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For further information, see CMDT Part 23-04: Interstitial Cystitis
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Essentials of Diagnosis
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General Considerations
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Etiology unknown
Most likely several diseases with similar symptoms
Associated diagnoses include severe allergies, irritable bowel syndrome, or inflammatory bowel disease
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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
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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
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Differential Diagnosis
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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
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Diagnostic Procedures
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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
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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
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Daniels
AM
et al. Interstitial cystitis: an update on the disease process and treatment. J Pain Palliat Care Pharmacother. ...