What is interstitial cystitis (IC), also known as bladder pain syndrome?

From the Guidelines

Interstitial cystitis (IC), also known as bladder pain syndrome, is a chronic condition characterized by bladder pressure, bladder pain, and sometimes pelvic pain, with symptoms including a persistent urge to urinate, frequent urination, and pain or discomfort while the bladder fills that may be temporarily relieved by emptying it. The exact cause of interstitial cystitis remains unknown, but it's believed to involve multiple factors including defects in the protective lining of the bladder, autoimmune reactions, allergies, infections, or hereditary factors 1.

Key Characteristics

• The pain typically ranges from mild discomfort to severe pain
• Symptoms can include a persistent urge to urinate, frequent urination (often in small amounts), and pain or discomfort while the bladder fills that may be temporarily relieved by emptying it
• IC is not an infection and does not respond to antibiotics, nor is it caused by psychological factors, though living with chronic pain can affect mental health ### Diagnosis and Treatment
• The clinical diagnosis of IC/BPS requires a careful history, physical examination, and laboratory examination to document basic symptoms that characterize the disorder and exclude infections or other confusable disorders 1
• There is no single treatment that works for everyone, but options include oral medications like pentosan polysulfate sodium (Elmiron), tricyclic antidepressants, or antihistamines; bladder instillations where medication is placed directly into the bladder; physical therapy for pelvic floor dysfunction; and lifestyle modifications such as dietary changes to avoid trigger foods (coffee, alcohol, spicy foods, citrus) 2
• Some patients find relief through stress reduction techniques as stress can worsen symptoms
• Behavioral modification strategies may include altering the concentration and/or volume of urine, either by fluid restriction or additional hydration; avoidance of certain foods known to be common bladder irritants; use of an elimination diet to determine which foods or fluids may contribute to symptoms; techniques applied to trigger points and areas of hypersensitivity (eg, application of heat or cold over the bladder or perineum); strategies to manage IC/BPS flare-ups (eg, meditation, imagery); pelvic floor muscle relaxation; and bladder training with urge suppression 3 ### Management
• Patients should be made aware that IC/BPS is typically a chronic disorder requiring continual and dynamic management, with adequate symptom control achievable but may require trials of multiple therapeutic options to identify the regimen that is effective for that patient 2
• Patients should be informed that, given the chronic nature of IC/BPS, the typical course involves symptom exacerbations and remissions
• A proper hematuria workup should be performed in patients with un-evaluated hematuria, and considered in patients with tobacco exposure given the high risk of bladder cancer in smokers 1

From the FDA Drug Label

Interstitial cystitis (IC) is not explicitly defined in the provided drug labels, but it is mentioned as a condition being treated with pentosan polysulfate (PO). The condition is described in relation to the treatment, where patients with chronic interstitial cystitis are evaluated for relief of pain.

• Key points about interstitial cystitis (IC) include: + It is a condition characterized by pain or discomfort in the bladder. + The exact cause of IC is not known, but pentosan polysulfate (PO) is used to treat the pain or discomfort associated with it. + Patients with IC may experience severe or unbearable pain, moderate pain, or mild or no pain. Based on the information provided in the drug labels 4 and 5, interstitial cystitis (IC) is a condition that causes bladder pain or discomfort, but its exact definition and cause are not explicitly stated.

From the Research

Definition and Characteristics of Interstitial Cystitis

• Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by bladder discomfort, urinary frequency, urgency, and pelvic pain 6.
• The condition is diagnosed by exclusion, and the histologic findings are neither specific for diagnosis nor correlated with symptoms 6.
• Bladder pain syndrome (BPS) is a chronic condition characterized by pelvic pain or pressure which is perceived to be originating from the bladder, accompanied by one or more urinary symptoms, including frequency, urgency, and nocturia 7.

Etiology and Pathogenesis

• The precise etiology of BPS is not fully understood, but several mechanisms have been implicated, including chronic bacterial infection, defective glycosaminoglycan (GAG) layer of the bladder urothelium, inappropriate activation of mast cells in the suburothelial layer of the bladder, autoimmune-mediated mechanisms, and autonomic nervous system dysfunction 7.

Treatment Options

• The treatment approach is multimodal and should be patient-specific, targeting the symptoms that they find most bothersome 7.
• Conservative treatment, including patient education, behavioral modification, dietary advice, stress relief, and physical therapy, is an essential initial management strategy for all patients 7.
• Oral treatments, such as amitriptyline, and intravesical instillation of DMSO or lidocaine, detrusor injections of botulinum toxin A, and neuromodulation can be used if initial management fails to improve symptoms 7.
• Pentosan polysulfate sodium (PPS) has been shown to be effective and safe in the treatment of IC/BPS, with statistically significant improvements in patient's overall response assessment, pain, and urgency 8, 9, 10.