein AJ, Malkowicz SB, editors. Penn Clinical Manual of Urology. Philadelphia, PA: Saunders; 2007. pp. 217-34.
  3. Clemens JQ, Joyce GF, Wise M, Payne CK. Interstitial cystitis and painful bladder syndrome. In: Litwin MS, Saigal CS, editors. Urologic Diseases in America. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office, 2007. NIH Publication No. 07-5512:125-154.
  4. Rosenberg MT, Newman DK, Page SA. Interstitial cystitis/painful bladder syndrome: symptom recognition is key to early identification, treatment. Cleve Clin J Med. 2007;74(Suppl 1):S54-S62.