Interstitial Cystitis: Epidemiology, Pathophysiology, and Clinical Presentation

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Key points

  • Interstitial cystitis is commonly underdiagnosed.

  • Patients with lower abdominal/pelvic pain or discomfort should be specifically questioned about associated symptoms such as frequency, urgency, and nocturia.

  • Nocturia in a young patient is abnormal, and this should lead the clinician to rule out interstitial cystitis as a possible cause for the pain.

  • Dyspareunia is also common in these patients.

  • There is a high association with other chronic pain conditions.

  • The etiology is still unknown, although

Prevalence

Prevalence data are difficult to obtain because they depend on the definition, the population studied, and the method. Prevalence appears to have changed significantly over the past 40 years or so. In a population-based study in 1975 the reported prevalence was 10 per 100,000 (0.01%), compared with 30 per 100,000 in (0.03%) in 1987 and 510 per 100,000 (0.5%) in 1994.8 In a cross-sectional study of the Boston area from 2002 to 2005, the prevalence of painful bladder syndrome was 2.6%. The

Urothelial and Epithelial Dysfunction

In patients undergoing cystoscopy for potential IC, epithelial abnormalities can be seen in the form of glomerulations and/or Hunner ulcers. The bladder urothelium is lined by a protective layer of dense glycosaminoglycans (GAG), which maintains impermeability to various solutes in the urine. The basic characteristic of this layer is to provide mechanical and electrostatic defense against penetration by toxic, acidic, or infective agents. This property is thought to be the basis of why the

Clinical presentation

Early teachings were that this was a disease of young, reproductive-age women. However, recent studies in multiple different countries have shown that it occurs across all ages. In a diverse population in Denmark, the age at diagnosis ranged from 16 to 88 years, with a median age of 53 years.28 In a recent cohort of 3397 community-dwelling women who met the RAND IC epidemiology case definition, age ranged from 18 to 92 years, with a mean age of 45.7 years for a high-sensitivity case definition

Association with nonbladder pain syndromes

There have been numerous and consistent reports on the association of IC with other chronic pain conditions. However, it is difficult to discern the antecedent disorder that may point to a common etiology or trigger.

Summary

For the practicing clinician, the important message is to consider IC/BPS in any patient with persistent pelvic or lower abdominal discomfort, particularly in the setting of any bladder symptom. This article underscores the importance of asking specifically about pain with bladder filling, urgency, frequency, and nocturia, and placing this diagnosis on the differential diagnosis of chronic pelvic pain. As there appears to be a high association with other chronic pain syndromes, it is useful to

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References (41)

Cited by (45)

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    It is often misdiagnosed for other conditions with similar symptom profile as it can be hard to distinguish.1 Epithelial abnormalities are inconsistent ranging from discrete inflammatory or Hunner's lesions but they can be absent as well.1,2 The difficulties in diagnosis most likely derive from the various pathophysiology.3

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    The treatment generally requires a pharmacological therapy acting on the cholinergic system, chiefly responsible for the modulation of the detrusor muscle tone, on the one hand, and the use of invasive mechanical methods, such as the application of catheters for the correct draining of urine, on the other. Interstitial cystitis is a painful chronic syndrome with higher incidence in women, mainly associated with a damage in the glycosaminoglycans (GAGs) layer with a loss of vesical epithelium functionality (McLennan, 2014). Symptoms include pelvic pain, urinary frequency, urgency and nycturia.

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    A physical examination during which there is a mild pressure on the urethra can help recognize bladder pain and distinguish interstitial cystitis from dyspareunia that is gynecologically driven.32 However, women with interstitial cystitis may also suffer from vaginal dryness, particularly if they are postmenopausal.33 According to a review by Tonyali and Yilmaz,34 more than 50% of women with interstitial cystitis report sexual dysfunctions in several studies.

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    When pain is perceived in the bladder, the term bladder pain syndrome (BPS) is used [1]. The prevalence of BPS is variable mainly due to the multiple definitions and diagnostic criteria used, although it may be as high as 30% [2,3], affecting mostly women in any age range [4]. BPS is a debilitating condition, with negative consequences on mental health, quality of life, and social and sexual life patterns of patients [5,6].

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