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Interstitial Cystitis

Interstitial Cystitis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • A condition of pain or discomfort in the bladder associated with a need to urinate frequently and urgently
  • A disease of unknown cause, probably representing a final common pathway from several etiologies
  • Likely, pathogenesis is disruption of urothelium, impaired lower urinary tract defenses, and loss of bladder muscular wall elasticity. The symptoms in many patients are insidious, and the disease progresses for years before diagnosis is established.
  • Newer research implicates urine and serum inflammatory proteins antiproliferative factor, epidermal growth factor, heparin-binding epidermal growth factor, glycosaminoglycans, and bladder nitric oxide as contributing factors.
  • Mild: normal bladder capacity under anesthesia; ulceration, cracking, or glomerulation of mucosa (or not) with bladder distention under anesthesia; no incontinence symptoms wax and wane and may not progress. Interstitial cystitis is a bladder sensory problem.
  • Severe: progressive bladder fibrosis; small true bladder capacity under anesthesia; poor bladder wall compliance. In 5–10% of cases, Hunner ulcers present at cystoscopy; may have overflow incontinence and/or chronic bacteriuria unresponsive to antibiotics
  • System(s) affected: renal/urologic
  • Synonym(s): urgency frequency syndrome; IC/bladder pain syndrome (BPS)

Pregnancy Considerations
Unpredictable symptom improvement or exacerbation during pregnancy; no known fetal effects from interstitial cystitis; usual problems of unknown effect on fetus with medications taken during pregnancy

Epidemiology

  • Occurs predominantly among whites
  • Predominant sex: female > male (10:1)
  • Patients <30 years have predominant symptoms: dysuria, frequency, urinary urgency, pain in external genitals, and dyspareunia, and those >60 years more commonly have nocturia, urinary incontinence, or Hunner ulcer disease.
  • Predominant age
    • Mild: 20 to 40 years
    • Severe: 20 to 70 years
  • Pediatric considerations
    • <10 years old and again at 13 to 17 years
    • Daytime enuresis, dysuria without infection

Prevalence

In the United States:

  • Up to 1 million affected, but many cases likely are unreported
  • 0.052% but may be higher up to 10%

Etiology and Pathophysiology

  • Unknown but is not primarily psychosomatic
  • Possible causes
    • Subclinical urinary infection
    • Damage to glycosaminoglycan mucus layer increasing bladder wall permeability to irritants such as urea
    • Autoimmune
    • Mast cell histamine release
  • Neurologic upregulation/stimulation

Risk Factors

Unknown

Commonly Associated Conditions

  • Fibromyalgia
  • Allergies
  • Chronic fatigue syndrome
  • Depression
  • Vulvodynia
  • Sexual dysfunction
  • Sleep disturbance
  • Migraines
  • Syncope
  • Dyspepsia
  • Chronic prostatitis
  • Chronic pelvic pain
  • Irritable bowel syndrome
  • Anal/rectal disease

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Citation

Stephens, Mark B., et al., editors. "Interstitial Cystitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116325/all/Interstitial_Cystitis.
Interstitial Cystitis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116325/all/Interstitial_Cystitis. Accessed April 18, 2019.
Interstitial Cystitis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116325/all/Interstitial_Cystitis
Interstitial Cystitis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116325/all/Interstitial_Cystitis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Interstitial Cystitis ID - 116325 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116325/all/Interstitial_Cystitis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -