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 difference between cystitis and interstitial cystitis is the presecence of infection in the bladder. Cystitis presents with an infection while interstitial cysitis does not. (Goodman) 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

IC affects more than 700,00 individuals each year in the United States. Women make up 90% of those affected by this disorder. (Goodman/Synder)

Characteristics/Clinical Presentation

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

Oral therapy

• Anticonvulsants
• Antihistamines
• Immunomodulators
• Narcotic analgesics
• Pentosan polysulfate sodiuma
• Tricyclic antidepressants

Intravesical therapy

• Anesthetic cocktails
• Bacillus Calmette-Guérin (BCG)
• Dimethylsulfoxide (DMSO)
• Heparin
• Hyaluronic acid

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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Differential Diagnosis

Since there is not a definitive test to identify IC, ruling out other conditions becomes necessary before a diagnosis can be made.

Among these disorders are:

• Bladder cancer
  
• Bladder inflammation or infection caused by radiation to the abdomen
  
• Chronic bacterial or non-bacterial prostatitis (in men)
  
• Endometriosis
• Eosinophilic and tuberculous cystitis
  
• Kidney stones
  
• Low-count bacteriuria
  
• Neurological disorders
  
• Sexually transmitted diseases (STDs)
  
• Urinary tract infections (UTI)
  
• Vaginal infections
  
  

Case Reports

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Resources

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Recent Related Research (from Pubmed)

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References

1. Dell JR. Interstitial Cystitis/Painful Bladder Syndrome: Appropriate Diagnosis and Management. Journal of Women's Health. 2007; 16 (8):1181-1187.
2. Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. St. Louis, MO: Saunders Elsevier; 2007.
3. 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.
   
4. Nickel JC: Interstitial Cystitis: The Paradigm shifts: International Consultations on Interstitial Cystitis. Rev. Urol.
   2004; 6: 200-202.
   
5. 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.
6. 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.
7. Teichman JMH, Parsons CL: Contemporary clinical presentation interstitial cystitis. Urology; 2007; 69 (supp 4A): 41-47.