Interstitial Cystitis

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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 (such as IL-8 and chemokines CXCL-1 and CXCL-10) antiproliferative factor, nerve growth 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. This type of interstitial cystitis is a bladder/pelvic hypersensitivity 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
  • When examined under scanning electron microscope, patients with interstitial cystitis/bladder pain syndrome (IC/BPS) were found to have defects of umbrella cell integrity of which the severity of damage coincided with severity of symptoms.
  • System(s) affected: renal/urologic
  • Synonym(s): urgency frequency syndrome; IC/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 of age 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
  • Chronic scrotal pain

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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 (such as IL-8 and chemokines CXCL-1 and CXCL-10) antiproliferative factor, nerve growth 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. This type of interstitial cystitis is a bladder/pelvic hypersensitivity 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
  • When examined under scanning electron microscope, patients with interstitial cystitis/bladder pain syndrome (IC/BPS) were found to have defects of umbrella cell integrity of which the severity of damage coincided with severity of symptoms.
  • System(s) affected: renal/urologic
  • Synonym(s): urgency frequency syndrome; IC/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 of age 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
  • Chronic scrotal pain

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