Skip to main content
SpringerLink
Log in

Interstitial cystitis

  • Review Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Interstitial cystitis (IC) is a multifactorial syndrome with symptoms of pelvic or perineal pain, urinary frequency and urgency. The etiologies are unknown, but several theories have been proposed. Diagnosis is often delayed because most of the conventional evaluation is normal. Pelvic examination is normal except for bladder tenderness. Urodynamics are normal except for increased bladder sensitivity and low capacity. Urinalysis, urine culture and office cystoscopy are also normal. The diagnostic test is cystoscopy under anesthesia with bladder distension. Small submucosal hemorrhages (glomerulations) or ulcers appear after distension. Many empiric treatments have been proposed for IC. None is universally effective, and so treatments are tried sequentially until good symptom relief is achieved. Bladder distension gives excellent (but transient) relief in some patients, especially those with severe bladder inflammation (who also tend to be older). A variety of oral, intravesical and adjunctive treatments are also described.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ratner V, Slade D, Greene G. Interstitial cystitis: a patient's perspective.Urol Clin North Am 1994;21:1–5

    PubMed  Google Scholar 

  2. Gillenwater JY, Wein AJ. Summary of the NIADDK Workshop on Interstitial Cystitis, NIH, Bethesda, Maryland, 28–29 August 1987.J Urol 1988;140:203–206

    PubMed  Google Scholar 

  3. Jones CA, Nyberg LM. Epidemiology of interstitial cystitis.Urology 1997;49(Suppl 5A):2–9

    Article  Google Scholar 

  4. Striker GE, KUH notes.J Urol 1989;142:139

    PubMed  Google Scholar 

  5. Simon LJ, Landis JR, Erickson DR, Nyberg LM, ICDB Study Group. The interstitial cystitis data base study: concepts and preliminary baseline descriptive statistics.Urology 1997;49(Suppl 5A):64–75

    Article  PubMed  Google Scholar 

  6. Simon LJ, Landis JR, Tomaszewski JE, Nyberg LM, ICDB Study Group. The interstitial cystitis data base study. In: Sant GR, ed. Interstitial cystitis. Philadelphia: Lippincott-Raven, 1997;17–24

    Google Scholar 

  7. Hanno PM, Matthews Y, Landis JR, ICDB Study Group. Diagnosing interstitial cystitis: lessons learned from the NIH interstitial cystitis data base (ICDB) study.J Urol 1997;157(Suppl):129

    PubMed  Google Scholar 

  8. Parsons CL, Stein PC, Bidair M, Lebow D. Abnormal sensitivity to intravesical potassium in interstitial cystitis and radiation cystitis.Neurourol Urodyn 1994;13:515–520

    PubMed  Google Scholar 

  9. Buffington CAT, Woodworth BE. Excretion of fluorescein in the urine of women with interstitial cystitis.J Urol 1997;158:786–789

    Article  PubMed  Google Scholar 

  10. Parsons CL, Lilly JD, Stein P. Epithelial dysfunction in nonbacterial cystitis (interstitial cystitis).J Urol 1991;145:732–735

    PubMed  Google Scholar 

  11. Chelsky MJ, Rosen SI, Knight LC et al. Bladder permeability in interstitial cystitis is similar to that of healthy volunteers: direct measurement by transversical absorption of99mtechnetium-diethylenetriaminepentaacetic acid.J Urol 1994;151:346–349

    PubMed  Google Scholar 

  12. Lilly JD, Parsons CL. Bladder surface glycosaminoglycans is a human epithelial permeability barrier.Surg Gynecol Obstet 1990;171:493–496

    PubMed  Google Scholar 

  13. Hurst RE, Roy JB, Min KW et al. A deficit of chondroitin sulfate proteoglycans on the bladder uroepithelium in interstitial cystitis.Urology 1996;48:817–821

