interstitial cystitis
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Introduction
Severe, chronic bladder disorder.
Etiology
- infection
- fastidious bacteria
- latent viruses
- dysfunctional bladder epithelium
- defective glycosaminoglycan layer
- abnormal intercellular junctions
- toxic substances in urine
- allergic/immune/autoimmune
- neurogenic disorders
- bladder mastocytosis
- psychogenic
- food intolerance
- endocrine disorders
- idiopathic
Epidemiology
- generally affects women
- rare in blacks
Pathology
- irritants in the urine penetrate the mucous layer of the bladder epithelium & activate nerves & muscles in the bladder wall[4]
Clinical manifestations
- urinary frequency (not always present)[4]
- urinary urgency
- nocturia
- suprapubic pain, lower abdominal pain[7] (not always present)[4]
- dyspareunia (75%)
- symptoms may be worsened by certain foods
- citrus fruits, foods high in K+, caffeinated beverages, alcoholic beverages
- symptoms may be provoked by physical or emotional stress, seasonal allergies
Diagnostic criteria
- Exclusion criteria
- < 18 years of age
- benign or malignant bladder tumors
- radiation cysititis
- bacterial cystitis
- vaginitis
- cyclophosphamide cystitis
- symptomatic urethral diverticulum
- uterine, cervical, vaginal or urethral cancers
- active Herpes
- bladder or lower urethral calculi
- waking frequency < 5 times in 12 hours
- nocturia < twice nightly
- symptoms relieved by antibiotics, urinary antiseptics or urinary analgesics (phenazopyridine {Pyridium})
- duration < 12 months
- involuntary bladder contractions (urodynamics)
- absence of sensory urgency with bladder capacity > 400 mL
- Inclusion criteria
Laboratory
- urinalysis & urine culture are negative
- hematuria is NOT a sign of interstitial cystitis
Diagnostic procedures
- cystoscopy:
- glomerulations (submucosal vascular anomalies) after hydrodistention
- biopsy
- potassium stimulation test
Differential diagnosis
Management
- symptoms do NOT respond to antibiotic therapy
- pharmaceutical agents
- amitriptyline or imipramine, start 25 mg PO QHS
- hydroxyzine
- oxybutynin 20 mg PO QD
- phenazopyridine 200 mg PO TID after meals
- pentosan polysulfate of no benefit[6]
- intravesicular agents
- dimethylsulfoxide
- chlorpactin
- heparin
- surgery rarely indicated
More general terms
Additional terms
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 264
- ↑ Journal Watch 23(21):167, 2003 Sant GR et al, J Urol 170:810, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/12913705 Nickerl JC, J Urol 170:816, 2003
- ↑ Lukban JC et al, Urol Clin North Am 29(3):649, 2003 (review) PMID: https://www.ncbi.nlm.nih.gov/pubmed/12476528
- ↑ 4.0 4.1 4.2 4.3 Rosenberg MT, Moldwin RM, Stanfod EJ, Early diagnosis and mangaement of interstitial cystitis, Women's Health in Primary Care 7:456, 2004
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
Vercellini P, Somigliana E, Vigano P et al Chronic pelvic pain in women: etiology, pathogenesis and diagnostic approach. Gynecol Endocrinol. 2009 Mar;25(3):149-58. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19347704 - ↑ 6.0 6.1 Nickel JC et al. Pentosan polysulfate sodium for treatment of interstitial cystitis/bladder pain syndrome: Insights from a randomized, double-blind, placebo controlled study. J Urol 2015 Mar; 193:857 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25245489 <Internet> http://www.jurology.com/article/S0022-5347%2814%2904431-0/abstract
- ↑ 7.0 7.1 7.2 NEJM Knowledge+ Nephrology/Urology
- ↑ National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Interstitial Cystitis (Painful Bladder Syndrome) https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome