Interstitial cystitis / bladder pain syndrome - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Interstitial cystitis (bladder pain syndrome) is a chronic, often debilitating clinical syndrome of urinary frequency, urgency, and pelvic pain. Symptoms vary with bladder filling.
Typified by periods of remission and exacerbations.
Diagnosis is one of exclusion, and physicians must carefully consider all patients with chronic pelvic pain as potential candidates.
Associated with several other comorbidities, including irritable bowel syndrome and systemic lupus erythematosus.
Treatment approach is aimed at symptom relief and pain management, with minimally invasive options tried before progressing to more complex, invasive therapies.

Glomerulations: hemorrhages seen after diagnostic cystoscopic hydrodistention

From the personal collection of Serge P. Marinkovic, MD

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Hunner ulcers: larger mucosal hemorrhages seen after diagnostic cystoscopic hydrodistention
Glomerulations: hemorrhages seen after diagnostic cystoscopic hydrodistention
Pelvic Pain and Urgency/Frequency (PUF) Questionnaire
Foods and beverages patients with IC may try or should avoid

Citations

Key Articles

Clemens JQ, Erickson DR, Varela NP et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2022 July;208(1):34-42.[Full Text]
Engeler D, Baranowski AP, Berghmans B, et al. European Association of Urology. Guidelines on chronic pelvic pain. 2022 [internet publication].[Full Text]
van de Merwe JP, Nordling J, Bouchelouche P, et al. Diagnostic criteria, classification, and nomenclature for painful bladder syndrome/interstitial cystitis: an ESSIC proposal. Eur Urol. 2008 Jan;53(1):60-7. [Abstract]
Cox A, Golda N, Nadeau G, et al. CUA guideline: diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2016 May-Jun;10(5-6):E136-55.[Abstract][Full Text]
Imamura M, Scott NW, Wallace SA, et al. Interventions for treating people with symptoms of bladder pain syndrome: a network meta-analysis. Cochrane Database Syst Rev. 2020 Jul 30;7(7):CD013325.[Abstract][Full Text]

Other Online Resources

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): your daily bladder diary
Interstitial Cystitis Symptom Index and Problem Index (ICSI-PI)
Interstitial Cystitis Association

Referenced Articles

1. Clemens JQ, Erickson DR, Varela NP et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2022 July;208(1):34-42.[Full Text]
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30. Hillelsohn JH, Rais-Bahrami S, Friedlander JI, et al. Fulguration for Hunner ulcers: long-term clinical outcomes. J Urol. 2012 Dec;188(6):2238-41.[Abstract]
31. Erickson DR, Tomaszewski JE, Kunselman AR, et al. Do the National Institute of Diabetes and Digestive and Kidney Diseases cystoscopic criteria associate with other clinical and objective features of interstitial cystitis? J Urol. 2005 Jan;173(1):93-7.[Abstract]
32. Ottem DP, Teichman JM. What is the value of cystoscopy with hydrodistension for interstitial cystitis? Urology. 2005 Sep;66(3):494-9.[Abstract]
33. Keay S. Cell signaling in interstitial cystitis/painful bladder syndrome. Cell Signal. 2008 Dec;20(12):2174-9.[Abstract]
34. Seth JH, Sahai A, Khan MS, et al. Nerve growth factor (NGF): a potential urinary biomarker for overactive bladder syndrome (OAB)? BJU Int. 2013 Mar;111(3):372-80.[Abstract]
35. Payne C, Allee T. Goal achievement provides new insights into interstitial cystitis/painful bladder syndrome symptoms and outcomes. Neurourol Urodyn. 2009;28(1):13-7. [Abstract]
36. Kushner L, Moldwin RM. Efficiency of questionnaires used to screen for interstitial cystitis. J Urol. 2006 Aug;176(2):587-92.[Abstract]
37. Clemens JQ, Brown SO, Kozloff L, et al. Predictors of symptom severity in patients with chronic prostatitis and interstitial cystitis. J Urol. 2006 Mar;175(3 Pt 1):963-6.[Abstract]
38. Paulson JD, Delgado M. The relationship between interstitial cystitis and endometriosis in patients with chronic pelvic pain. JSLS. 2007 Apr-Jun;11(2):175-81.[Abstract]
39. Warren JW, Howard FM, Cross RK, et al. Antecedent nonbladder syndromes in case-control study of interstitial cystitis/painful bladder syndrome. Urology. 2009 Jan;73(1):52-7.[Abstract]
40. Cox A, Golda N, Nadeau G, et al. CUA guideline: diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2016 May-Jun;10(5-6):E136-55.[Abstract][Full Text]
41. Parsons CL, Dell J, Stanford EJ, et al. Increased prevalence of interstitial cystitis: previously unrecognized urologic and gynaecologic cases identified using a new symptom questionnaire and intravesical potassium sensitivity. Urology. 2002 Oct;60(4):573-8.[Abstract]
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45. Geirsson G, Wang YH, Lindstrom S, et al. Traditional acupuncture and electrical stimulation of the posterior tibial nerve: a trial in chronic interstitial cystitis. Scand J Urol Nephrol. 1993;27(1):67-70.[Abstract]
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50. Theoharides TC, Sant GR. Hydroxyzine therapy for interstitial cystitis. Urology. 1997 May;49(5A Suppl):108-10.[Abstract]
51. Sant GR, Propert KJ, Hanno PM, et al. A pilot clinical trial of oral pentosan polysulfate and oral hydroxyzine in patients with interstitial cystitis. J Urol. 2003 Sep;170(3):810-5.[Abstract]
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53. van Ophoven A, Pokupic S, Heinecke A, et al. A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol. 2004 Aug;172(2):533-6.[Abstract]
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57. Sairanen J, Forsell T, Ruutu M. Long-term outcome of patients with interstitial cystitis treated with low dose cyclosporine A. J Urol. 2004 Jun;171(6 Pt 1):2138-41.[Abstract]
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64. Giannantoni A, Costantini E, Di Stasi SM, et al. Botulinum A toxin intravesical injections in the treatment of painful bladder syndrome: a pilot study. Eur Urol. 2006 Apr;49(4):704-9.[Abstract][Full Text]
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67. Peters KM, Konstandt D. Sacral neuromodulation decreases narcotic requirements in refractory interstitial cystitis. BJU Int. 2004 Apr;93(6):777-9.[Abstract]
68. Peters K, Killinger K, Boguslawski BM, et al. Chronic pudendal neuromodulation: expanding available treatment options for refractory urologic symptoms. Neurourol Urodyn. 2010 Sep;29(7):1267-71.[Abstract]
69. Fariello JY, Whitmore K. Sacral neuromodulation stimulation for IC/PBS, chronic pelvic pain, and sexual dysfunction. Int Urogynecol J. 2010 Dec;21(12):1553-8.[Abstract]
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77. Czarapata BJ. Super-strength, freeze-dried Aloe vera capsules in interstitial cystitis, painful bladder syndrome, chronic pelvic pain, and nonbacterial prostatitis: a double-blind, placebo-controlled crossover trial using Desert Harvest aloe vera at the Urology Wellness Center, Rockville, Maryland. Paper presented at: the NIDDK Scientific Symposium. 1995. San Diego, California.[Full Text]
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