Interstitial cystitis (IC),
or painful bladder syndrome (PBS)
, belongs to a family of disorders known as the chronic pelvic pain syndromes that include fibromyalgia,
irritable bowel syndrome and chronic fatigue syndrome. Previously IC/PBS has
been termed as urethral syndrome, trigonitis and bladder
. The International
Continence Society described IC/PBS
as "the complaint of supra-pubic pain
related to bladder filling, accompanied by other symptoms such as increased
daytime and night time frequency, in the absence of a proven urinary infection
and other obvious pathology."
is a long-lasting condition of unclear origin and has a 10 fold higher incidence in women than men.
IC/PBS the glycosaminoglycan (GAG) layer
amplifies permeability of the bladder urothelium such that urine components
(urea, ammonia, and potassium) seep into the bladder tissue - leading to pelvic
pain and annoying voiding urges. Plus, higher mast-cell activation results in
bladder wall inflammation and fibrotic modifications.
IC/PBS patients vary as per the urgency,
frequency, and/or pain. Typical
IC/PBS symptoms include pelvic pain, painful sexual intercourse, repeated
urinary tract infections, repeated vaginitis or prostatitis, waking up from
sleep at night to urinate, and increased urinary occurrence and urges. During
the premenstrual week women may undergo a flare up of symptoms.
Diagnosis is based on
medical history and physical checkup
including a pelvic test to exclude vaginitis, vulvar lesions, urethral
diverticula, and pelvic-floor dysfunction. IC/PBS screening is based on The
Pelvic Pain and Urgency/Frequency Patient Symptom Scale and the O'Leary-Sant
Interstitial Cystitis Symptom Index and Problem Index questionnaires. Urinalysis, cystoscopy, potassium
sensitivity test and a full bladder are used to detect hematuria, defects
in the bladder lining, urothelium dysfunction and bladder pain respectively
per the American Urological Association (AUA) guidelines, IC/PBS treatment depends on a patient's choice, seriousness of symptom
and the doctor's assessment. All patients should be provided behavior
modification strategies and receive drugs that control their pain and stress.
drug therapy includes intravesical drug
instillation, also known as bladder bath or wash, with dimethylsulfoxide (DMSO) to decrease
symptoms and pain. A troublesome garlicky flavor and scent is a frequent
side-effect of DMSO.
Oral IC/PBS treatment includes cimetidine, amitriptyline, hydroxyzine
and pentosan polysulfate sodium (PPS). PPS, FDA-approved for IC/PBS, dose
regimen includes three-times-a-day, 100 mg tablet, 1 hour before or 2 hours
after a meal.PPS acts slowly and reduces symptoms after 3-4 months of
medication intake. Cimetidine relieves symptoms, amitriptyline regulates
bladder pain and urgency, hydroxyzine suppresses mast-cell degranulation and
Surgical procedures such as cystoplasty and urinary
diversion are performed in IC/PBS patients that do not experience symptom
relief with other therapies. A
combination treatment strategy is the best approach to reduce symptoms.
However, further treatment options are needed to better treat IC/PBS patients.
conclusion, IC/PBS is a long-lasting condition which is frequently a challenge
to diagnose and manage.
Cystitis and Chronic Pain Syndrome; Amy Witte et al; US Pharm. 2012;