Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 23-04: Interstitial Cystitis + Key Features Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ 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 Download Section PDF Listen +++ +++ Prognosis ++ No cure, but most patients achieve symptomatic relief +++ When to Refer ++ Persistent and bothersome symptoms in the absence of identifiable cause + References Download Section PDF Listen +++ + +Daniels AM et al. Interstitial cystitis: an update on the disease process and treatment. J Pain Palliat Care Pharmacother. 2018 Mar;32(1):49–58. [PubMed: 30212267] + +Giusto LL et al. An evaluation of the pharmacotherapy for interstitial cystitis. Expert Opin Pharmacother. 2018 Jul;19(10):1097–108. [PubMed: 29972328] + +Hanno PM et al; American Urological Association. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015 May;193(5):1545–53. [PubMed: 25623737] + +Marcu I et al. Interstitial cystitis/bladder pain syndrome. Semin Reprod Med. 2018 Mar;36(2):123–35. [PubMed: 30566978] + +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] + +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]