From the Guidelines
Interstitial cystitis (IC) in males is primarily caused by a combination of factors, including chronic prostatitis/chronic pelvic pain syndrome, which shares overlapping symptoms, as well as potential defects in the protective lining of the bladder and autoimmune reactions, among others. The exact cause of IC in males remains unclear, but potential causes include defects in the protective lining of the bladder, allowing toxic substances in urine to irritate the bladder wall; autoimmune reactions where the body's immune system attacks the bladder; infection from an undetected organism; activation of mast cells that release histamine and other chemicals that lead to symptoms; neurogenic inflammation; and pelvic floor muscle dysfunction 1. Males may also develop IC due to chronic prostatitis/chronic pelvic pain syndrome, which shares overlapping symptoms, such as pain in the perineum, suprapubic region, testicles or tip of the penis, and voiding symptoms like sense of incomplete bladder emptying and urinary frequency 1. Some key points to consider in the diagnosis and treatment of IC in males include:
- Risk factors, such as chronic stress, previous bladder trauma, pelvic surgery, and certain medications
- Genetic predisposition, as IC sometimes runs in families
- Unlike in females, hormonal factors are less significant in male IC
- Diagnosis typically involves ruling out other conditions through cystoscopy, urodynamic testing, and urine analysis
- Treatment approaches include dietary modifications, stress management, physical therapy for pelvic floor muscles, and medications such as pentosan polysulfate sodium (Elmiron), antihistamines, tricyclic antidepressants, and in some cases, bladder instillations. Given the complexity and variability of IC in males, a comprehensive treatment plan should be tailored to the individual patient's needs and symptoms, taking into account the potential causes and risk factors, as well as the latest evidence-based guidelines 1.
From the Research
Causes of Interstitial Cystitis in Males
- The exact causes of interstitial cystitis in males are not well understood, and the etiology is believed to involve multiple pathways leading to a common clinical entity 2.
- Some studies suggest that autoimmune diseases may play a role in the development of interstitial cystitis/bladder pain syndrome (IC/BPS), with a recent Mendelian randomization study finding a causal relationship between genetically predicted asthma and the risk of developing IC/BPS 3.
- Bladder outlet obstruction (BOO) has also been identified as a potential factor in IC/BPS, with one study finding that 48% of female patients with IC/BPS met criteria for obstruction 4.
- However, it is unclear whether these findings apply to male patients, as most studies have focused on female populations.
- The diagnosis of IC/BPS in males is often delayed, and men are often misdiagnosed with other conditions such as prostatitis, benign prostatic hyperplasia, or epididymitis before receiving a correct diagnosis 2.
- Further research is needed to understand the causes of interstitial cystitis in males and to develop effective diagnostic and treatment strategies for this population.
- Some of the key factors that may contribute to the development of IC/BPS in males include: