Interstitial cystitis
Encyclopedia
Interstitial cystitis or bladder pain syndrome (commonly abbreviated to "IC/BPS") is a chronic, oftentimes severely debilitating disease
of the urinary bladder
. Of unknown cause, it is characterized by: pain associated with the bladder, pain associated with urination
(dysuria
), urinary frequency (as often as every 10 minutes), urgency, and/or pressure in the bladder and/or pelvis.
The disease has a profound impact on quality of life. A Harvard University study concluded, "the impact of interstitial cystitis on quality of life is severe and debilitating". A Harvard Medical School guide states that the quality of life of interstitial cystitis patients resembles that of a person on kidney dialysis or suffering from chronic cancer pain. The condition is officially recognized as a disability.
It is not unusual for patients to have been misdiagnosed with a variety of other conditions, including: overactive bladder, urethritis
, urethral syndrome
, trigonitis
, prostatitis
and other generic terms used to describe frequency/urgency symptoms in the urinary tract.
IC/BPS affects men and women of all cultures, socioeconomic backgrounds, and ages. Although the disease previously was believed to be a condition of menopausal
women, growing numbers of men and women are being diagnosed in their twenties and younger. IC/BPS is not a rare condition, however IC/BPS is more common in women than in men. Early research suggested that IC/BPS prevalence ranged from 1 in 100,000 to 5.1 in 1,000 of the general population. In 2009, new research (now known as the RAND study) revealed that in the U.S alone, between 3 and 8 million people have interstitial cystitis. Up to 12% of women may have early symptoms of IC/BPS.
) or a UTI
. However, IC/BPS has not been shown to be caused by a bacterial infection, and the mis-prescribed treatment of antibiotics is ineffective. The symptoms of IC/BPS may also initially be attributed to prostatitis
and epididymitis
(in men) and endometriosis
and uterine fibroids
(in women).
The most common symptom of IC/BPS is pain, which is found in 100% of patients, frequency (82% of patients) and nocturia (62%).
In general, symptoms are:
During cystoscopy
, 5 to 10% of patients are found to have Hunner's ulcers. Far more patients may experience a very mild form of IC/BPS, in which they have no visible wounds in their bladder, yet struggle with symptoms of pain, frequency and/or urgency. Still other patients may have discomfort only in their urethra
, while others struggle with pain in the entire pelvis.
Patients may experience nocturia
, pelvic floor dysfunction and tension (thus making it difficult to start their urine stream), pain with sexual intercourse
, and discomfort and difficulty driving, traveling or working.
For the most part, people with interstitial cystitis will either have lots of pain and very little frequency or they'll have lots of frequency and very little pain.
(IBS), fibromyalgia
, chronic fatigue syndrome
, endometriosis
, vulvodynia
, chemical sensitivities
and anxiety disorder
. In addition, men with IC/BPS are frequently diagnosed as having chronic nonbacterial prostatitis, and there is an extensive overlap of symptoms and treatment between the two conditions, leading researchers to posit that the conditions share the same etiology and pathology.
The presence of endometriosis has a strong association with typical IC findings on cystoscopy including glomerulations, ulcers, and reduced bladder capacity.
and stress
-psychological. In addition, recent research shows that IC patients may have a substance in the urine that inhibits the growth of cells in the bladder epithelium. An infection may then predispose those patients to get IC.
Regardless of the origin, it is clear that the majority of IC/BPS patients struggle with a damaged urothelium, or bladder lining. When the surface glycosaminoglycan (GAG) layer is damaged (via a urinary tract infection
(UTI), excessive consumption of coffee or sodas, traumatic injury, etc.), urinary chemicals can "leak" into surrounding tissues, causing pain, inflammation, and urinary symptoms. Oral medications like pentosan polysulfate
and medications that are placed directly into the bladder via a catheter
sometimes work to repair and rebuild this damaged/wounded lining, allowing for a reduction in symptoms.
GP 51 is a urinary glycoprotein that functions as a protective barrier to the bladder wall. A study evaluated urinary GP 51 levels in patients with and without interstitial cystitis and found that these levels are significantly reduced in patients with the disease.
s were once thought to be responsible for allergic reactions. Mast cells release histamine. Histamine causes pain, swelling, scarring and prevents healing. Mast cells have in some studies been shown to be critically important in interstitial cystitis.
Current evidence from clinical and laboratory studies confirms that mast cells play a central role in IC/PBS.
Research has shown that there is proliferation of nerve fibers in the bladders of IC patients that does not exist in the bladders of people who have not been diagnosed with IC.
test, also known as the potassium sensitivity test, uses a mild potassium
solution to test the integrity of the bladder wall. Though the latter is not specific for IC/BPS, it has been determined to be helpful in predicting the use of compounds, such as pentosan polysulphate, which are designed to help repair the GAG layer. The previous gold standard
test for IC/BPS was the use of hydrodistention with cystoscopy
. Researchers, however, determined that this visual examination of the bladder wall after stretching the bladder was not specific for IC/BPS and that the test, itself, can contribute to the development of small glomerulation
s (that is, petechial hemorrhages) often found in IC/BPS. Thus, a diagnosis of IC/BPS is one of exclusion
, as well as a review of clinical symptoms.
In 2006, the ESSIC society proposed more rigorous and demanding diagnostic methods with specific classification criteria so that it cannot be confused with other, similar conditions. Specifically, they require that a patient must have pain associated with the bladder, accompanied by one other urinary symptom. Thus, a patient with just frequency or urgency would be excluded from a diagnosis. Secondly, they strongly encourage the exclusion of confusable diseases through an extensive and expensive series of tests including (A) a medical history and physical exam, (B) a dipstick urinalysis
, various urine cultures, and a serum PSA in men over 40, (C) flowmetry and post-void residual urine volume by ultrasound scanning and (D) cystoscopy. A diagnosis of IC/BPS would be confirmed with a hydrodistention during cystoscopy with biopsy.
They also propose a ranking system based upon the physical findings in the bladder. Patients would receive a numeric and letter based score based upon the severity of their disease as found during the hydrodistention. A score of 1-3 would relate to the severity of the disease and a rating of A-C represents biopsy findings. Thus, a patient with 1A would have very mild symptoms and disease while a patient with 3C would have the worst available symptoms.
In 2009, Japanese researchers identified a urinary marker called phenylacetylglutamine
that could be used for early diagnosis.
instillations, such as chlorpactin (oxychlorosene) or silver nitrate
, designed to kill "infection" and/or strip off the bladder lining. In 2005, our understanding of IC/BPS has improved dramatically and these therapies are now no longer done. Rather, IC/BPS therapy is typically multi-modal, including the use of a bladder coating, an antihistamine
to help control mast cell
activity and a low dose antidepressant
to fight neurogenic inflammation
.
is believed to provide a protective coating in the bladder, but studies show it is not statistically significant compared to placebo. However, some studies have found that a minority of patients do respond to pentosan polysulfate.
can reduce symptoms in patients with IC/BPS. Patient overall satisfaction with the therapeutic result of amitriptyline was excellent or good in 46%. A May 2010 study concluded in part that amitriptyline may be beneficial in doses greater than 50 mg.
was found to be ineffective as a treatment. There is a U.S. Patent 6150396 for the use of duloxetine for treatment of interstitial cystitis although one study found positive outcomes in only a small proportion of cases. There has been further work to suggest that neuropathic pain localized in the pelvic region may respond to neurotransmitter reuptake inhibitors.
, a wood pulp extract, is the only approved bladder instillation for IC/BPS yet it is much less frequently used in urology clinics. Research studies presented at recent conferences of the American Urological Association by C. Subah Packer have demonstrated that the FDA approved dosage of a 50% solution of DMSO had the potential of creating irreversible muscle contraction. However, a lesser solution of 25% was found to be reversible. Long term use is questionable, at best, particularly given the fact that the method of action of DMSO is not fully understood.
or heparin
, sodium hyaluronate
, lidocaine
and sodium bicarbonate
, has generated considerable excitement in the IC/BPS community because it is the first therapeutic intervention that can be used to reduce a flare of symptoms. Published studies report a 90% effectiveness in reducing symptoms.
Sometimes these rescue instillations are given on a regular basis for treatment. It is important to note that this is off-label use for both pentosan polysulfate and heparin, as neither medicine has been approved to be used this way.
) and Uracyst (chondroitin
). They are believed to replace the deficient GAG layer on the bladder wall. Like most other intravesical bladder treatments, this treatment may require the patient to lie for 20 – 40 minutes, turning over every ten minutes, to allow the chemical to 'soak in' and give a good coating, before it is passed out with the urine.
Cystistat is not currently available in the United States or Canada, though testing has recently started in Canada. Testing has also begun for Uracyst in both Canada and the United States. Uracyst is available in Canada.
The American Urological Association states that most (but not all) people with IC find that certain foods make their symptoms worse.
The challenge with diet triggers is that they vary from person to person: the best way for a person to discover his or her own triggers is to use an elimination diet
. The foundation of therapy is a modification of diet to help patients avoid those foods which can further irritate the damaged bladder wall.
Pain that worsened with a certain food or drink and/or worsened with bladder filling and/or improved with urination was reported by 97% of patients, in one study.
Anecdotal evidence has linked gluten
intolerance to UCPPS symptoms. Studies are lacking in this area.
The mechanism by which dietary modification benefits patients with IC is unclear. Researchers hypothesize that integration of neural signals from pelvic organs mediates the effects of diet on symptoms of IC:
A study done at University of South Florida found that IC/BPS patients do not have to be overly restrictive of their diets. This study recommended that patients avoid citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C. It also found that many patients had reduced sensitivity to trigger foods if they consumed calcium glycerophosphate and/or sodium bicarbonate.
, done under general anaesthesia
) has shown some success in reducing urinary frequency and giving pain relief to patients. However, many experts still cannot understand precisely how this can cause pain relief. Recent studies showing that pressure on pelvic trigger points can relieve symptoms may be connected. Unfortunately, the relief achieved by bladder distensions is only temporary (weeks or months) and consequently, it is not really viable as a long-term treatment for IC/BPS.
. Current protocols largely focus on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as trigger points), physical therapy to the area, and progressive relaxation therapy to reduce causative stress.
Most major IC/BPS clinics now evaluate the pelvic floor and/or refer patients directly to a physical therapist for a prompt treatment of pelvic floor muscle tension or weakness. Chronic pelvic floor tension can cause pain in the bladder and/or pelvis, which is often described by women as a burning sensation, particularly in the vagina. Men with pelvic floor tension experience referred pain, particularly at the tip of their penis. In 9 out 10 IC/BPS patients struggling with painful sexual relations, muscle tension is the primary cause of that pain and discomfort. Tender trigger points —small, tight, hyperirritable bundles of muscle— may also be found in the pelvic floor.
Pelvic floor dysfunction is a fairly new area of specialty for physical therapists world wide. The goal of therapy is to relax and lengthen the pelvic floor muscles, rather than to tighten and/or strengthen them as is the goal of therapy for patients with incontinence. Thus, traditional exercises such as Kegels, can be helpful as they strengthen the muscles, however they can provoke pain and additional muscle tension. A specially trained physical therapist can provide direct, hands on, evaluation of the muscles, both externally and internally. While weekly therapy is certainly valuable, most providers also suggest an aggressive self-care regimen at home to help combat muscle tension, such as daily muscle relaxation audiotapes, stress reduction and anxiety management on a daily basis. Anxiety is often found in patients with painful conditions and can subconsciously trigger muscle tension.
alleviates pain associated with IC/BPS as part of multimodal treatment. While a 1987 study showed that 11 of 14 (78%) patients had a >50% reduction in pain, another study (published in 1993) found no beneficial effect. A 2008 review found that although there are hardly any controlled studies on alternative medicine and IC/BPS, "rather good results have been obtained" when acupuncture is combined with other treatments.
, a relaxation technique aimed at helping people control functions of the autonomous nervous system, has shown some benefit in controlling pain associated with IC/BPS as part of a multimodal approach that may also include medication or hydrodistention of the bladder.
Further QoL evidence:
Other research has shown that the impact of IC/BPS on Quality of Life
is as severe as that of endstage renal disease and rheumatoid arthritis.
