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
  • The symptoms in many patients are insidious, and the disease progresses for years before diagnosis is established.
  • 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/bladder pain syndrome

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

Epidemiology

  • Occurs predominantly among whites
  • Predominant sex: female > male (10:1)
  • Predominant symptoms in patients <30 years: dysuria, frequency, urinary urgency, pain in external genitals, and dyspareunia
  • Predominant symptoms in those >60 years: dysuria, 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
    • Pathogenesic factors are disruption of urothelium, impaired lower urinary tract defenses with high urothelium permeability, (subclinical) UTIs, decreased tight junction protein, afferent nerve plasticity, pelvic floor dysfunction, 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 CXCL1 and CXCL10) antiproliferative factor, nerve growth factor, epidermal growth factor, heparin-binding epidermal growth factor, glycosaminoglycan damage, mast cell activation, and bladder nitric oxide as contributing factors.
    • Neurologic upregulation/stimulation
    • Autoimmune

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

-- To view the remaining sections of this topic, please or --

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
  • The symptoms in many patients are insidious, and the disease progresses for years before diagnosis is established.
  • 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/bladder pain syndrome

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

Epidemiology

  • Occurs predominantly among whites
  • Predominant sex: female > male (10:1)
  • Predominant symptoms in patients <30 years: dysuria, frequency, urinary urgency, pain in external genitals, and dyspareunia
  • Predominant symptoms in those >60 years: dysuria, 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
    • Pathogenesic factors are disruption of urothelium, impaired lower urinary tract defenses with high urothelium permeability, (subclinical) UTIs, decreased tight junction protein, afferent nerve plasticity, pelvic floor dysfunction, 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 CXCL1 and CXCL10) antiproliferative factor, nerve growth factor, epidermal growth factor, heparin-binding epidermal growth factor, glycosaminoglycan damage, mast cell activation, and bladder nitric oxide as contributing factors.
    • Neurologic upregulation/stimulation
    • Autoimmune

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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