From the Guidelines
Interstitial cystitis (IC), also known as bladder pain syndrome, presents with several characteristic signs and symptoms, including chronic pelvic pain, pressure, or discomfort related to the bladder, urinary urgency, and frequency, as noted in the most recent guideline 1. The hallmark symptom is chronic pelvic pain, pressure, or discomfort related to the bladder that typically worsens as the bladder fills and improves temporarily after urination. Patients frequently experience urinary urgency (the sudden, strong need to urinate) and frequency (urinating more than 8 times during the day or multiple times at night), often without evidence of infection. Some key points to consider in the diagnosis of IC include:
- Pain during sexual intercourse is common, particularly in women
- Symptoms may flare in response to certain triggers including specific foods (acidic, spicy, caffeinated, or alcoholic), stress, menstruation, or prolonged sitting
- The severity of symptoms often fluctuates, with periods of improvement followed by exacerbations
- Some patients may have small bladder capacity and pinpoint hemorrhages (glomerulations) or Hunner's lesions visible on cystoscopy, though these findings aren't present in all cases
- Unlike typical urinary tract infections, urine cultures in IC patients are negative for bacteria
- Diagnosis typically involves ruling out other conditions with similar symptoms, such as urinary tract infections, bladder cancer, or overactive bladder, before confirming IC based on the symptom pattern and exclusion of other causes, as outlined in the guideline 1. It's worth noting that IC/BPS is a heterogeneous clinical syndrome, with subgroups or phenotypes within the condition, and initial treatment should typically be nonsurgical, with concurrent, multi-modal therapies offered, as recommended in the most recent study 1.
From the Research
Signs and Symptoms of Interstitial Cystitis
The signs and symptoms of interstitial cystitis (IC) can vary from person to person, but common characteristics include:
- Excessive urgency and frequency of urination 2
- Suprapubic pain 2
- Dyspareunia (painful intercourse) 2
- Chronic pelvic pain 2, 3
- Negative urine cultures 2
- Bladder pain or discomfort 4
- Bothersome storage symptoms 4
- Pelvic pain exacerbated by bladder filling 5
- Lower urinary tract symptoms, including frequency and urgency 5
Diagnosis and Clinical Features
Diagnosis of IC is based on clinical features, and the possibility of other conditions must be ruled out first 4. Cystoscopy and hydrodistention of the bladder can be used to confirm the diagnosis, with glomerulations or Hunner's ulcers being diagnostic 2. The course of the disease is usually marked by flare-ups and remissions 2.
Impact on Quality of Life
IC can have a significant impact on a patient's quality of life, with chronic pelvic pain and disruption of daily life activities being common 3. Treatment for IC often revolves around symptom management and improving quality of life 3.