Interstitial Cystitis (Chronic Pelvic Pain Syndrome)
Interstitial Cystitis or Painful Bladder Syndrome (IC/PBS) is a chronic bladder condition. IC/PBS refers to pain, pressure, discomfort within the urinary bladder, with symptoms lasting more than six weeks, of infection or other identifiable causes. Symptoms often include an urgent need to urinate, pain if delay urination, and frequent need to urinate or a combination of symptoms. Pain can also occur during menstruation or vaginal intercourse. Symptoms can range from mild to severe, intermittent to constant. Symptoms may disappear with treatment or without explanation, but sometimes can return days, weeks, months or years later. IC/PBS can be associated with irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome and other pain syndromes. It is felt to fall under the larger entity – Chronic pelvic pain syndrome.
IC/PBS is more common in women, estimated to occur in 3-8% of U.S. women and 2-3% of U.S. men. The diagnosis of IC/PBS is clinical, meaning it is mostly based on a patient’s symptoms. It involves a detailed history and physical exam and tests to rule out other conditions that may present with similar symptoms. Some of these other conditions include Urinary Tract Infection (UTI) (LINK), endometriosis, overactive bladder or urinary retention. Tests that can help rule out other diseases include urinalysis, urine culture and procedures such as cystoscopy or urodynamic study. The exact cause of IC is not clear, but scientists believe it is related to one or more physiologic pathways such as defects in bladder epithelium, abnormal firing of bladder nerve signals, pelvic floor abnormalities, or autoimmune process. It is thought that these symptoms can come from many different causes.
There are a multitude of treatment options that have been used to treat IC/PBS.There is no one magic treatment because the cause may be very different from person to person. The key is to start with more conservative treatments, weigh the risk and benefit and target the treatment individually.Treatments that have been used include diet modification, bladder training, specialized pelvic floor physical therapy, medications, bladder instillation with medication, bladder distension, electrical nerve stimulation, bladder surgery.
International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases