Interstitial cystitis (IC) is defined as a chronic irritative bladder syndrome of
multifactorial aetiology and pathogenesis. The syndrome is characterised by clinical
presentation of chronic pain, pressure or discomfort related to the urinary bladder.
It is also associated with increased urinary urgency and frequency in the absence
of proven urinary infection or obvious pathology.1
Nomenclature for IC
There is a lack of international agreement on the nomenclature of the term IC. The
term IC covers the clinical symptomatology of pain around the bladder region in
the absence of demonstrable local inflammation. The term IC was revised to painful
bladder syndrome (PBS) introduced by the International Continence Society in 2002.
PBS was defined as Increase in the urinary frequency with suprapubic pain in the
absence of urinary infection or other obvious pathology. The European Society for
the Study of Interstitial Cystitis (ESSIC) in an attempt to create a consensus on
definition, diagnosis and classification of IC has introduced the term of bladder
pain syndrome (BPS) to replace IC. At present, all the three terms IC/PBS/BPS are
used interchangeably worldwide.1-3
IC is a chronic painful bladder syndrome primarily found in women. White patients
account for 90% of the total patient population of IC. Women account for 90% of
the patient population and men comprise the remaining 10%. In a managed care population,
Clemens et al observed the prevalence of IC to be 197 cases per 100,000 women and
41 cases per 100,000 men. Statistics show a prevalence of only 10% of the condition
in men. However, symptoms of chronic prostatitis are seen to overlaps with the symptoms
of IC in men. Similarly, the prevalence of IC is rare in the paediatric population.
However, a study by Close et al from Seattle showed an increasing evidence of the
occurrence of symptoms in children with a mean age of 4.5 years.
The prevalence of IC varies depending on the country of origin and the criteria
used in the diagnosis. The differences in diagnostic criteria adopted across the
world are the likely reason for the differences seen in the prevalence rate. Reports
show a prevalence of 52 to 67 cases per 100,000 women in the US, 8 to 16 cases per
100,000 women in Netherlands and 450 cases per 100,000 women in Finland.1,4-7
Types of IC
IC is divided into ulcerative (classical) and nonulcerative (Messing-Stamey). This
division is based on the intraoperative findings at cystoscopy and bladder overdistension.
Around 5% to 10% of the patients with IC have ulcerative IC. It is associated with
a reduction in the bladder capacity as the condition progresses. The characteristic
cystoscopic finding on overdistension of the bladder is a diffusely reddened appearance
of the surface epithelium. The dome and lateral walls of the bladder show presence
of one or more ulcerative patches and mucosal congestion. Biopsy in patients with
classical case of IC shows transmural involvement of the bladder wall with inflammatory
changes, granulation tissue, mast cell infiltration and fibrosis.
The cystoscopic findings on overdistension of the bladder are tiny discreet raspberry-like
lesions termed as glomerulations seen on the dome and lateral walls of the bladder.
They are also associated with tiny mucosal tears and submucosal haemorrhages. However,
there are no remarkable findings during biopsy in these patients.8-10
Aetiology of IC
IC has a multifactorial aetiology. Some of the causes of the syndrome are as follows:
History of recurrent UTIs
Associated chronic illnesses such as inflammatory bowel disease, SLE and IBS
Psychiatric conditions such as anxiety disorder and depression
Gynaecologic surgery in the past.
Pelvic floor muscle dysfunction
Infection with a slow-growing virus
Production of toxic substances in the urine
Local inflammation mediating neurogenic hypersensitivity at the bladder or spinal
Differential diagnosis for PBS/IC
The differential diagnoses of IC include urological, gynaecological, inflammatory
and neurological conditions. Some of the causes are listed below: