Interstitial Cystitis/Painful Bladder Syndrome

BASICS

DESCRIPTION

  • A condition characterized by pain, pressure or discomfort of the bladder or pelvic region associated with one or more of the following urinary symptoms: increased frequency, urgency, or nocturia
  • A chronic inflammatory disease of unknown etiology, with associated urinary symptoms for >6 weeks without other identifiable causes such as infection or other pathology
  • The symptoms in many patients are insidious, and the disease progresses for years with relapsing and remitting symptoms often before diagnosis is established.
  • Types include interstitial cystitis/bladder pain syndrome without Hunner lesions and interstitial cystitis/bladder pain syndrome with Hunner lesions.
  • System(s) affected: renal/urologic
  • Synonym(s): urgency frequency syndrome; IC/bladder pain syndrome; chronic cystitis; Hunner ulcer

Pregnancy Considerations
Unpredictable symptom improvement or exacerbation during pregnancy; may be associated with increased risk of preeclampsia and preterm birth, but further prospective studies are needed; usual problems of unknown effect on fetus with medications taken during pregnancy

EPIDEMIOLOGY

  • Occurs predominantly among white patients
  • Predominant sex: female > male (5:1) in patients 25 to 80 years of age
  • Most common in adults >30 years of age and diagnosis increases with age

Incidence

Difficult to estimate due to different diagnostic criteria and regional differences, but 1-year incidence has been reported as:

  • 21 per 100,000 female patients
  • 4 per 100,000 male patients

Prevalence

In the United States:

  • Prevalence is variable.
  • Up to 1.2 million female and 82,000 male patients affected, but many cases likely are undiagnosed.
  • 0.052% but may be ≥10%

ETIOLOGY AND PATHOPHYSIOLOGY

  • Etiology is unclear, and pathophysiology is likely multifactorial.
  • Potential causes include:
    • Disruption of urothelium, production of antiproliferative factor, and diminished glycosaminoglycan layer
    • Afferent nerve plasticity
    • Pelvic floor dysfunction
    • Mast cell infiltration, bladder nitric oxide
    • Reduced vascularization
    • Neurogenic inflammation
    • Autoimmune

RISK FACTORS

Unclear but some reported risks include the following:

  • Female
  • Recent urinary tract infection (UTI)
  • Irritable bowel syndrome (IBS)
  • Allergies
  • History of sexual abuse

COMMONLY ASSOCIATED CONDITIONS

  • Fibromyalgia/Chronic fatigue syndrome
  • Allergies
  • Depression and panic disorder
  • Vulvodynia
  • Sexual dysfunction
  • Sleep disturbance
  • Migraines
  • Chronic prostatitis
  • Chronic pelvic pain and pelvic floor dysfunction
  • IBS
  • Anal/rectal disease
  • Chronic scrotal pain
  • Trauma
  • Autoimmune conditions such as systemic lupus erythematosus (SLE) and Sjögren syndrome

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