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Interstitial Cystitis


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

Epidemiologic Data

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.

Classical IC

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.

Nonulcerative IC

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
  • Atopic allergy
  • Psychiatric conditions such as anxiety disorder and depression
  • Gynaecologic surgery in the past.
  • Genetic predisposition
  • Autoimmune disorder
  • 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 cord level9,10

Differential diagnosis for PBS/IC

The differential diagnoses of IC include urological, gynaecological, inflammatory and neurological conditions. Some of the causes are listed below:

  • Overactive bladder, bladder cancer, renal diseases, urethral diverticulitis and radiation cystitis
  • Endometriosis, pelvic inflammatory disease
  • Recurrent urinary tract infections, bacterial cystitis
  • Cerebrovascular accident, detrusor overactivity
  • Autoimmune diseases1,7

  1. Panzera AK. Interstitial cystitis/Painful bladder syndrome. Urol Nurs. 2007;27(1):13-19.
  2. Carr LK, Corocs J, Njckel C, Teichman J. Diagnosis of Intersitial cystitis June 2007. Can Urol Assoc J. 2009;3(1):81-86.
  3. Van de Merve JP, Nordling J, Bouchelouche P, et al. Diagnostic criteria, classification, and nomenclaturefor painful bladder syndrome/interstitial cystitis: An ESSIC proposal. European Urology. 2008;53(1):60-67.
  4. Hanno PM. Interstitial cystitis - Epidemiology, Diagnostic criteria, Clinical Markers. Rev Urol. 2002;4(1):S3-S8.
  5. Heck BN. Interstitial cystitis:Enhancing early identification in primary care settings. JNP. 2007;3(8):509-519.
  6. Mattox TF. Interstitial cystitis in adolscents and children:a review. J Pediatr Adolesc Gynecol. 2004;17:7-11.
  7. Teichman JMH, Parsons CL. Contemporary clincal presentation of interstitial cystitis. Urology. 2007;69(4A):41-47.
  8. Association of Reproductive Health Professionals. Screening, treatment, and management of IC/PBS. www arhp org. Accessed March 9, 2009.
  9. Evans RJ. Pathophysiology and clinical presentation of interstitial cystitis. Avd Stud Pharm. 2005;8-14.
  10. National Kidney and Urologic diseases Information Clearinghouse(NKUDIC). Interstitial cystitis/ painful bladder syndrome. www kidney niddk nih gov. Accessed March 9, 2009.