    Article  PubMed  Google Scholar 

  14. Moskowitz MO, Byrne DS, Gallahan HJ, Parsons CL, Valderrama E, Moldwin RM. Decreased expression of a glycoprotein component of bladder surface mucin (GP1) in interstitial cystitis.J Urol 1994;151:343–345

    PubMed  Google Scholar 

  15. Erickson DR, Mast S, Ordille S, Bhavanandan VP. Urinary epitectin (MUC-1 glycoprotein) in the menstrual cycle and in interstitial cystitis.J Urol 1996;156:938–942

    Article  PubMed  Google Scholar 

  16. Parsons CL, Hurst RE. Decreased urinary uronic acid levels in individuals with interstitial cystitis.J Urol 1990;143:690–693

    PubMed  Google Scholar 

  17. Hurst RE, Parsons CL, Roy JB, Young JL. Urinary glycosaminoglycan excretion as a laboratory marker for interstitial cystitis.J Urol 1993;149:31–35

    PubMed  Google Scholar 

  18. Erickson DR, Ordille S, Martin A, Bhavanandan VP. Urinary chondroitin sulfates heparan sulfate and total sulfated glycosaminoglycans in interstitial cystitis.J Urol 1997;157:61–64

    Article  PubMed  Google Scholar 

  19. Parsons CL, Housley T, Schmidt JD, Lebow D. Treatment of interstitial cystitis with intravesical heparin.Br J Urol 1994;73:504–507

    PubMed  Google Scholar 

  20. Berez-Marrero R, Emerson LE, Maharajh DO, Juma S. Prolongation of response to DMSO by heparin maintenance.Urology 1993;41(Suppl):64–66

    Article  PubMed  Google Scholar 

  21. Morales A, Emerson L, Nickel JC, Lundie M. Intravesical hyaluronic acid in the treatment of refractory interstitial cystitis.J Urol 1996;156:45–48

    Article  PubMed  Google Scholar 

  22. Holm-Bentzen M, Jacobsen F, Nerstrom B et al. A prospective double-blind clinically controlled multicenter trial of sodium pentosanpolysulfate in the treatment of interstitial cystitis and related painful bladder disease.J Urol 1987;138:503–507

    PubMed  Google Scholar 

  23. Mulholland SG, Hanno PM, Parsons CL, Sant GR, Staskin DR. Pentosanpolysulfate sodium for therapy of interstitial cystitis.Urology 1990;35:552–558

    Article  PubMed  Google Scholar 

  24. Fritjofsson A, Fall M, Juhlin R, Persson BE, Ruutu M. Treatment of ulcer and nonulcer interstitial cystitis with sodium pentosanpolysulfate: a multicenter trial.J Urol 1987; 138:508–512.

    PubMed  Google Scholar 

  25. Parsons CL, Mulholland SG. Successful therapy of interstitial cystitis with pentosanpolysulfate.J Urol 1987;138:513–516

    PubMed  Google Scholar 

  26. Lose G, Frandsen B. Subcutaneous heparin in the treatment of interstitial cystitis. In: Hanno P, Staskin DR, Krane RJ, Wein AJ, eds. Interstitial cystitis. New York: Springer-Verlag, 1990;152–156

    Google Scholar 

  27. Laurent TC, Laurent UB, Fraser JRE. The structure and function of hyaluronan: an overview.Immunol Cell Biol 1996;74:A1–7

    PubMed  Google Scholar 

  28. McGuire EJ, Lytton B, Cornog JL. Interstitial cystitis following colocystoplasty.Urology 1973;2:28–29

    Article  PubMed  Google Scholar 

  29. Beier-Holgersen R, Hermann GG, Mortensen SO, Steven K. The in vitro cytotoxicity of urine from patients with interstitial cystitis.J Urol 1994;151:206–207

    PubMed  Google Scholar 

  30. Ruggieri MR, Hanno PM, Whitmore KE, Balagani RK. Effect of repeated instillation of interstitial cystitis urine on the rabbit urinary bladder.Urology 1993;42:646–652