Countries are increasingly recognizing how severely IC/PBS can affect patients' lives, by officially recognizing that it can completely impair functioning. Countries in which Interstitial Cystitis/Painful Bladder Syndrome IC/PBS is now recognized with an official disability code:
(NIDDK) began using the umbrella term Urologic Chronic Pelvic Pain Syndromes (UCPPS) to refer to pain syndromes associated with the bladder (i.e. interstitial cystitis/bladder pain syndrome, IC/BPS) and the prostate gland (i.e. Chronic prostatitis/chronic pelvic pain syndrome
).
In 2008, terms currently in use in addition to IC/BPS include painful bladder syndrome, bladder pain syndrome and hypersensitive bladder syndrome, alone and in a variety of combinations. These different terms are being used in different parts of the world.
The term "interstitial cystitis" is the primary term used in ICD-10
and MeSH
.
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
of the urinary bladder
Urinary bladder
The urinary bladder is the organ that collects urine excreted by the kidneys before disposal by urination. A hollow muscular, and distensible organ, the bladder sits on the pelvic floor...
. Of unknown cause, it is characterized by: pain associated with the bladder, pain associated with urination
Urination
Urination, also known as micturition, voiding, peeing, weeing, pissing, and more rarely, emiction, is the ejection of urine from the urinary bladder through the urethra to the outside of the body. In healthy humans the process of urination is under voluntary control...
(dysuria
Dysuria
In medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria....
), urinary frequency (as often as every 10 minutes), urgency, and/or pressure in the bladder and/or pelvis.
The disease has a profound impact on quality of life. A Harvard University study concluded, "the impact of interstitial cystitis on quality of life is severe and debilitating". A Harvard Medical School guide states that the quality of life of interstitial cystitis patients resembles that of a person on kidney dialysis or suffering from chronic cancer pain. The condition is officially recognized as a disability.
It is not unusual for patients to have been misdiagnosed with a variety of other conditions, including: overactive bladder, urethritis
Urethritis
Urethritis is inflammation of the urethra. The most common symptom is painful or difficult urination.-Causes:The disease is classified as either gonococcal urethritis, caused by Neisseria gonorrhoeae, or non-gonococcal urethritis , most commonly caused by Chlamydia trachomatis...
, urethral syndrome
Urethral syndrome
Urethral syndrome is defined as symptoms suggestive of a lower urinary tract infection but in the absence of significant bacteruria with a conventional pathogen...
, trigonitis
Trigonitis
Trigonitis is a condition of inflammation of the trigone region of the bladder. It is more common in women.The cause of trigonitis is not yet known, and there is no solid treatment yet. Electrocautery is sometimes used, but is generally unreliable as a treatment, and typically does not have quick...
, prostatitis
Chronic prostatitis/chronic pelvic pain syndrome
Chronic nonbacterial prostatitis or chronic prostatitis/chronic pelvic pain syndrome is a pelvic pain condition in men, and should be distinguished from other forms of prostatitis such as chronic bacterial prostatitis and acute bacterial prostatitis...
and other generic terms used to describe frequency/urgency symptoms in the urinary tract.
IC/BPS affects men and women of all cultures, socioeconomic backgrounds, and ages. Although the disease previously was believed to be a condition of menopausal
Menopause
Menopause is a term used to describe the permanent cessation of the primary functions of the human ovaries: the ripening and release of ova and the release of hormones that cause both the creation of the uterine lining and the subsequent shedding of the uterine lining...
women, growing numbers of men and women are being diagnosed in their twenties and younger. IC/BPS is not a rare condition, however IC/BPS is more common in women than in men. Early research suggested that IC/BPS prevalence ranged from 1 in 100,000 to 5.1 in 1,000 of the general population. In 2009, new research (now known as the RAND study) revealed that in the U.S alone, between 3 and 8 million people have interstitial cystitis. Up to 12% of women may have early symptoms of IC/BPS.
Signs and symptoms
The symptoms of IC/BPS are often misdiagnosed as a "common" bladder infection (cystitisCystitis
Cystitis is a term that refers to urinary bladder inflammation that results from any one of a number of distinct syndromes. It is most commonly caused by a bacterial infection in which case it is referred to as a urinary tract infection.-Signs and symptoms:...
) or a UTI
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
. However, IC/BPS has not been shown to be caused by a bacterial infection, and the mis-prescribed treatment of antibiotics is ineffective. The symptoms of IC/BPS may also initially be attributed to prostatitis
Prostatitis
Prostatitis is an inflammation of the prostate gland, in men. A prostatitis diagnosis is assigned at 8% of all urologist and 1% of all primary care physician visits in the United States.-Classification:...
and epididymitis
Epididymitis
Epididymitis is a medical condition in which there is inflammation of the epididymis . This condition comprises gradual onset of testicular pain that can vary from mild to severe, and the scrotum may become red, warm and swollen...
(in men) and endometriosis
Endometriosis
Endometriosis is a gynecological medical condition in which cells from the lining of the uterus appear and flourish outside the uterine cavity, most commonly on the ovaries. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones...
and uterine fibroids
Uterine fibroids
A uterine fibroid is a benign tumor that originates from the smooth muscle layer and the accompanying connective tissue of the uterus.Fibroids are the most common benign tumors in...
(in women).
The most common symptom of IC/BPS is pain, which is found in 100% of patients, frequency (82% of patients) and nocturia (62%).
In general, symptoms are:
- Painful urination
- Pain that is worsened with bladder filling and/or improved with urination.
- Pain that is worsened with a certain food or drink.
- Some patients report dysuriaDysuriaIn medicine, specifically urology, dysuria refers to painful urination.Difficult urination is also sometimes described as dysuria.It is one of a constellation of irritative bladder symptoms, which includes urinary frequency and haematuria....
(burning sensation in the urethra when urinating).
- Urinary frequency (as often as every 10 minutes), urgency, and pressure in the bladder and/or pelvis.
- Some patients report waking at night to urinateNocturiaNocturia , also called nycturia , is the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly...
, hesitancy (needing to wait for the stream to begin), pain with sexual intercourseSexual intercourseSexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
, and discomfort and difficulty driving, travelling or working.
During cystoscopy
Cystoscopy
Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...
, 5 to 10% of patients are found to have Hunner's ulcers. Far more patients may experience a very mild form of IC/BPS, in which they have no visible wounds in their bladder, yet struggle with symptoms of pain, frequency and/or urgency. Still other patients may have discomfort only in their urethra
Urethra
In anatomy, the urethra is a tube that connects the urinary bladder to the genitals for the removal of fluids out of the body. In males, the urethra travels through the penis, and carries semen as well as urine...
, while others struggle with pain in the entire pelvis.
Patients may experience nocturia
Nocturia
Nocturia , also called nycturia , is the need to get up in the night to urinate, thus interrupting sleep. Its occurrence is more frequent in pregnant women and in the elderly...
, pelvic floor dysfunction and tension (thus making it difficult to start their urine stream), pain with sexual intercourse
Sexual intercourse
Sexual intercourse, also known as copulation or coitus, commonly refers to the act in which a male's penis enters a female's vagina for the purposes of sexual pleasure or reproduction. The entities may be of opposite sexes, or they may be hermaphroditic, as is the case with snails...
, and discomfort and difficulty driving, traveling or working.
For the most part, people with interstitial cystitis will either have lots of pain and very little frequency or they'll have lots of frequency and very little pain.
Association with other conditions
Some people with IC/BPS suffer from other conditions that may have the same etiology as IC/BPS. These include: irritable bowel syndromeIrritable bowel syndrome
Irritable bowel syndrome is a diagnosis of exclusion. It is a functional bowel disorder characterized by chronic abdominal pain, discomfort, bloating, and alteration of bowel habits in the absence of any detectable organic cause. In some cases, the symptoms are relieved by bowel movements...
(IBS), fibromyalgia
Fibromyalgia
Fibromyalgia is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. It is an example of a diagnosis of exclusion...
, chronic fatigue syndrome
Chronic fatigue syndrome
Chronic fatigue syndrome is the most common name used to designate a significantly debilitating medical disorder or group of disorders generally defined by persistent fatigue accompanied by other specific symptoms for a minimum of six months, not due to ongoing exertion, not substantially...
, endometriosis
Endometriosis
Endometriosis is a gynecological medical condition in which cells from the lining of the uterus appear and flourish outside the uterine cavity, most commonly on the ovaries. The uterine cavity is lined by endometrial cells, which are under the influence of female hormones...
, vulvodynia
Vulvodynia
Vulvodynia is a chronic pain syndrome that affects the vulvar area and occurs without an identifiable cause or visible pathology categorized in the ICD-9 group 625—specifically ICD-9 625.7, which is for pain and other disorders of the female genital organs...
, chemical sensitivities
Multiple chemical sensitivity
Multiple chemical sensitivity is a chronic medical condition characterized by symptoms the affected person attributes to exposure to low levels of chemicals. Commonly suspected substances include smoke, pesticides, plastics, synthetic fabrics, scented products, petroleum products and paints...
and anxiety disorder
Anxiety disorder
Anxiety disorder is a blanket term covering several different forms of abnormal and pathological fear and anxiety. Conditions now considered anxiety disorders only came under the aegis of psychiatry at the end of the 19th century. Gelder, Mayou & Geddes explains that anxiety disorders are...
. In addition, men with IC/BPS are frequently diagnosed as having chronic nonbacterial prostatitis, and there is an extensive overlap of symptoms and treatment between the two conditions, leading researchers to posit that the conditions share the same etiology and pathology.
The presence of endometriosis has a strong association with typical IC findings on cystoscopy including glomerulations, ulcers, and reduced bladder capacity.
Causes
The cause of IC/BPS is unknown, though several theories have been put forward (these include autoimmune theory, nerve theory, mast cell theory, leaky lining theory, infection theory and a theory of production of a toxic substance in the urine. Other theories are neurologic, allergic, geneticGenetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
and stress
Stress (biology)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
-psychological. In addition, recent research shows that IC patients may have a substance in the urine that inhibits the growth of cells in the bladder epithelium. An infection may then predispose those patients to get IC.
Regardless of the origin, it is clear that the majority of IC/BPS patients struggle with a damaged urothelium, or bladder lining. When the surface glycosaminoglycan (GAG) layer is damaged (via a urinary tract infection
Urinary tract infection
A urinary tract infection is a bacterial infection that affects any part of the urinary tract. Symptoms include frequent feeling and/or need to urinate, pain during urination, and cloudy urine. The main causal agent is Escherichia coli...
(UTI), excessive consumption of coffee or sodas, traumatic injury, etc.), urinary chemicals can "leak" into surrounding tissues, causing pain, inflammation, and urinary symptoms. Oral medications like pentosan polysulfate
Pentosan polysulfate
Pentosan polysulfate is the only oral medication approved by the U.S. FDA for the treatment of interstitial cystitis, also known as painful bladder syndrome....
and medications that are placed directly into the bladder via a catheter
Catheter
In medicine, a catheter is a tube that can be inserted into a body cavity, duct, or vessel. Catheters thereby allow drainage, administration of fluids or gases, or access by surgical instruments. The process of inserting a catheter is catheterization...
sometimes work to repair and rebuild this damaged/wounded lining, allowing for a reduction in symptoms.
Anxiety and stress
Numerous studies have noted the link between IC, anxiety, stress, hyperresponsiveness, and panic.<Autoimmune
The body's immune system attacks the bladder. Biopsies on the bladder walls of people with IC usually contain mast cells. Mast cells gather when an allergic reaction is occurring. They contain histamine packets. The body identifies the bladder wall as a foreign agent, and the histamine packets burst open and attack. The body attacks itself, which is the basis of autoimmune disorders.Genes
Some genetic subtypes, in some patients, have been linked to the disorder.- An antiproliferative factor secreted by the bladders of IC/BPS patients which inhibits bladder cell proliferation, thus possibly causing the missing bladder lining.
- PAND, at gene map locus 13q22-q32, is associated with a constellation of disorders (a "pleiotropic syndrome") including IC/BPS and other bladder and kidney problems, thyroid diseases, serious headaches/migraines, panic disorderPanic disorderPanic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...
, and mitral valve prolapseMitral valve prolapseMitral valve prolapse is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. There are various types of MVP, broadly classified as classic and nonclassic. In its nonclassic form, MVP carries a low risk of...
.
Leaky Bladder Lining
Most literature supports the belief that IC's symptoms are associated with a defect in the bladder epithelium lining allows irritating substances in the urine to penetrate into the bladder — essentially, a breakdown of the bladder lining (also known as Adherence Theory). Deficiency in this glycosaminoglycan layer on the surface of the bladder results in increased permeability of the underlying submucosal tissues.GP 51 is a urinary glycoprotein that functions as a protective barrier to the bladder wall. A study evaluated urinary GP 51 levels in patients with and without interstitial cystitis and found that these levels are significantly reduced in patients with the disease.
Mast Cells
Mast cellMast cell
A mast cell is a resident cell of several types of tissues and contains many granules rich in histamine and heparin...
s were once thought to be responsible for allergic reactions. Mast cells release histamine. Histamine causes pain, swelling, scarring and prevents healing. Mast cells have in some studies been shown to be critically important in interstitial cystitis.
Current evidence from clinical and laboratory studies confirms that mast cells play a central role in IC/PBS.
Research has shown that there is proliferation of nerve fibers in the bladders of IC patients that does not exist in the bladders of people who have not been diagnosed with IC.
Nerve damage theory
An unknown toxin or stimulus causes nerves in the bladder wall to fire uncontrollably. When they fire, they release substances called neuropeptides that induce a cascade of reactions that cause pain in the bladder wall.Diagnosis
Diagnosis has been greatly simplified in recent years with the development of two new methodologies. The Pelvic Pain Urgency/Frequency (PUF) Patient Survey, created by C. Lowell Parsons, is a short questionnaire that will help doctors identify if pelvic pain could be coming from the bladder. The KClPotassium chloride
The chemical compound potassium chloride is a metal halide salt composed of potassium and chlorine. In its pure state, it is odorless and has a white or colorless vitreous crystal appearance, with a crystal structure that cleaves easily in three directions. Potassium chloride crystals are...
test, also known as the potassium sensitivity test, uses a mild potassium
Potassium
Potassium is the chemical element with the symbol K and atomic number 19. Elemental potassium is a soft silvery-white alkali metal that oxidizes rapidly in air and is very reactive with water, generating sufficient heat to ignite the hydrogen emitted in the reaction.Potassium and sodium are...
solution to test the integrity of the bladder wall. Though the latter is not specific for IC/BPS, it has been determined to be helpful in predicting the use of compounds, such as pentosan polysulphate, which are designed to help repair the GAG layer. The previous gold standard
Gold standard
The gold standard is a monetary system in which the standard economic unit of account is a fixed mass of gold. There are distinct kinds of gold standard...
test for IC/BPS was the use of hydrodistention with cystoscopy
Cystoscopy
Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.Diagnostic cystoscopy is usually carried out with local anaesthesia...
. Researchers, however, determined that this visual examination of the bladder wall after stretching the bladder was not specific for IC/BPS and that the test, itself, can contribute to the development of small glomerulation
Glomerulation
Glomerulation refers to bladder hemorrhages which are thought to be associated with some types of interstitial cystitis .The presence of glomerulations, also known as petechial hemorrhages, in the bladder suggests that the bladder wall has been damaged, irritated and/or inflamed...
s (that is, petechial hemorrhages) often found in IC/BPS. Thus, a diagnosis of IC/BPS is one of exclusion
Diagnosis of exclusion
A diagnosis of exclusion is a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from examination or testing...
, as well as a review of clinical symptoms.
In 2006, the ESSIC society proposed more rigorous and demanding diagnostic methods with specific classification criteria so that it cannot be confused with other, similar conditions. Specifically, they require that a patient must have pain associated with the bladder, accompanied by one other urinary symptom. Thus, a patient with just frequency or urgency would be excluded from a diagnosis. Secondly, they strongly encourage the exclusion of confusable diseases through an extensive and expensive series of tests including (A) a medical history and physical exam, (B) a dipstick urinalysis
Urinalysis
A urinalysis , also known as Routine and Microscopy , is an array of tests performed on urine, and one of the most common methods of medical diagnosis...
, various urine cultures, and a serum PSA in men over 40, (C) flowmetry and post-void residual urine volume by ultrasound scanning and (D) cystoscopy. A diagnosis of IC/BPS would be confirmed with a hydrodistention during cystoscopy with biopsy.
They also propose a ranking system based upon the physical findings in the bladder. Patients would receive a numeric and letter based score based upon the severity of their disease as found during the hydrodistention. A score of 1-3 would relate to the severity of the disease and a rating of A-C represents biopsy findings. Thus, a patient with 1A would have very mild symptoms and disease while a patient with 3C would have the worst available symptoms.
In 2009, Japanese researchers identified a urinary marker called phenylacetylglutamine
Phenylacetylglutamine
Phenylacetylglutamine is a product formed by the conjugation of phenylacetate and glutamine. It is a common metabolite that can be found in human urine....
that could be used for early diagnosis.
Medication
As recently as a decade ago, treatments available were limited to the use of astringentAstringent
An astringent substance is a chemical compound that tends to shrink or constrict body tissues, usually locally after topical medicinal application. The word "astringent" derives from Latin adstringere, meaning "to bind fast"...
instillations, such as chlorpactin (oxychlorosene) or silver nitrate
Silver nitrate
Silver nitrate is an inorganic compound with chemical formula . This compound is a versatile precursor to many other silver compounds, such as those used in photography. It is far less sensitive to light than the halides...
, designed to kill "infection" and/or strip off the bladder lining. In 2005, our understanding of IC/BPS has improved dramatically and these therapies are now no longer done. Rather, IC/BPS therapy is typically multi-modal, including the use of a bladder coating, an antihistamine
Antihistamine
An H1 antagonist is a histamine antagonist of the H1 receptor that serves to reduce or eliminate effects mediated by histamine, an endogenous chemical mediator released during allergic reactions...
to help control mast cell
Mast cell
A mast cell is a resident cell of several types of tissues and contains many granules rich in histamine and heparin...
activity and a low dose antidepressant
Antidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
to fight neurogenic inflammation
Neurogenic inflammation
Neurogenic inflammation is inflammation arising from the local release from afferent neurons of inflammatory mediators such as Substance P and Calcitonin Gene-Related Peptide ....
