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Key Features

Essentials of Diagnosis

  • Pain with full bladder or urinary urgency

  • Submucosal petechiae or ulcers on cystoscopic examination

  • Diagnosis of exclusion

General Considerations

  • Etiology unknown

  • Most likely several diseases with similar symptoms

  • Associated diseases include severe allergies, irritable bowel syndrome, or inflammatory bowel disease

Demographics

  • Prevalence of between 18 and 40 per 100,000 people

  • Both sexes, but majority of patients are women

  • Mean age at onset of 40 years

Clinical Findings

Symptoms and Signs

  • History: pain with bladder filling that is relieved with urination, or urgency, frequency, and nocturia

  • Physical examination should exclude genital herpes, vaginitis, or a urethral diverticulum

Differential Diagnosis

  • Up to 40% of patients referred to urologists for interstitial cystitis are found to have a different diagnosis after careful evaluation

  • Exposure to radiation (radiation cystitis) or cyclophosphamide (chemical cystitis)

  • Bacterial vaginitis

  • Genital herpes

  • Urethral diverticulum

  • Urethral carcinoma

  • Bladder carcinoma

  • Eosinophilic cystitis

  • Tuberculous cystitis

Diagnosis

Laboratory Tests

  • Urinalysis and urine culture to exclude infectious causes

  • Urinary cytology to exclude bladder malignancy

Diagnostic Procedures

  • Urodynamic testing assesses bladder sensation and compliance and excludes detrusor instability

  • The bladder is distended with fluid (hydrodistention) to detect glomerulations (submucosal hemorrhage)

  • Bladder biopsy to exclude other causes

Treatment

Diet

  • Avoid foods that exacerbate symptoms (eg, tomatoes)

Medications

  • Amitriptyline (10–75 mg/d orally) is often used as first-line medical therapy

  • Nifedipine (30–60 mg/d orally) and other calcium channel blockers have also demonstrated some activity

  • Pentosan polysulfate sodium (Elmiron)—an oral synthetic sulfated polysaccharide—helps restore integrity to the epithelium of the bladder

  • Intravesical instillation of dimethyl sulfoxide (DMSO) or heparin

  • Intravesical bacillus Calmette-Guérin is not beneficial

Surgery

  • Cystourethrectomy with urinary diversion in extreme cases

Procedures

  • Symptomatic relief from hydrodistention

  • Transcutaneous electric nerve stimulation (TENS)

  • Acupuncture

Outcome

Prognosis

  • No cure, but most patients achieve symptomatic relief

When to Refer

  • Persistent and bothersome symptoms in the absence of identifiable cause

References

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Hanno  PM,  et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011 Jun;185(6):2162–70.
[PubMed: 21497847]  
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Patanaik  SS,  et al. Etiology, pathophysiology and biomarkers of interstitial cystitis/painful bladder syndrome. Arch Gynecol Obstet. 2017 Jun;295(6):1341–59.
[PubMed: 28391486]  
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Zhang  W,  et al. Intravesical treatment of interstitial cystitis/painful bladder syndrome: a network meta-analysis. Int Urogynecol J. 2017 Apr;28(4):515–25.
[PubMed: 27614759]  

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