Interstitial cystitis

From IDWiki

Background

  • Chronic bladder disorder
  • About 3-6% prevalence in adult women

Clinical Manifestations

  • Pelvic pain with urinary symptoms, such as urinary frequency (the most common presenting complaint), urgency, or nocturia
    • The pain is often described as discomfort, pressure, burning, sharp
    • The pain is typically suprapubic but may be referred to other parts of the pelvis, including the urethra, vagina, labia, inguinal area, perineum, or lower abdomen or back
  • Sterile pyuria
  • Often worse a few days before onset of menses
  • Occurs episodically, with flares triggered by stress, intercourse, menses, or diet
    • Dietary triggers include coffee, alcohol, citrus fruits, tomatoes, carbonated beverages, and spicy foods
  • May have a classic Hunner's ulcer or lesion seen on cystoscopy
    • Have more severe symptoms

Differential Diagnosis

Disease Distinguishing Features
Endometriosis pain worse during menses (rather than a few days prior)
Non-infectious cystitis history of radiation, NSAID unse, cyclophosphamide, or ketamine use
Vulvar disorders pain only during voiding (when urine contacts vulva) and/or pain with sex
Overactive bladder syndrome responds to antimuscarinics; patients void to avoid incontinence (rather than to relieve pain)
Pudendal nerve entrapment positional; worse with sitting
Prostate disorders pain during or after ejaculation, pain on prostate examination
Pelvic floor disorders trigger point, fascial, or muscle pain and tenderness; spasms on palpation

Diagnostic Criteria

  • An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms for more than six weeks duration, in the absence of infection or other identifiable causeshanno2009st

Management

Medication Dose Notes
Alkalanized lidocaine intravesicular
Amitriptyline 25 to 75 mg p.o. qhs
Chondroitin sulfate (CS) intravesicular
Cimetidine 400 mg p.o. bid
Cyclosporine A 2 to 3 mg/kg divided bid
Dimethylsulfoxide (DMSO) intravesicular
Gabapentin 300 to 2100 mg p.o. divided tid
Heparin intravesicular
Hyaluronic acid (HA) intravesicular
Hydroxyzine 10 to 50 mg p.o. qhs
Oxybutynin intravesicular
Pentosan polysulfate (PPS) 100 mg p.o. tid; or intravesicular monitor for maculopathy
Quercetin 500 mg p.o. bid

Further Reading

  • CUA guideline: Diagnosis and treatment of interstitial cystitis/bladder pain syndrome. Can Urol Assoc J. 2016;10(5-6):E136-E155. doi: 10.5489/cuaj.3786