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For further information, see CMDT Part 23-04: Interstitial Cystitis

Key Features

Essentials of Diagnosis

  • Pain with bladder filling 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 diagnoses 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

  • Pain, pressure, or discomfort with bladder filling that is relieved with urination

  • Urgency, frequency, and nocturia

  • Physical examination should exclude genital herpes, vaginitis, or 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 can be done to assess bladder sensation and compliance and to exclude detrusor instability

  • Cystoscopy may reveal glomerulations (submucosal hemorrhage) with hydrodistention of the bladder

  • Total bladder capacity should be determined

  • Biopsy of any suspicious lesions should be performed to exclude other causes, such as carcinoma, eosinophilic cystitis, and tuberculous cystitis

Treatment

Diet

  • Avoid foods that exacerbate symptoms (eg, tomatoes)

Medications

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

  • Nifedipine (30–60 mg/day 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

  • Transcutaneous electric nerve stimulation (TENS)

  • Acupuncture

  • Stress reduction

  • Exercise

  • Biofeedback

  • Massage

  • Pelvic floor relaxation

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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Daniels  AM  et al. Interstitial cystitis: an update on the disease process and treatment. J Pain Palliat Care Pharmacother. ...

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