.
Pentosan polysulfate
Oral pentosan polysulfatePentosan polysulfate
Pentosan polysulfate is the only oral medication approved by the U.S. FDA for the treatment of interstitial cystitis, also known as painful bladder syndrome....
is believed to provide a protective coating in the bladder, but studies show it is not statistically significant compared to placebo. However, some studies have found that a minority of patients do respond to pentosan polysulfate.
Amitriptyline
AmitriptylineAmitriptyline
Amitriptyline is a tricyclic antidepressant . It is the most widely used TCA and has at least equal efficacy against depression as the newer class of SSRIs...
can reduce symptoms in patients with IC/BPS. Patient overall satisfaction with the therapeutic result of amitriptyline was excellent or good in 46%. A May 2010 study concluded in part that amitriptyline may be beneficial in doses greater than 50 mg.
Duloxetine
The antidepressant duloxetineDuloxetine
Duloxetine is a serotonin-norepinephrine reuptake inhibitor manufactured and marketed by Eli Lilly. It is effective for major depressive disorder and has been shown to be as effective as venlafaxine for generalized anxiety disorder...
was found to be ineffective as a treatment. There is a U.S. Patent 6150396 for the use of duloxetine for treatment of interstitial cystitis although one study found positive outcomes in only a small proportion of cases. There has been further work to suggest that neuropathic pain localized in the pelvic region may respond to neurotransmitter reuptake inhibitors.
DMSO
DMSODimethyl sulfoxide
Dimethyl sulfoxide is an organosulfur compound with the formula 2SO. This colorless liquid is an important polar aprotic solvent that dissolves both polar and nonpolar compounds and is miscible in a wide range of organic solvents as well as water...
, a wood pulp extract, is the only approved bladder instillation for IC/BPS yet it is much less frequently used in urology clinics. Research studies presented at recent conferences of the American Urological Association by C. Subah Packer have demonstrated that the FDA approved dosage of a 50% solution of DMSO had the potential of creating irreversible muscle contraction. However, a lesser solution of 25% was found to be reversible. Long term use is questionable, at best, particularly given the fact that the method of action of DMSO is not fully understood.
Rescue instillations
More recently, the use of a "rescue instillation" composed of pentosan polysulfatePentosan polysulfate
Pentosan polysulfate is the only oral medication approved by the U.S. FDA for the treatment of interstitial cystitis, also known as painful bladder syndrome....
or heparin
Heparin
Heparin , also known as unfractionated heparin, a highly sulfated glycosaminoglycan, is widely used as an injectable anticoagulant, and has the highest negative charge density of any known biological molecule...
, sodium hyaluronate
Sodium hyaluronate
Sodium hyaluronate is the sodium salt of hyaluronan. The name hyaluronic acid is derived from the Greek word ύαλος meaning vitreous, and uronic acid as it was first isolated from the vitreous humour in the eye and possesses a high uronic acid content. The term hyaluronate also refers to the...
, lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
and sodium bicarbonate
Sodium bicarbonate
Sodium bicarbonate or sodium hydrogen carbonate is the chemical compound with the formula Na HCO3. Sodium bicarbonate is a white solid that is crystalline but often appears as a fine powder. It has a slightly salty, alkaline taste resembling that of washing soda . The natural mineral form is...
, has generated considerable excitement in the IC/BPS community because it is the first therapeutic intervention that can be used to reduce a flare of symptoms. Published studies report a 90% effectiveness in reducing symptoms.
Sometimes these rescue instillations are given on a regular basis for treatment. It is important to note that this is off-label use for both pentosan polysulfate and heparin, as neither medicine has been approved to be used this way.
Bladder coatings
Other bladder coating therapies include Cystistat (sodium hyaluronateSodium hyaluronate
Sodium hyaluronate is the sodium salt of hyaluronan. The name hyaluronic acid is derived from the Greek word ύαλος meaning vitreous, and uronic acid as it was first isolated from the vitreous humour in the eye and possesses a high uronic acid content. The term hyaluronate also refers to the...
) and Uracyst (chondroitin
Chondroitin
Chondroitin is a chondrin derivative.Types include:* Chondroitin sulfate* Dermatan sulfate...
). They are believed to replace the deficient GAG layer on the bladder wall. Like most other intravesical bladder treatments, this treatment may require the patient to lie for 20 – 40 minutes, turning over every ten minutes, to allow the chemical to 'soak in' and give a good coating, before it is passed out with the urine.
Cystistat is not currently available in the United States or Canada, though testing has recently started in Canada. Testing has also begun for Uracyst in both Canada and the United States. Uracyst is available in Canada.
Diet
In 2007, a study done at Long Island University reported that over 90 percent of interstitial cystitis patients experience an increase in symptoms when they consume certain foods and beverages, especially coffee, tea, soda, alcoholic beverages, citrus fruits and juices, artificial sweeteners and hot pepper.The American Urological Association states that most (but not all) people with IC find that certain foods make their symptoms worse.
The challenge with diet triggers is that they vary from person to person: the best way for a person to discover his or her own triggers is to use an elimination diet
Elimination diet
An elimination diet is a method of identifying foods that an individual cannot consume without adverse effects. Adverse effects may be due to food allergy, food intolerance, other physiological mechanisms , or a combination of these...
. The foundation of therapy is a modification of diet to help patients avoid those foods which can further irritate the damaged bladder wall.
Pain that worsened with a certain food or drink and/or worsened with bladder filling and/or improved with urination was reported by 97% of patients, in one study.
Anecdotal evidence has linked gluten
Gluten
Gluten is a protein composite found in foods processed from wheat and related grain species, including barley and rye...
intolerance to UCPPS symptoms. Studies are lacking in this area.
The mechanism by which dietary modification benefits patients with IC is unclear. Researchers hypothesize that integration of neural signals from pelvic organs mediates the effects of diet on symptoms of IC:
A study done at University of South Florida found that IC/BPS patients do not have to be overly restrictive of their diets. This study recommended that patients avoid citrus fruits, tomatoes, coffee, tea, carbonated and alcoholic beverages, spicy foods, artificial sweeteners, and vitamin C. It also found that many patients had reduced sensitivity to trigger foods if they consumed calcium glycerophosphate and/or sodium bicarbonate.
Bladder distension
Bladder distension (a procedure which stretches the bladder capacityVolume
Volume is the quantity of three-dimensional space enclosed by some closed boundary, for example, the space that a substance or shape occupies or contains....
, done under general anaesthesia
General anaesthesia
General anaesthesia is a state of unconsciousness and loss of protective reflexes resulting from the administration of one or more general anaesthetic agents...
) has shown some success in reducing urinary frequency and giving pain relief to patients. However, many experts still cannot understand precisely how this can cause pain relief. Recent studies showing that pressure on pelvic trigger points can relieve symptoms may be connected. Unfortunately, the relief achieved by bladder distensions is only temporary (weeks or months) and consequently, it is not really viable as a long-term treatment for IC/BPS.
Surgery
Surgical interventions are rarely used for IC/BPS. Surgical intervention is very unpredictable for IC/BPS, and is considered a treatment of last resort when all other treatment modalities have failed and pain is severe. Some patients who opt for surgical intervention continue to experience pain after surgery. Surgical interventions for IC/BPS include transurethral fulguration and resection of ulcers, using electricity/laser; bladder denervation, where some of the nerves to the bladder are cut (Modified Ingelman-Sundberg Procedure); bladder augmentation; bladder removal (cystectomy); electrical nerve stimulation, similar to TENS, where an electrical unit is implanted in the body and provides continuous or intermittent electrical pulses to the affected areas (Interstim); spinal cord stimulation (SCS), where an electrical unit is implanted that provides electrical stimulation to the spinal cord, interfering with pain reception to the brain (ANS/Advanced Neuromodulation Systems spinal Cord Stimulator); and the implantation of the intrathecal pain pump, where very small amounts of medication, like morphine sulfate, dilaudid, or baclophen are released into the cerebrospinal fluid via a catheter stemming from the small electrical pump, requiring only about 1/100 to 1/300 the amount of medication needed orally for the same therapeutic benefit, but with significantly fewer side effects.Pain control
Pain control is usually necessary in the IC/BPS treatment plan. The pain of IC/BPS has been rated equivalent to cancer pain and may lead to central sensitization if untreated.Pelvic floor treatments
Work by Wise and Anderson (see details) has shown that urologic pelvic pain syndromes, such as IC/BPS and CP/CPPS, may have no initial trigger other than anxiety, often with an element of Obsessive Compulsive Disorder or other anxiety-spectrum problem. This is theorized to leave the pelvic area in a sensitized condition resulting in a loop of muscle tension and heightened neurological feedback (neural wind-up). This is a form of myofascial pain syndromeMyofascial pain syndrome
Myofascial pain syndrome , also known as chronic myofascial pain , is a syndrome characterized by chronic pain caused by multiple trigger points and fascial constrictions...
. Current protocols largely focus on stretches to release overtensed muscles in the pelvic or anal area (commonly referred to as trigger points), physical therapy to the area, and progressive relaxation therapy to reduce causative stress.
Most major IC/BPS clinics now evaluate the pelvic floor and/or refer patients directly to a physical therapist for a prompt treatment of pelvic floor muscle tension or weakness. Chronic pelvic floor tension can cause pain in the bladder and/or pelvis, which is often described by women as a burning sensation, particularly in the vagina. Men with pelvic floor tension experience referred pain, particularly at the tip of their penis. In 9 out 10 IC/BPS patients struggling with painful sexual relations, muscle tension is the primary cause of that pain and discomfort. Tender trigger points —small, tight, hyperirritable bundles of muscle— may also be found in the pelvic floor.
Pelvic floor dysfunction is a fairly new area of specialty for physical therapists world wide. The goal of therapy is to relax and lengthen the pelvic floor muscles, rather than to tighten and/or strengthen them as is the goal of therapy for patients with incontinence. Thus, traditional exercises such as Kegels, can be helpful as they strengthen the muscles, however they can provoke pain and additional muscle tension. A specially trained physical therapist can provide direct, hands on, evaluation of the muscles, both externally and internally. While weekly therapy is certainly valuable, most providers also suggest an aggressive self-care regimen at home to help combat muscle tension, such as daily muscle relaxation audiotapes, stress reduction and anxiety management on a daily basis. Anxiety is often found in patients with painful conditions and can subconsciously trigger muscle tension.
Neuromodulation
Neuromodulation can be successful in treating IC/BPS symptoms, including pain. Electronic pain-killing options include TENS. PTNS stimulators have also been used, with varying degrees of success. Percutaneous sacral nerve root stimulation (PNS) was able to produce statistically significant improvements in several parameters, including pain.Acupuncture
A 2002 review study reported that acupunctureAcupuncture
Acupuncture is a type of alternative medicine that treats patients by insertion and manipulation of solid, generally thin needles in the body....
alleviates pain associated with IC/BPS as part of multimodal treatment. While a 1987 study showed that 11 of 14 (78%) patients had a >50% reduction in pain, another study (published in 1993) found no beneficial effect. A 2008 review found that although there are hardly any controlled studies on alternative medicine and IC/BPS, "rather good results have been obtained" when acupuncture is combined with other treatments.
Biofeedback
BiofeedbackBiofeedback
Biofeedback is the process of becoming aware of various physiological functions using instruments that provide information on the activity of those same systems, with a goal of being able to manipulate them at will...
, a relaxation technique aimed at helping people control functions of the autonomous nervous system, has shown some benefit in controlling pain associated with IC/BPS as part of a multimodal approach that may also include medication or hydrodistention of the bladder.
Prognosis
A survey showed that among people with interstitial cystitis:- 40% were unable to work
- 27% were unable to have sex due to pain
- 27% had marriage breakdown
- 55% contemplated suicide
- 12% had attempted suicide
Further QoL evidence:
- Prior studies have suggested that urologic chronic pelvic pain syndromes (UCPPS) can have severe adverse impact on quality of life (Temml, et al., 2003; Nickel et al., 2005). Population-based studies (e.g. Michael, et al., 2000) using the SF-36 have found significant decrease in QoL dimensions, including role/physical, bodily pain, vitality and social function, results that were supported by Rothrock's (et al., 2002) cross-sectional study of IC patients showing decreased physical functioning, decreased ability to function in one's normal role, decreased vitality, and depression.