    Article  PubMed  Google Scholar 

  31. Keay S, Zhang C-O, Trifillis AL et al. Decreased3H-thymidine incorporation by human bladder epithelial cells following exposure to urine from interstitial cystitis patients.J Urol 1996;156:2073–2078

    Article  PubMed  Google Scholar 

  32. Sant GR, Theoharides TC. The role of the mast cell in interstitial cystitis.Urol Clin North Am 1994;21:41–53

    PubMed  Google Scholar 

  33. Hanno PM, Levin RM, Monson FC et al. Diagnosis of interstitial cystitis.J Urol 1990;143:278–281

    PubMed  Google Scholar 

  34. Yun SK, Laub DJ, Weese DL, Lad PM, Leach GE, Zimmern PE. Stimulated release of urine histamine in interstitial cystitis.J Urol 1992;148:1145–1148

    PubMed  Google Scholar 

  35. El-Mansoury M, Boucher W, Sant GR, Theoharides TC. Increased urine histamine and methylhistamine in interstitial cystitis.J Urol 1994;152:250–353

    Google Scholar 

  36. Holm-Bentzen M, Sondergaard I, Hald T. Urinary excretion of a metabolite of histamine (1,4-methyl-imidazole-acetic-acid) in painful bladder disease.Br J Urol 1987;59:230–233

    PubMed  Google Scholar 

  37. Boucher W, El-Mansoury M, Pang X, Sant GR, Theoharides TC. Elevated mast cell tryptase in the urine of patients with interstitial cystitis.Br J Urol 1995;76:94–100

    PubMed  Google Scholar 

  38. Elbadawi A. Interstitial cystitis: a critique of current concepts with a new proposal for pathologic diagnosis and pathogenesis.Urology 1997;49(Suppl 5A):14–40

    Article  PubMed  Google Scholar 

  39. Theoharides TC, Sant GR, El-Mansoury M, LeTourneau R, Ucci AA, Meares EM. Activation of bladder mast cells in Interstitial cystitis: a light and electron microscopic study.J Urol 1995;153:629–636

    Article  PubMed  Google Scholar 

  40. Pang X, Marchand J, Sant GR, Kream RM, Theoharides TC. Increased number of substance P positive nerve fibers in interstitial cystitis.Br J Urol 1995;75:744–50

    PubMed  Google Scholar 

  41. LeTourneau R, Pang X, Sant GR, Theoharides TC. Intragranular activation of bladder mast cells and their association with nerve processes in interstitial cystitis.Br J Urol 1996;77:41–54

    PubMed  Google Scholar 

  42. Johansson SL, Fall M. Clinical features and spectrum of light microscopic changes in interstitial cystitis.J Urol 1990;143:1118–1124

    PubMed  Google Scholar 

  43. Harrington DS, Fall M, Johansson SL. Interstitial cystitis: bladder mucosa lymphocyte immunophenotyping and peripheral blood flow cytometry analysis.J Urol 1990;144:848–871

    Google Scholar 

  44. Lynes WL, Flynn SD, Shortliffe LD, Stamey TA. The histology of interstitial cystitis.Am J Surg Pathol 1990;14:969–976

    PubMed  Google Scholar 

  45. Erickson DR, Belchis DA, Dabbs DJ: Inflammatory cell types and clinical features of interstitial cystitis.J Urol 1997;158:790–793

    Article  PubMed  Google Scholar 

  46. Zuraw BL, Sugimoto S, Parsons CL, Hugli T, Lotz M, Koziol J. Activation of urinary kallikrein in patients with interstitial cystitis.J Urol 1994;152:874–878

    PubMed  Google Scholar 

  47. Lotz M, Villiger P, Hugli T, Koziol J, Zuraw B. Interleukin-6 and interstitial cystitis.J Urol 1994;152:869–873

    PubMed  Google Scholar 

  48. Fleischmann JD, Huntley HN, Shingleton WB, Wentworth DB. Clinical and immunological response to nifedipine for treatment of interstitial cystitis.J Urol 1991;146:1235–1239

