Interstitial Cystitis/Bladder Pain Syndrome

Interstitial cystitis or bladder pain syndrome (IC/BPS) is a female-predominant, debilitating disorder characterized by pain with bladder filling that is partially relieved by emptying, urinary frequency, and urgency, persisting for 6 weeks or more. It is known to have a waxing and waning pattern over years which can often delay diagnosis. Episodes of pain can be triggered by diet, increased activity, menstrual cycles, and stressful situations. IC/BPS coexists with various pelvic and systemic comorbidities common to many chronic pain conditions such as endometriosis, irritable bowel syndrome, recurrent urinary tract infections, fibromyalgia, and depression. The etiology is unknown and the pain is thought to be compounded by central sensitization. IC/BPS is a diagnosis of exclusion and is suspected when typical symptoms are present and pelvic, urinary tract, and gastrointestinal pathologies have been excluded. Glomerulations (petechial hemorrhages) or Hunner’s ulcers may be seen on cystoscopy but are not required for the diagnosis. A stepwise approach to management starts with behavioral modification, dietary changes, pelvic floor therapy, and oral/intravesicular medications. Pentosan polysulfate, tricyclic antidepressants, and antihistamines are common oral medications used in the treatment of IC/BPS. Referrals to a urologist or urogynecologist are needed when the diagnosis is in doubt, when there is unexplained hematuria or urinary incontinence, or when intravesical treatments, including pentosan polysulfate and dimethyl sulfoxide, are needed. Multidisciplinary management teams, which may include pain specialists and mental health providers, can be considered for refractory cases. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

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Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Review Questions Review Questions - 1. A 42-year-old woman presents with bladder pain. She has been voiding frequently to avoid pain with fullness and awakens four to six times a night to urinate for the past 8 weeks. She underwent knee surgery 2 months ago and had a catheter in overnight. She was last sexually active 1 month ago. What test is first step in the diagnostic evaluation? - A. Complete blood count. - B. Urinalysis. - C. Urine culture. - D. Urine chlamydia. The correct answer is B. In the initial management of a patient with bladder pain and urinary frequency, it is most important to evaluate for a urinary tract infection as a cause of her symptoms. A complete blood count would not aid in the diagnosis of urinary tract infection. A urinalysis should be completed as a first step. If her urinalysis is unremarkable, a urine culture in this patient is not appropriate and thus is not the first step in this evaluation. Urine chlamydia testing would not be the first test given her risk factor of recent catheterization [1]. - A. - 2. A healthy 65-year-old woman presents with urinary urgency and frequency. She complains of dysuria and has burning in the vulvar area. She had a urinary tract infection 4 months ago, but a recent urinalysis was negative. She is not sexually active. What is a reasonable initial treatment? - A. Lifestyle changes and avoidance of trigger foods. - B. Vaginal moisturizers or estrogen therapy. - C. Antibiotic therapy. - D. Pentosan polysulfate. The correct answer is B. This patient is clearly in her postmenopausal years and is likely to have genitourinary syndrome of menopause (GSM) based on her clinical history and the fact that GSM is much more common than IC/BPS. She does not have a urinary tract infection as urinalysis was negative. GSM is not triggered by certain foods like IC/BPS. Treating GSM might completely resolve her symptoms and should be attempted first with vaginal estrogen or vaginal moisturizers. If her symptoms persist, then one would consider IC/BPS and could treat empirically with pentosan polysulfate after behavioral and lifestyle modifications are made [26]. - A. - 3. A 42-year-old woman presents with 6-month history of urinary frequency and urgency. She complains of pain in her bladder that is relieved with voiding. She voids frequently to avoid the pain. She has regular menses and finds that her symptoms are worse during her menstrual cycle. Her urinalysis and urine culture are negative. What is a reasonable next treatment after behavioral techniques? - A. Vaginal estrogen treatment. - B. Antibiotic suppression. - C. Cystoscopy with hydrodistension. - D. Sacral neuromodulation. - E. Pelvic floor therapy. The correct answer is E. This is a typical presentation of a woman with IC/BPS. Based on the AUA treatment algorithm, it is recommended to start with dietary/behavioral techniques for symptom control and then add second-line treatments such as pelvic floor therapy. Answers A and B are not appropriate as the presentation is not consistent with genitourinary syndrome of menopause or recurrent urinary tract infections. Options C and D are reserved for patients that fail conservative therapy [1]. - A. Rights and permissions Copyright information © 2020 Springer Nature Switzerland AG About this chapter Cite this chapter Koduri, S. (2020). Interstitial Cystitis/Bladder Pain Syndrome. In: Tilstra, S.A., Kwolek, D., Mitchell, J.L., Dolan, B.M., Carson, M.P. (eds) Sex- and Gender-Based Women's Health. Springer, Cham. https://doi.org/10.1007/978-3-030-50695-7_30 Download citation DOI: https://doi.org/10.1007/978-3-030-50695-7_30 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-50694-0 Online ISBN: 978-3-030-50695-7 eBook Packages: MedicineMedicine (R0)