Interstitial Cystitis

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Definition/Description

Interstitial cystitis (IC) aka. Painful Bladder Syndrome (PBS) is a disorder affecting the bladder characterized by uroepithelial inflammation and/or hypersenstivity of the afferent nerves of the bladder.(Oyama, IA) The International Continence Society definition is "the complaint of suprapubic pain related to bladder filling, accompanied by other symptoms such as increased daytime and night time frequency, in the absence of proven urinary infection or other obvious pathology." (Bharucha & Trabuco)

Prevalence

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Characteristics/Clinical Presentation

Clinical Symptoms at Time of Diagnosis (Teichmen JM)

• Urinary urgency (57-98%)
• Daytime frequency (84-97%)
• Pain (66-94%)
• Nocturia (44-90%)
• Pain with voiding/dysuria (71-98%)
• Suprapubic pain (39-71%)
• Perineal pain (25-56%)
• Patient sensation of bladder spasms (50-74%)
• Pubic pressure (60-71%)
• Dyspareunia (46-80%)
• Depression (55-67%)
  
• Gross Hematuria (14-33%)

Pelvic floor dysfunction has been shown to be prominent in 85% of patients with IC resulting in pelvic floor spasms causing pelvic pain, dyspareunia, and urinary hesitancy.(Peters KM)

Associated Co-morbidities

• Endometriosis
  
• Irritable Bowel Syndrome (IBS)

Medications

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Diagnostic Tests/Lab Tests/Lab Values

Diagnostic approaches for IC vary widely and there is not a general agreement on a diagnostic algorithm. Currently, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Criteria is used.

NIDDK Diagonostic Critera for Interstitial Cystitis (MacDiarmid SA)

Automatic Inclusion:

• Hunner's ulcer

Positive factors (2 must be present for inclusion):

• Pain on bladder filling relieved by emptying
• Pain (suprapublic, pelvic, urethral, vaginal, or perineal)
• Glomerulations on cystoscopy
• Decreased compliance on cystometrogram

Exclsuions:

• Nocturia < 2 times per night
• Symptoms duration < 12 months
• Bladder Capacity > 400 mL
• Involuntary bladder contractions
• Other causes of sxs:

Bladder Cancer, Cystitis (radiation, tuberculous, bacterial, vaginitis, active herpes, bladder or lower calculi, involuntary bladder contractions.

Three consensus panels concluded that the diagnosis is suspected on the basis of history, physical examination, and laboratory tests, including negative urinalysis, negative urine culture, negative cytology, and possibly cystoscopy findings. (Nickel JC)

Causes

Several theories currently considered for IC:

1. Infectious organisms (has not been proven)
2. A defect in the mucous layer that coats the bladder epithelium.

Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Alternative/Holistic Management (current best evidence)

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Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

1. Mac Diarmid SA, Sand PK. Diagnosis of Interstitial Cystitis/Painful Bladder Syndrome in Patients with Overactive Bladder Symptoms. Rev. Urol. 2007; 9 (1): 9-16.
   
2. Nickel JC: Interstitial Cystitis: The Paradigm shifts: International Consultations on Interstitial Cystitis. Rev. Urol.
   2004; 6: 200-202.
   
3. Oyama IA, Reijba A, Lukban JC, Fletcher E, et al. Modified Thiele Massage as Therapeutic Intervention for Female Patients with Interstitial Cystitis and High-Tone Pelvic Floor Dysfunction. Urology; 64 (5): 862-865.
4. Peters KM, Carrico DJ, Kalinowski SE, Ibrahim IA, Diokno AC. Prevalence of Pelvic Floor Dysfunction in Patients with Interstitial Cystitis. Urology; 2207; 70: 16-18.
5. Teichman JMH, Parsons CL: Contemporary clinical presentation interstitial cystitis. Urology; 2007; 69 (supp 4A): 41-47.