    PubMed  Google Scholar 

  49. Elgebaly SA, Allam ME, Walzak MP, Oselinsky D, Gillies C, Yamase H. Urinary neutrophil chemotactic factors in interstitial cystitis patients and a rabbit model of bladder inflammation.J Urol 1992;147:1382–1387

    PubMed  Google Scholar 

  50. Ratliff TL, Klutke CG, Hofmeister M, He F, Russell JH, Becich MJ. Role of the immune response in interstitial cystitis.Clin Immunol Immunopathol 1995;74:209–216

    Article  PubMed  Google Scholar 

  51. Ochs RL, Tan EM. Autoimmunity in interstitial cystitis. In: Sant GR, ed. Interstitial cystitis. Philadelphia: Lippincott-Raven, 1997:47–52

    Google Scholar 

  52. Oravisto KJ. Interstitial cystitis as an autoimmune disease.Eur Urol 1980;6:10–13

    PubMed  Google Scholar 

  53. Oravisto KJ, Alfthan OS. Treatment of interstitial cystitis with immunosuppression and chloroquine derivatives.Eur Urol 1976;2:82–84

    PubMed  Google Scholar 

  54. Forsell T, Ruutu M, Isoniemi H, Ahonen J, Alfthan O. Cyclosporine in severe interstitial cystitis.J Urol 1996;155:1591–1593

    Article  PubMed  Google Scholar 

  55. Mattila J. Vascular immunopathology in interstitial cystitis.Clin Immunol Immunopathol 1982;23:648–655

    Article  PubMed  Google Scholar 

  56. Gillespie L, Said J, Sostrin S, Kleiwer K. Immunofluorescent and histochemical staining confirm the identification of the many diseases called interstitial cystitis.Br J Urol 1990;66:265–273

    PubMed  Google Scholar 

  57. Christmas TJ, Bottazzo GF. Abnormal urothelial HLA-DR expression in interstitial cystitis.Clin Exp Immunol 1992;87:450–454

    PubMed  Google Scholar 

  58. Liebert M, Wedemeyer G, Stein JA et al. Evidence for urothelial cell activation in interstitial cystitis.J Urol 1993;149:470–475

    PubMed  Google Scholar 

  59. Ochs RL, Stein TW, Peebles CL, Gittes RF, Tan EM. Autoantibodies in interstitial cystitis.J Urol 1994;151:587–592

    PubMed  Google Scholar 

  60. Bullock AD, Becich J, Klutke CG, Ratliff TL. Experimental autoimmune cystitis: a potential murine model for ulcerative interstitial cystitis.J Urol 1992;148:1951–1956

    PubMed  Google Scholar 

  61. Christensen MM, Keith I, Rhodes PR et al. A guinea pig model for study of bladder mast cell function: histamine release and smooth muscle contraction.J Urol 1990;144:1293–1300

    PubMed  Google Scholar 

  62. Kim YS, Levin RM, Wein AJ, Longhurst PA. Effects of sensitization on the permeability of urothelium in guinea pig urinary bladder.J Urol 1992;147:270–273

    PubMed  Google Scholar 

  63. Domingue GJ, Ghoniem GM. Occult infection in interstitial cystitis. In: Sant GR, ed. Interstitial cystitis. Philadelphia: Lippincott-Raven, 1997:77–86

    Google Scholar 

  64. Warren JW. Interstitial cystitis as an infectious disease.Urol Clin North Am 1994;21:31–39

    PubMed  Google Scholar 

  65. Wilkins EGL, Payne SR, Pead PJ, Moss ST, Maskell RM. Interstitial cystitis and the urethral syndrome: a possible answer.Br J Urol 1989;64:39–44

    PubMed  Google Scholar 

  66. Keay S, Schwalbe RS, Trifillis AL, Lovchik JC, Jacobs S, Warren JW. A prospective study of microorganisms in urine and bladder biopsies from interstitial cystitis patients and controls.Urology 1995;45:223–229

