What is interstitial cystitis (inflammatory bladder condition)?

From the Guidelines

Interstitial cystitis (IC), also known as bladder pain syndrome, is a chronic condition that causes bladder pressure, bladder pain, and sometimes pelvic pain, with symptoms including frequent urination, urgent need to urinate, and pain during sexual intercourse, and its diagnosis requires a careful history, physical examination, and laboratory examination to document basic symptoms and exclude infections or other confusable disorders 1.

Key Characteristics of Interstitial Cystitis

• The pain typically ranges from mild discomfort to severe pain
• Symptoms can include frequent urination, urgent need to urinate, and pain during sexual intercourse
• Unlike typical urinary tract infections, IC has no identifiable bacterial cause, making it difficult to diagnose and treat
• The condition is more common in women and can significantly impact quality of life if not properly managed

Diagnosis and Treatment Approaches

• Treatment usually involves a multimodal approach including oral medications, bladder instillations, and lifestyle modifications
• Lifestyle modifications are crucial and include avoiding trigger foods and beverages, stress management, pelvic floor physical therapy, and bladder training techniques 1
• A proper diagnosis requires excluding other conditions that may mimic IC/BPS, such as bladder cancer, bladder stones, and intravesical foreign bodies, and documenting symptoms that characterize the disorder, including the number of voids per day, sensation of constant urge to void, and the location, character, and severity of pain, pressure, or discomfort 1

Management Strategies

• Behavioral modification strategies may include altering the concentration and/or volume of urine, avoidance of certain foods known to be common bladder irritants, and use of an elimination diet to determine which foods or fluids may contribute to symptoms 1
• Techniques applied to trigger points and areas of hypersensitivity, such as application of heat or cold over the bladder or perineum, and strategies to manage IC/BPS flare-ups, such as meditation and imagery, may also be beneficial 1
• Pelvic floor muscle relaxation and bladder training with urge suppression are additional management strategies that may help alleviate symptoms 1

From the Research

Definition and Symptoms of Interstitial Cystitis

• Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating condition characterized by symptoms such as bladder pain, frequent urination, and nocturia 2, 3, 4, 5.
• Pain is typically perceived in the lower abdomen, pelvic floor, or urethra, causing significant discomfort and impacting quality of life 2.
• The condition is often associated with pelvic pain that varies with bladder filling, and resulting discomfort may range from abdominal tenderness to intense bladder spasms 4.

Etiology and Pathogenesis

• The etiology of IC/BPS is still not well understood, and different hypotheses have been formulated, including autoimmune processes, allergic reactions, chronic bacterial infections, exposure to toxins or dietary elements, and psychosomatic factors 3, 5.
• A recent hypothesis suggests that IC/BPS could be pathophysiologically related to a disruption of the bladder mucosa surface layer with consequent loss of glycosaminoglycans (GAGs) 3.
• The loss of GAGs may expose the urothelium to many urinary toxic agents, triggering a chain reaction in the submucosa 3.

Diagnosis and Treatment

• Diagnosis and management of IC/BPS may be difficult and is often made by its typical cystoscopic features 4.
• Treatment strategies can be categorized broadly into four different approaches: (i) intravesical drug instillation, (ii) systemic (oral) medical therapy, (iii) administration of local treatments, and (iv) surgical procedures for refractory disease 5.
• Multimodal symptomatic treatment approaches, including glycosaminoglycan replenishment, botulinum toxin A injection, platelet-rich plasma injection, low-energy shock waves, immunosuppression, and low-dose oral prednisolone, may be effective in managing IC/BPS 2, 6.
• Patient-tailored phenotype-directed multimodal therapy is the most promising treatment strategy, and combined phenotypic categorization with specific biomarkers could help toward better treatment 6.