Interstitial Cystitis Part I

Interstitial Cystitis: A Comprehensive Overview

Also known as painful bladder syndrome, Interstitial Cystitis (IC) is a chronic disorder causing pain and discomfort for many people, oftentimes impeding normal life.  Though a malady affecting both sexes, females are much more likely to suffer from the condition. Recent studies report an IC incidence rate of 197 diagnoses in women per 100,000 compared to 41 diagnoses in men per 100,000.¹ Perhaps the numbers appear at first to be negligible in the grand scheme of things, yet this disease can be life-altering.

Symptomatology

As the name implies, IC is an uncomfortable affliction, causing symptoms such as bladder pressure and pain, bladder urgency with little output, painful intercourse, as well as pelvic pain and discomfort. Ranging from mild to severe, the pain can significantly impair everyday activities such as social engagements, exercise, sleep and the ability to perform job duties.^{2, 3} Further, many people experience flare-ups due to triggering events such as menstruation, stress, exercise and extended periods of sitting.²

Diagnosis

Oftentimes difficult to diagnose, doctors frequently attempt to rule out other illnesses with similar symptom profiles such as kidney stones, bladder cancer, sexually transmitted diseases, endometriosis, inflamed prostate, chronic pelvic pain syndrome and infection before looking further into the possibility of an IC diagnosis.² Frequently, IC symptoms may mirror signs of a chronic urinary tract infection but generally no infection is present in those suffering from this condition.^{2, 3} If, however, an IC patient does contract a urinary infection, symptoms are oftentimes heightened.³ In addition, most experts agree that due to IC’s wide range of symptoms and intensity of pain and discomfort, that IC may actually be a combination of multiple diseases.² Further complicating the diagnostic process is the fact that not only are many family physicians lacking in knowledge in regard to IC but there often tend to be multiple comorbidities with it as well.^{4, 5} These factors oftentimes present symptom-overlap and subsequent misdiagnoses which will be discussed shortly.^{4, 5}

Though IC is predominantly observed and diagnosed during middle age (average age of onset 40 years), both men and women can see the emergence of the disorder between the ages of 20 and 50.⁶ As mentioned previously, IC is much more common in females than males due to the shorter length of the urethra in women.⁷ Because of this difference in anatomy, bacteria has an easier method of reaching the bladder and becoming overpopulated, thus causing inflammation.^{2, 7}

IC can be categorized several different ways. Oftentimes it is divided into two phenotypes, non-ulcerative and ulcerative.⁸ Non-ulcerative IC accounts for approximately 90% of patients with the disorder and is typically identified by the observance of pinpoint hemorrhages in the bladder wall (indicating bladder inflammation is present).⁸ Ulcerative IC comprises 5-10% of IC patients and is identified when patients present with Hunner’s ulcers (red, bleeding areas) on the bladder wall.⁸ End stage or severe IC has also been used as a classification of the disorder, referring to patients who have developed very hard bladders as well as low bladder capacity and excruciating pain.⁸

IC is also sometimes identified as being uncomplicated and complicated in nature.⁷ Uncomplicated IC is characterized by symptoms contained within the lower urinary tract as well as the absence of risk factors for severe infection or long-term impairment.⁷ Further, uncomplicated IC is typically easily treatable and eliminated without much difficulty.⁷  In contrast, complicated IC typically does not respond to antibiotic treatment, may present an increased risk of infection, possible spreading of infection to the kidneys, and inflammation of the renal pelvis (pyelonephritis).⁷ Particular populations are at greater risk for complicated IC including those with compromised immune systems, kidney problems or who demonstrate anatomical abnormalities in the urinary tract.⁷

Diagnostic tests for IC include urine samples to test for bacteria, white and red blood cells, proteins and nitrites (can be an indicator of bacteria); ultrasound to examine the kidneys and bladder; and in rare cases, cystoscopy or x-ray (only used when a woman has severe and recurrent symptoms).⁷ Additional tests that are less common but sometimes performed include bladder and urethra biopsy, bladder stretching and in men, prostate fluid culture.²

References

 1.  Arora HC, Shoskes DA. The enigma of men with interstitial cystitis/bladder pain syndrome. Translational Andrology and Urology. 2015;4 (6): 668-676.

2. WebMD. Interstitial Cystitis. Available at: https://www.webmd.com/urinary-incontinence-oab/interstitial-cystitis#1. Accessibility verified July 6, 2018.

3.     Mayo Clinic. Interstitial Cystitis. Available at: https://www.mayoclinic.org/diseases-conditions/interstitial-cystitis/symptoms-causes/syc-20354357. Accessibility verified July 6, 2018.

4.     Clemens JQ, Calhoun EA, Litwin MS, et al. A survey of primary care physician practices in the diagnosis and management of women with interstitial cystitis/ painful bladder syndrome. Urology. 2010; 76(2): 323-328.

5.     American Urological Association. First-ever clinical guidance on interstitial cystitis/bladder pain Syndrome Released: Effective treatment includes valid diagnosis, effective symptom control and focus on quality of life. Available at: http://auanet.mediaroom.com/2011-03-01-FIRST-EVER-CLINICAL-GUIDANCE-ON-INTERSTITIAL-CYSTITIS-BLADDER-PAIN-SYNDROME-RELEASED. Accessibility verified July 6, 2018.

6.     Harvard Health Publishing Harvard Medical School: Trusted Advice for a Healthier Life. Interstitial Cystitis. Available at: https://www.health.harvard.edu/diseases-and-conditions/interstitial-cystitis. Accessibility verified July 6, 2018.

7.     PubMed Health. Cystitis: overview. Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072587/. Accessibility verified July 6, 2018.