    Article  PubMed  Google Scholar 

  67. Fall M, Johansson SL, Vahlne A. A clinicopathological and virological study of interstitial cystitis.J Urol 1985;133:771–773

    PubMed  Google Scholar 

  68. Hanash KA, Pool TL. Interstitial and hemorrhagic cystitis: viral, bacterial and fungal studies.J Urol 1970;104:705–706

    PubMed  Google Scholar 

  69. Domingue GJ, Ghoniem GM, Bost KL, Fermin C, Human LG. Dormant microbes in interstitial cystitis.J Urol 1995;153:1321–1326

    Article  PubMed  Google Scholar 

  70. Haarala M, Jalava J, Laato M, Kilholma P, Nurmi M, Alanen A. Absence of bacterial DNA in the bladder of patients with interstitial cystitis.J Urol 1996;156:1843–1845

    Article  PubMed  Google Scholar 

  71. Keay S, Zhang C-O, Baldwin BR, Jacobs SC, Warren JW. Polymerase chain reaction amplication of bacterial 16S rRNA genes in interstitial cystitis and control patient bladder biopsies.J Urol 1998;159:280–283

    PubMed  Google Scholar 

  72. Durier, JL. Anti-anaerobic antibotic use in chronic inflammation, urgency-frequency, urge incontinence and in interstitial cystitis. Research Symposium on Interstitial Cystitis, National Institutes of Health, Bethesda, Maryland, 9–11 January, 1995, Abstracts p. 112.

  73. Lundenberg T, Liedberg H, Nordling L, Theodorsson E, Owzarski A, Ekman P. Interstitial cystitis: correlation with nerve fibers, mast cells and histamine.Br J Urol 1993;71:427–429

    PubMed  Google Scholar 

  74. Christmas TJ, Rode J, Chapple CR, Milroy EJG, Turner-Warwick RT. Nerve fibre proliferation in interstitial cystitis.Virchows Archiv A Pathol Anat 1990;416:447–451

    Article  Google Scholar 

  75. Hohenfeller M, Nunes L, Schmidt RA, Lampel A, Thuroff JW, Tanagho EA. Interstitial cystitis: increased sympathetic innervation and related neuropeptide synthesis.J Urol 1992;147:587–591

    PubMed  Google Scholar 

  76. Ruggieri MR, Chelsky MJ, Rosen SI, Shickley TJ, Hanno PM. Current findings and future research avenues in the study of interstitial cystitis.Urol Clin North Am 1994;21;163–176

    PubMed  Google Scholar 

  77. Irwin P, Galloway NT. Impaired bladder perfusion in interstitial cystitis: a study of blood supply using laser Doppler flowmetry.J Urol 1993;149:890–892

    PubMed  Google Scholar 

  78. Irwin PP, James S, Watts L, Fleming LL, Galloway NT. Abnormal pedal thermoregulation in interstitial cystitis.Neurourol Urodyn 1993;12:139–144

    PubMed  Google Scholar 

  79. Irwin PP, Hammonds WD, Galloway NT. Lumbar epidural blockade for management of pain in interstitial cystitis.Br J Urol 1993;71:413–416

    PubMed  Google Scholar 

  80. Brookoff D. The causes and treatment of pain in interstitial cystitis. In: Sant GR, ed. Interstitial cystitis. Philadelphia: Lippincott-Raven, 1997:177–192

    Google Scholar 

  81. Coderre TJ, Katz J, Vaccarino AL, Melzack R, Contribution of central neuroplasticity to pathological pain: review of clinical and experimental evidence.Pain 1993;52:259–285

