Interstitial cystitis (IC) is a symptom complex of chronic pelvic pain and urinary
frequency in the absence of any urologic or systemic pathology. It is an idiopathic
hypersensory condition of the bladder characterised by epithelial dysfunction, sensory
nerve upregulation and mast cell activation.
The initial description of IC was done by Skene in 1887. He described it as an inflammation
of the urinary bladder mucosa, partly or wholly, which extends into the muscular
parieties. Guy Hunner later defined it as a disease identified by characteristic
bladder wall ulcers. At the National Institute of Diabetes & Digestive & Kidney
Diseases (NIDDK) meeting in 1987, pain was considered a prominent aspect of the
case definition. The terminology of painful bladder disease was first introduced
by Gillenwater et al.
However, the fluctuations in symptoms, extreme variability in presentation and findings,
diagnostic criteria, and treatment response leads to underdiagnosis of this condition.
In addition, there is a lack of knowledge of the epidemiology of IC, the burden
of the disease and the possible risk factors to be identified. It is frequently
misdiagnosed in the clinical setting owing to the overlap with other gynaecologic
and urologic diseases such as urinary tract infections, endometriosis, prostatitis,
overactive bladder and chronic pelvic pain syndrome. The classical presentation
of IC comprise flare-ups and remissions of excessive urgency and frequency of urination,
suprapubic pain, dyspareunia, chronic pelvic pain, and negative urine cultures.
Disease progression owing to a delay in diagnosis affects the quality of life. Successful
management of IC necessitates prompt diagnosis with initiation of effective treatment
interventions in the early stages of the disease. While traditional diagnosis was
based on findings in severe and advances disease with procedures to establish the
diagnosis, the current approach is based on patient history, physical examination,
laboratory findings and symptom surveys.
In spite of considerable research, there are no universal consensuses on treatment
protocols for IC. It usually consists of supportive, behavioural and pharmacological
measures. A surgical approach is rarely warranted. The identification of clinical
markers in the future may aid in ascertaining the aetiology and pathophysiology
An overview of the pathology, symptomatology, physical findings and management of
painful bladder syndrome (PBS)/IC, is described in this review. It also aims at
increasing awareness of IC with improvement in patient identification, diagnosis,