Other research has shown that the impact of IC/BPS on Quality of Life
Quality of Life
Quality of Life is a 2004 drama film, telling the fictional story of two graffiti writers in the Mission District of San Francisco.Directed by Benjamin Morgan, Quality of Life stars Lane Garrison, Brian Burnam, Luis Saguar and Mackenzie Firgens. Morgan co-wrote the screenplay with Burnam, who is a...
is as severe as that of endstage renal disease and rheumatoid arthritis.
Countries are increasingly recognizing how severely IC/PBS can affect patients' lives, by officially recognizing that it can completely impair functioning. Countries in which Interstitial Cystitis/Painful Bladder Syndrome IC/PBS is now recognized with an official disability code:
- United States of America
History
- 1808 Dr. Phillip Syng Physic describes an inflammatory condition of the bladder producing the same lower urinary tract symptoms as a bladder stone [referenced in archival material, Philadelphia College of Physicians][53]
- 1836 Dr. Phillip Syng Physic expands this concept to include a chronic frequency, urgency and pain syndrome occurring in the absence of demonstrable etiology[53]
- 1836 Philadelphia surgeon Joseph Parrish (Dr. Phillip Syng Physic's mentee) publishes earliest record of interstitial cystitis, in 1836 textbook by Physic's mentee [53]
- 2002 In the U.S.A., the Social Security Act is amended to include interstitial cystitis as a disability: 'This Ruling explains that IC (a complex, chronic bladder disorder), when accompanied by appropriate symptoms, signs, and laboratory findings, is a medically determinable impairment that can be the basis for a finding of "disability"'.[54]
- 2004 American research study on interstitial cystitis history — earliest known descriptions of bladder inflammation and interstitial cystitis [53]
- 2009 Release of Japanese guideline for diagnosis and treatment of interstitial cystitis
- 2011 The American Urological Association releases the first-ever American clinical guidelines for diagnosing and treating interstitial cystitis/bladder pain syndrome (IC/BPS)[55]
Nomenclature
Originally called interstitial cystitis , this disorder was renamed to interstitial cystitis/bladder pain syndrome in the 2002-2010 timeframe. In 2007, the National Institute of Diabetes and Digestive and Kidney DiseasesNational Institute of Diabetes and Digestive and Kidney Diseases
The National Institute of Diabetes and Digestive and Kidney Diseases , of the U.S. National Institutes of Health, conducts and supports research on many of the most serious diseases affecting public health...
(NIDDK) began using the umbrella term Urologic Chronic Pelvic Pain Syndromes (UCPPS) to refer to pain syndromes associated with the bladder (i.e. interstitial cystitis/bladder pain syndrome, IC/BPS) and the prostate gland (i.e. Chronic prostatitis/chronic pelvic pain syndrome
Chronic prostatitis/chronic pelvic pain syndrome
Chronic nonbacterial prostatitis or chronic prostatitis/chronic pelvic pain syndrome is a pelvic pain condition in men, and should be distinguished from other forms of prostatitis such as chronic bacterial prostatitis and acute bacterial prostatitis...
).
In 2008, terms currently in use in addition to IC/BPS include painful bladder syndrome, bladder pain syndrome and hypersensitive bladder syndrome, alone and in a variety of combinations. These different terms are being used in different parts of the world.
The term "interstitial cystitis" is the primary term used in ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
and MeSH
Medical Subject Headings
Medical Subject Headings is a comprehensive controlled vocabulary for the purpose of indexing journal articles and books in the life sciences; it can also serve as a thesaurus that facilitates searching...
.
See also
- Overactive bladderOveractive bladderOveractive bladder is a urological condition defined by a set of symptoms: urgency, with or without urge incontinence, usually with frequency and nocturia. Frequency is usually defined as urinating more than 8 times a day. The International Continence Society is responsible for this definition...
- Pelvic MyoneuropathyPelvic MyoneuropathyPelvic myoneuropathy is a new term given to the most common form of non-bacterial pelvic pain experienced by men. It is sometimes referred to as chronic nonbacterial prostatitis or male chronic pelvic pain syndrome...
- a new explanation for painful bladder. - QuercetinQuercetinQuercetin , a flavonol, is a plant-derived flavonoid found in fruits, vegetables, leaves and grains. It also may be used as an ingredient in supplements, beverages or foods.-Occurrence:...
- alternative medicineAlternative medicineAlternative medicine is any healing practice, "that does not fall within the realm of conventional medicine." It is based on historical or cultural traditions, rather than on scientific evidence....
- a flavonoid that has anti-inflammatoryAnti-inflammatoryAnti-inflammatory refers to the property of a substance or treatment that reduces inflammation. Anti-inflammatory drugs make up about half of analgesics, remedying pain by reducing inflammation as opposed to opioids, which affect the central nervous system....
properties, used to treat IC/BPS with some success. - Trigger PointsTrigger pointTrigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. Trigger point practitioners believe that palpable nodules are small contraction knots and a common cause of...
- a key to myofascial pain syndrome. - Chronic prostatitis/chronic pelvic pain syndromeChronic prostatitis/chronic pelvic pain syndromeChronic nonbacterial prostatitis or chronic prostatitis/chronic pelvic pain syndrome is a pelvic pain condition in men, and should be distinguished from other forms of prostatitis such as chronic bacterial prostatitis and acute bacterial prostatitis...
- women have vestigial prostate glands that may cause IC/BPS-like symptoms. Men with IC/BPS may have prostatitis, and vice versa.
External links
- http://www.ncbi.nlm.nih.gov/pubmed/14665834/National Library of Medicine: The Historical Origins of Interstitial
- The Urologic Chronic Pelvic Pain Syndrome Society
- International Pelvic Pain Society
- The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
- Clinical guidelines for interstitial cystitis and hypersensitive bladder syndrome (International Journal of Urology)
- European Urology