Also Known As
Interstitial Cystitis (IC), Bladder Pain Syndrome (BPS), Painful Bladder Syndrome (PBS), Hypersensitive Bladder Syndrome, Urethral Syndrome, IC/BPS
Definition
Interstitial cystitis/bladder pain syndrome (IC/BPS), formerly called interstitial cystitis, is a chronic (>6 weeks duration) pelvic condition that affects or appears to affect the urinary bladder with symptoms of discomfort, pressure, or pain.1 The condition is characterized by chronic inflammation and lower urinary tract symptoms, not due to infection or any other clearly identifiable cause.1,2
IC/BPS is a complex disorder involving the bladder’s lining, resulting in recurring and often severe discomfort, urgency, and frequency of urination.3 The bladder wall may show signs of inflammation, including Hunner ulcers in some patients, which are described as central scars in areas of erythematous mucosa.4 The protective glycosaminoglycan (GAG) layer of the bladder mucosa is often compromised in IC/BPS patients, potentially allowing irritants in the urine to penetrate the bladder wall and trigger inflammatory responses.5
Clinical Context
Interstitial cystitis/bladder pain syndrome is diagnosed and managed in clinical settings when patients present with chronic bladder pain, pressure, or discomfort perceived to be related to the urinary bladder, accompanied by at least one other urinary symptom such as persistent urgency or frequency.1 The condition affects both women and men, though it is more commonly diagnosed in women.3
Patient selection for IC/BPS diagnosis typically involves excluding other conditions with similar symptoms, such as urinary tract infections, bladder cancer, overactive bladder, and in men, chronic prostatitis.1,4 The diagnosis is primarily one of exclusion, often leading to delayed identification or misdiagnosis, particularly in men.1
The clinical evaluation typically includes laboratory examinations (CBC, CMP, glucose, HbA1c), urinalyses, and urine cultures to rule out other disorders.1 Cystoscopy may be appropriate in certain cases, particularly for patients over 50 years of age who have a higher likelihood of Hunner ulcers, which are diagnostic of classic IC.1,4
Treatment approaches are multimodal and individualized, beginning with conservative measures such as dietary modifications to avoid bladder irritants.1,4 Pharmacological interventions may include oral medications (pentosan polysulfate sodium, amitriptyline, antihistamines), intravesical treatments (dimethyl sulfoxide, heparin, lidocaine), and in cases of Hunner ulcers, fulguration or triamcinolone injection.1,4,5
The prognosis for IC/BPS varies widely among patients. While some experience symptom improvement with treatment, others may have persistent symptoms that significantly impact quality of life, affecting physical activity, sleep, and intimate relationships.3