Aidan: Created page with "== Background == * Chronic bladder disorder * About 3-6% prevalence in adult women == Clinical Manifestations == * Pelvic pain with urinary symptoms, such as urinary freque..."

2022-02-01T12:30:11Z

Created page with "== Background == * Chronic bladder disorder * About 3-6% prevalence in adult women == Clinical Manifestations == * Pelvic pain with urinary symptoms, such as urinary freque..."

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== 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 ==
{| class="wikitable"
!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 causes[[CiteRef::hanno2009st]]

== Management ==

* Non-pharmacologic management, including education, dietary modification, and sexual counselling
* Management based on specific phenotype
** Urinary: bladder training, [[anticholinergics]], intravesical agents ([[heparin]], [[DMSO]], [[hyaluronic acid]], [[chondroitin sulfate]], [[Pentosan polysulfate|PPS]], [[oxybutynin]]), hydrodistension, [[botulinum toxin A]], sacral neuromodulation, radical surgery
** Psychosocial: stress management and psychological support
** Organ-specific
*** Non-Hunner's: [[amitriptyline]], [[cimetidine]], hydroxyzine, PPS, quercetin, intravesical agents ([[DMSO]], [[heparin]], [[hyaluronic acid]], [[chondroitin sulfate]], alkalinized [[lidocaine]], [[Pentosan polysulfate|PPS]]), hydrodistension, botulinum toxin A, radical surgery
*** Hunner's: [[cyclosporine A]], endoscopic treatment (fulguration, laser, resection, steroid injection), [[hyperbaric oxygen]], radical surgery
** Infectious: antimicrobials
** Neurologic: [[gabapentinoids]], [[hydroxyzine]], [[cimetidine]], sacral neuromodulation
** Tenderness: pelvic floor physiotherapy, massage, acupuncture, trigger point injections

{| class="wikitable"
!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: [https://doi.org/10.5489/cuaj.3786 10.5489/cuaj.3786]

[[Category:Urology]]

Interstitial cystitis - Revision history

Aidan: Created page with "== Background == * Chronic bladder disorder * About 3-6% prevalence in adult women == Clinical Manifestations == * Pelvic pain with urinary symptoms, such as urinary freque..."