    Article  PubMed  Google Scholar 

  82. Myers RR. The pathogenesis of neuropathic pain.Reg Anesth 1995;20:173–184

    PubMed  Google Scholar 

  83. Baskin LS, Tanagho EA. Pelvic pain without pelvic organs.J Urol 1992;147:683–686

    PubMed  Google Scholar 

  84. Lotenfoe RR, Christie J, Parsons A, Burkett P, Helal M, Lockhart JL. Absence of neuropathic pelvic pain and favorable psychological profile in the surgical selection of patients with disabling interstitial cystitis.J Urol 1995;154:2039–2042

    Article  PubMed  Google Scholar 

  85. Spanos C, Pang X, Ligris K et al. Stress-induced bladder mast cell activation: implications for interstitial cystitis.J Urol 1997;157:669–672

    Article  PubMed  Google Scholar 

  86. Fall M, Lindstrom S. Transcutaneous electrical nerve stimulation in classic and nonulcer interstitial cystitis.Urol Clin North Am 1994;21:131–139

    PubMed  Google Scholar 

  87. Koziol JA, Adams H-P, Frutos A. Discrimination between the ulcerous and the nonulcerous forms of interstitial cystitis by noninvasive findings.J Urol 1996;155:87–90

    Article  PubMed  Google Scholar 

  88. Parsons CL. Interstitial cystitis: clinical manifestations and diagnostic criteria in over 200 cases.Neurourol Urodyn 1990;9:241–250

    Google Scholar 

  89. Perez-Marrero R, Emerson L, Juma S. Urodynamic studies in interstitial cystitis.Urology 1987;29(Suppl):27–30

    PubMed  Google Scholar 

  90. Gillespie L. You don't have to live with cystitis! New York: Avon Books, 1986:244

    Google Scholar 

  91. Chaiken DC, Blaivas JG, Blaivas ST. Behavioral therapy for the treatment of refractory interstitial cystitis.J Urol 1993; 149:1445–1448

    PubMed  Google Scholar 

  92. Parsons CL, Koprowski PF. Interstitial cystitis: successful management by increasing urinary voiding intervals.Urology 1991;37:207–212

    Article  PubMed  Google Scholar 

  93. Hanno PM. Amitriptyline in the treatment of interstitial cystitis.Urol Clin North Am 1994;2:89–91

    Google Scholar 

  94. Theoharides TC. Hydroxyzine in the treatment of interstitial cystitis.Urol Clin North Am 1994;21:113–119

    PubMed  Google Scholar 

  95. Seshadri P, Emerson L, Morales A. Cimetidine in the treatment of interstitial cystitis.Urology 1994;44:614–616

    Article  PubMed  Google Scholar 

  96. Smith SD, Wheeler MA, Foster HE, Weiss RM. Improvement in interstitial cystitis symptom scores during treatment with orall-arginine.J Urol 1997;158:703–708

    Article  PubMed  Google Scholar 

  97. Perez-Marrero R, Emerson LE, Feltis JT. A controlled study of dimethyl sulfoxide in interstitial cystitis.J Urol 1988;140:36–39

    PubMed  Google Scholar 

  98. Sant GR, LaRock DR. Standard intravesical therapies for interstitial cystitis.Urol Clin North Am 1994;21:73–83

    PubMed  Google Scholar 

  99. Edwards L, Bucknall TE, Makin C. Interstitial cystitis: possible cause and clinical study of sodium cromoglycate.Br J Urol 1986;58:95–96

    PubMed  Google Scholar 

  100. Peters K, Diokno A, Steinart B et al. The efficacy of intravesical Tice strain bacillus Clamette-Guerin in the treatment of interstitial cystitis: a double-blind, prospective, placebo controlled trial.J Urol 1997;157:2090–2094

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Urology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, PO Box 850, MCHO55, 17033-0850, Hershey, Pennsylvania, USA

    D. R. Erickson & M. F. Davies

Authors
  1. D. R. Erickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. F. Davies
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Erickson, D.R., Davies, M.F. Interstitial cystitis. Int Urogynecol J 9, 174–183 (1998). https://doi.org/10.1007/BF02001088

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02001088

Keywords

Search

Navigation