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Diagnosis and Management of Interstitial Cystitis/Painful Bladder Syndrome

(Published May 2008)

Introduction to Interstitial Cystitis/
Painful Bladder Syndrome

Overview

  • Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic debilitating condition characterized by pelvic pain, urinary urgency, and urinary frequency.1
  • The type and severity of symptoms in IC/PBS can vary widely, which may lead to misdiagnosis or a delayed diagnosis.
  • Experts estimate that the condition affects about 1.2 million women and 82,000 men in the United States, although these figures may significantly underestimate the true prevalence of the condition.2

Definition

  • Clearly defining IC/PBS is difficult because the underlying pathology has not yet been elucidated, biological markers are not yet available, and the type and severity of symptoms can vary.
  • Participants of an expert consensus meeting on IC/PBS convened by the Association of Reproductive Health Professionals (ARHP) and the Interstitial Cystitis Association (ICA) in February 2007 accepted the following as a definition for IC/PBS:
    Pelvic pain, pressure, or discomfort related to the bladder, typically associated with persistent urge to void or urinary frequency, in the absence of infection or other pathology.

Symptoms

  • Bladder pain (or pressure or discomfort)
    • A defining symptom.
    • Characteristic of IC/PBS: pain or discomfort often increases with bladder filling and may diminish during voiding.3
    • Bladder pain or discomfort is associated with a persistent urge to void, urinary frequency, or both.
  • Urinary urgency
    • Often a progressive course of urgency that may be relieved by voiding.
    • Urgency is caused by increasing pain, unlike overactive bladder (OAB), in which urgency waxes and wanes and is due to concern about impending incontinence.3
    • Persistence of urgency often is useful in differentiating IC/PBS from acute urinary tract infection (UTI) or OAB.
  • Urinary frequency
    • Common in IC/PBS, with voiding 10 to 15 times or more within 24 hours.
    • May be severe, with voiding more than once an hour.2
  • Other symptoms
    • Nocturia is common and may cause sleep deprivation.
    • Dyspareunia is common in women with IC/PBS.4
    • Incontinence is uncommon.

Symptom presentation

  • Variable presentation.
  • Symptoms range from very severe, described as a sharp pain, to less severe, described as feeling similar to a persistent urinary tract infection.
  • Symptoms can be intermittent or constant.
  • Symptoms can wax and wane over time.
  • Among women, symptoms may flare during the premenstrual week.4

Comorbid conditions

  • Certain conditions are more common in patients with IC/PBS than in the general population.
  • Some of these conditions have an immunologic or allergic basis.
  • In late 2007, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) launched research opportunities to better understand the relationship between IC/PBS and these comorbid conditions.
  • Providers should be alert for the presence of such conditions in patients who have IC/PBS or who present with symptoms suggestive of IC/PBS.
  • Identifying and treating these conditions can reduce or eliminate a secondary source of pain for patients who have IC/PBS.
  • Comorbid conditions5-8
    • Allergies
    • Chronic fatigue syndrome
    • Endometriosis
    • Fibromyalgia
    • Inflammatory bowel disease
    • Irritable bowel syndrome
    • Migraine headaches
    • Pelvic floor dysfunction
    • Sensitive skin
    • Systemic lupus erythematosus
    • Vulvodynia

Pelvic floor dysfunction (PFD)6

  • Common among patients with IC/PBS.
  • Defined as myofascial dysfunction of the pelvic floor muscles (e.g., levator ani—the posterior portion of the pelvic floor muscle).
  • A frequent cause of chronic pelvic pain.
  • Common symptoms:
    • Constipation
    • Decreased force of urinary stream
    • Urinary hesitancy
    • Straining with urination
    • Sense of incomplete void
    • Low-back pain
    • Dyspareunia
  • Tenderness of the levator ani muscle found on pelvic or rectal exam.
  • Therapy directed at PFD may help reduce IC/PBS symptoms in patients.

References

  1. Hanno PM. Painful bladder syndrome/interstitial cystitis and related disorders. In: Wein AJ, editor. Campbell-Walsh Urology. 9th ed. Philadelphia: Saunders; 2007. p. 330-70.
  2. 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.
  3. Hanno PM. Painful bladder syndrome (interstitial cystitis). In: Hanno PM, Wein AJ, Malkowicz SB, editors. Penn Clinical Manual of Urology. Philadelphia: Saunders; 2007. p. 217-34.
  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.
  5. Alagiri M, Chottiner S, Ratner V, Slade D, Hanno PM. Interstitial cystitis: unexplained associations with other chronic disease and pain syndromes. Urology. 1997;49(Suppl 5A):52-7.
  6. Moldwin RM, Kaye J. Pelvic floor dysfunction in the painful bladder syndrome/interstitial cystitis (PBS/IC) population. NIDDK International Symposium: Frontiers in Painful Bladder Syndrome and Interstitial Cystitis, 2006 October 26–27; Bethesda, MD.
  7. Aaron LA, Herrell R, Ashton S, Belcourt M, Schmaling K, Goldberg J, et al. Comorbid clinical conditions in chronic fatigue: a co-twin control study. J Gen Intern Med. 2001;16(1):24-31.
  8. Chung MK, Chung RP, Gordon D. Interstitial cystitis and endometriosis in patients with chronic pelvic pain: The “Evil Twins” syndrome. JSLS. 2005;9(1):25-9.